Addressing Global Disparities in Breast Cancer by Transforming Surgical Pathology in Ethiopia: Early Implementation of Immunohistochemistry.

Abstract

Surgical pathology services are essential for breast cancer (BC) diagnosis and treatment. Building capacity in immunohistochemistry (IHC) is urgently needed in sub-Saharan Africa. Here, we analyze the implementation process and results from launching manual IHC in a tertiary cancer center in southern Ethiopia between 2021 and 2024. A phased implementation approach was used. We reviewed the facilities that sent surgical specimen, preanalytical variables, and clinicopathologic characteristics. The distribution of BC phenotype was compared with reports in the country as an implementation metric. A total of 125 surgical specimens underwent manual IHC. Specimen came from 21 facilities, one 500 km away. Of the total 125 cases, 68% (n = 85) were missing information on specimen cold ischemia time and 60% (n = 50) were missing fixation time in formalin. Of the 32% with cold ischemia time reported, the median time was 20 minutes (range, 1-60 minutes). Of the 40% cases reporting fixation time, the median duration was 72 hours (range, 24-192). The median age of BC was 38 years. The majority (66%) were estrogen receptor (ER) positive. Of the 70 with Ki-67 staining, 39% were low; 61.4% high. Thirteen cases were stained for HER2neu. A significant association was observed with ER and Ki-67 expression. A manual IHC program for BC was established in a tertiary hospital in southern Ethiopia. The service reached facilities up to 500 km away. Facilities that reported the cold ischemia and formalin time have met standards of care. The median age of BC was 38 years, and two-third were hormone positive, consistent with other reports in the country. Future work will include more regional training on preanalytical variables and developing capacity to evaluate HER2neu 2+ equivocal cases.