Using Fine Needle Aspiration (FNA) as a Tool to Establish Cancer Burden in Resource-Limited Settings: Liberia, 2018 [A319]

INTRODUCTION: Low- and middle-income countries (LMICs) have a disproportionate cancer burden, greater mortality, and later diagnosis compared to higher resource countries. This ultimately portends worse outcomes for patients with few survivors. Fine needle aspiration (FNA) is a well-known procedure for pathologic diagnosis that can be implemented in LMICs to diagnose malignancy with low cost, high efficiency, and minimal invasiveness. We present data from an FNA clinic established in Liberia, a LMIC, demonstrating these qualities. METHODS: This is a retrospective review of data from an FNA clinic in Liberia between January 2018 and December 2018 whose patients presented with palpable masses and underwent uncomplicated FNA biopsies. Institutional review board approval was waived for this study. RESULTS: 478 FNA biopsies were performed in the study period. A total of 64% of findings were benign, 26% were malignant, and 6% were suspicious for malignancy. Four percent of samples were unsatisfactory for analysis. The most common malignancies were breast cancer (40%, N=51), metastasis from unknown primary (12%, N=16), hematogenous cancer (11%, N=14), and cervical cancer (10%, N=13). Among children's cancers, Burkitt lymphoma comprised more than half of cases (58.3%, N=7). There were no reported complications from the FNA procedures (N=0). CONCLUSION: Efforts to reduce the tumor burden of LMICs like Liberia should include the funding and establishment of FNA clinics for early tumor diagnosis. Additional steps include increasing cancer awareness among the population to encourage earlier presentation, training local providers to hone their skill in performing FNA biopsies, and building a cancer registry in order to direct national funding toward further cancer screening, diagnosis, and treatment.