Gastroenteropancreatic neuroendocrine tumours: Clinicopathological evaluation at Shifa International Hospital, Islamabad.

OBJECTIVE: Clinicopathological features of gastroenteropancreatic neuroendocrine tumours (GEP-NETs) have rarely been studied in Pakistani population. We investigated clinical characteristics of these tumours according to updated World Health Organization (WHO) 2010 classification. METHODS: The data of Shifa International Hospital, Islamabad was retrospectively analysed for pathologically confirmed GEP-NETs from January 2013 to March 2018. RESULTS: One hundred and eighteen patients (mean age, 52.2± 16.4 years; Of these 65(55.1%) were males. Majority, 98(83.1%) of the patients were symptomatic including 6(5.1%) with functional tumours. Pancreas was the most frequent primary site noted in 33(28%) patients. The most common histologic type was well differentiated neuroendocrine tumour (WDNET) in 96(81.4%) patients followed by neuroendocrine carcinoma (NEC) in 11(16.1%) patients. Almost half the cases or 54(45.8%) of WDNET were grade 1, 32 (27.1%) were grade 2, and 10 (8.5%) were grade 3. Distant metastasis at the time of diagnosis was found in 18(15.3%) cases with 14,(77.7%) in liver as the most common metastatic site. Synaptophysin positivity was seen in 60 (96.8%) cases of grade 1, 32(27.2%) of grade 2 WDNET, 8(100%) cases of grade 3 WDNET and 12(92.3%) of NEC and chromogranin was positive in 49(94.2%) of grade 1 and grade 2 WDNET, 5 (83.3%) cases of grade 3 WDNET and 5 (45.4%) cases of NEC. CONCLUSIONS: GEP-NETs showed a wide clinicopathological spectrum. Pancreas is the most common site of involvement by the GEP-NET, however, grade 3 WDNET had a predilection for colon. Small cell carcinoma was commonly observed in the oesophagus.

Accuracy of intra-operative frozen section in the diagnosis of female genital tract neoplasms.

OBJECTIVE: To evaluate the accuracy of intra-operative frozen section in the diagnosis of various pelvic neoplasms, including ovarian tumours. METHODS: The retrospective study was conducted at Shifa International Hospital and comprised records of all patients with lesions of female genital tract who underwent frozen section between January 2010 and December 2012. Comparison was made with the final diagnosis after histopathology was performed on examining permanent paraffin sections. RESULTS: The mean age of the 54 patients was 43.70+/-14.8 years (range: 19-75 years). The frozen section was accurate in 51(92.6%) cases. It had a moderately high sensitivity of 75%, high specificity of 97.6%, high positive predictive value of 90% and high negative predictive value of 93.2%. Lack of agreement was found in cases of ovarian tumours of the mucinous and borderline variety. CONCLUSIONS: Frozen section showed a considerable level of accuracy when dealing with suspected pelvic neoplasms.

Evaluation of fine needle aspiration cytology as a screening tool in thyroid lesions.

OBJECTIVE: To assess the efficacy of fine needle aspiration cytology in the evaluation of thyroid lesions. METHODS: The retrospective study comprised data of all patients who presented for fine needle aspiration cytology at the Shifa International Hospital, Islamabad, between January 2009 and April 2011. The data was retrieved from the departmental records and the results were recorded. All cases who underwent subsequent surgery were also retrieved and histopathology results were compared with the cytology results. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. RESULTS: Of the 327 patients, the results were inconclusive in 18 (5.5%), benign in 230 (70.3%), suspicious in 64 (19.6%) and malignant in 15 (4.6%) cases. Besides, 59 (18%) of these patients underwent subsequent surgery. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of fine needle aspiration cytology was calculated to be 85.7%, 73.3%, 50%, 94.2% and 76.2% respectively. CONCLUSION: Fine needle aspiration cytology is a reasonably sensitive, specific and accurate initial diagnostic test for pre-operative evaluation of patients with thyroid swellings. The clinicians should be encouraged to use the procedure as it is minimally invasive and easily performed in an outpatient setting.

Delivering endocrinology and reproduction in an integrated modular curriculum.

OBJECTIVE: To ascertain the perceptions of students and faculty of Shifa College of Medicine, Islamabad regarding the delivery of Endocrinology and Reproduction module as a component of the newly introduced Integrated Modular Curriculum. METHODS: A descriptive study, using mixed qualitative and quantitative method, starting from June 6 to August 15 2008. A period of 10 weeks was spent on the study including 8 weeks of planning, 2 weeks of delivery and assessment and a 2 weeks period of post hoc analysis and data collection. A multidisciplinary team of faculty developed themes, clinical cases, objectives and table of specification of the Endocrinology and Reproduction Module for Fourth Year MBBS Class. Continuous assessment was done by theme-based assignments and student presentations. Summative assessment was done by Multiple Choice and Short Answer Questions. Likert scale-based student feedback questionnaire was administered while the students were also encouraged to comment on the module for improvement. Feedback was obtained from the faculty in a similar manner. RESULTS: Out of a class of 86 students, 47 (55%) agreed to a balance between basic and clinical concepts addressed in the module, 21 (24%) agreed that emphasis on clinical concepts was appropriate, 37 (43%) agreed that learning strategies were well integrated, 50 (58%) were of the opinion that the assigned learning material was consistent with the session objectives, while 39 (45%) agreed that case-based instruction was useful, and 40 (47%) students were of the opinion that large group discussion was useful. Faculty feedback was positive towards integrated learning. CONCLUSIONS: Integrated Endocrinology and Reproduction module received mixed response from students. This led us to modify and tailor the curriculum to better cater for the needs of students. Feedback from students and faculty is essential for improvement in the quality of educational interventions.