Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Shahin Sayed

Second Supervisor/Advisor

Miriam Mutebi


Pathology (East Africa)


Background: Breast cancer as the most frequently occurring cancer in women is highly heterogeneous in its pathological characteristics. Assessment of tumor biologic characteristics including hormone receptor profile and growth factor receptor activity is important in characterizing the pathologic nature of such cancers. Tumor biomarker activity plays a big role in diagnosis and management of invasive breast cancer (IBC). Biological specimens are the primary sources of this molecular information. Optimal handling of the specimen through the various analytic phases assures of the validity of the final pathologic diagnosis.

Objective: To assess the feasibility of implementing an intervention plan to improve specific breast specimen pre-analytic processes which include cold ischemia time, usage of 10% neutral buffered formalin as fixative media, appropriate ratio of tissue mass to fixative volume and total time spent in fixative media.

Methods: A pre-post study examining these specific pre-analytic variables in breast specimen handling. Specimens’ charts were reviewed in the retrospective phase and their findings compared with the prospective phase specimens’ chart audit after an interventional training workshop was carried out in the intervening period between the two study phases. Significance of change was calculated using the Fisher’s exact test.

Results: Improvement of documentation and compliance with guidelines advocated by the American Society of Oncology-College of American Pathologists (ASCO-CAP) occurred across board after holding a training workshop on the importance of these guidelines with significant change seen in the cold ischemia time.

Conclusion: The study shows that it is feasible to improve on breast specimens’ pre-analytic processes to comply with universally agreed guidelines. Greater integration of impact and process assessment, more stringent formulation and measurement of scale-up targets, and outcome evaluation strategies that allow for comparison of effects at different phases of scale-up can all help to achieve program scalability.

Included in

Pathology Commons