Pathological findings of Retinoblastoma in Egypt; implementing CAP protocol in developing countries.

Taha, H., Elzomor H., Alei Eldin A., Elhaddad A., Nour R., Zaghloul S. M., et al. (2013).  Pathological findings of Retinoblastoma in Egypt; implementing CAP protocol in developing countries.. International Society of Genetic Eye Diseases and Retinoblastoma meeting..


Introduction / Purpose: Retinoblastoma is the most common intra-ocular tumour of childhood. Radiotherapy and chemotherapy has improved survival for the disease over the last 40 years. Looking for prognostic criteria is one of the major research areas that inspires disease management teams all-over the world. Many protocols were designed over the years to correlate the presence of certain pathological and/or molecular features and prognosis of the disease. Children’s Cancer Hospital Egypt 57357 (CCHE) is a new cancer center in Egypt that serves about 25-40% of the pediatric oncology population in the country. The aim of this study is to present the histopathological findings in Egypt leading pediatric oncology center and impact of implementing CAP protocol on the improvement of patient care. Materials & Methods: CCHE Retinoblastoma study team implemented College of American Pathologist (CAP) protocol of Retinoblastoma version 3.0 (Based on AJCC/UICC TNM, 7th edition) for examining enucleation specimens. Pathology team has conducted an internal training for pathologists. New electronic case report forms (eCRFs) were designed for reporting the progress. Real-time online statistical analysis system was integrated with eCRFs. Implementation included prospective processing and data entry of new specimens properties beside revising of all specimens prior to the implementation of the protocol. Healthcare quality measures included required time for releasing the reports. Results: Between July 2007 and May 2013 we’ve examined 198 enucleation specimens. Mean of all ocular diameters was 22.2 mm. Mean Optic nerve stump length was 6.35 mm. Invaded structures included Cornea (5.3%), Anterior chamber (15.4%), Iris (8.3%), Lens (5.9%), Ciliary body (18.3%), Choroid, (72.2%), Sclera (17.2%), and Orbital tissue (7.1%). Any degree of Optic Nerve invasion was noted in 51% of specimens while surgical margin was involved in 10.8%. Validation rules in eCRFs helped the team to complete missing data and provide systematic reporting. Integrated online analysis system provided a real-time reporting facility for detecting protocol implementation progress. Conclusions / Significance: Implementing CAP retinoblastoma protocol resembled a roadmap for improving patients’ care. It supported the systematic reporting of cases, decreasing errors and missing data and provided research informatics team with a blueprint for developing a real-time monitoring system. This system can be integrated in the practice of emerging teams to ensure adherence to quality measures.