Childhood primary glomerular diseases in the western region of Saudi Arabia.

We report our institute experience on primary glomerular disease in children in the western region of Saudi Arabia over the last 18 years (1988 to 2006). A total of 169 cases were identified as primary glomerular diseases in children and adolescent with age range from first year of life till 18 years. Minimal change disease and focal segmental glomerulosclerosis were the commonly encountered primary glomerular diseases (20.1%and 19.5% respectively), mesangioproliferative glomerulonephritis IgM nephropathy (14.8%), IgA nephropathy (10.7%), postinfectious glomerulonephritis (9.5%), membranous glomerulonephritis (7.1%), membranoproliferative glomerulonephritis (5.9%) and mesangioproliferative glomerulonephritis with negative immunofluorescence (5.9%). The less frequently encountered primary glomerular diseases were congenital nephritic syndrome Finnish type (2.4%), Alport syndrome (2.4%), dense deposit disease (1.2%), and mesangio-proliferative glomerulonephritis with IgG positive (0.6%). We concluded that minimal change disease and focal segmental glomerulosclerosis are the most common primary glomerular disorder en-countered in children in our series and with similar age distribution.

Frequency of benign and preinvasive breast diseases.

OBJECTIVE: The importance of benign proliferative and non-invasive breast lesions as a risk factor preceding the development of invasive mammary carcinoma is well established in the literature. The objective of this study is to estimate the magnitude of benign proliferative diseases as well as mammary intra-epithelial neoplasia in the Western region of the Kingdom of Saudi Arabia (KSA), in order to encourage nationwide breast cancer screening programs for early detection of the high risk proliferative and pre-invasive breast lesions. METHODS: We reviewed histopathology records (reports and slides of selected cases) of 2129 breast cases including mastectomies and breast biopsies from January 1985 to December 2002 in King Abdul-Aziz University Hospital and King Khalid National Guard Hospital, Jeddah, KSA. All the cases and diagnosis are listed and reclassified using systematized nomenclature of medicine (SNOMED) coding system and then regrouped based on the associated risk factors of developing breast carcinoma. RESULTS: Two thousand one hundred and twenty-nine reports were reviewed and 2343 diagnosis were identified as some cases had more than one diagnosis. The total of benign diagnosis were 1504 after exclusion of malignant diagnosis (558), normal breast tissue, gynecomastia, and non-mammary tissue (281). All diagnosis (1504) were reclassified based on anatomical prognostic indicators into non-proliferative (1283/1504), proliferative (140/1504), atypical hyperplasia (AH) (8/1504), and carcinoma in situ (CIS) (73/1504). We compare our findings with the literature and we found that the percentage of benign non-proliferative diagnosis was 85.3% that is higher than the literature 69.7%. Proliferative diseases were 9.3% and atypical hyperplasia was 0.5%, which was lower than the literature 26.2% and 3.6%. On the other hand, CIS diagnosis was 4.9%, which is much higher than the reported literature 1.7%. The study findings could be explained on the basis of higher prevalence of benign breast lesions in our population, or it is related to the number of cases studied, or to the diagnostic criteria followed initially. CONCLUSION: These findings should encourage us to refine our diagnostic criteria of proliferative diseases, AH and CIS (mammary intraepithelial neoplasia [MIN]). In addition, we strongly encourage a breast cancer screening program, nationwide.

Role of fine needle aspiration in diagnosing breast lesions.

OBJECTIVE: To determine the diagnostic efficacy of breast fine needle aspiration (FNA), using 72 cases that were having both FNA cytology and follow-up histology diagnosis. The study results were compared with results of 27 other studies in the literature. A review of literature regarding the additional benefits of performing "Triple Test" in increasing the cumulative diagnostic accuracy of FNA is also included. METHODS: Our study group consisted of 72 FNA cytologies of female breasts performed at our institution and followed by a histological diagnosis. The following parameters: Sensitivity, specificity, accuracy, predictive values, false positive and negative fraction rates were determined to establish the diagnostic efficacy of the breast FNA. RESULTS: The sensitivity of FNA procedure was 98.4% and specificity 60%, with the predictive value for positive diagnosis 93.9% and for negative diagnosis 85.7%. The overall diagnostic accuracy was 93%. The false positive fraction was 6% and the false negative fraction was 14.2%. The false positive and false negative cases were recorded as having a minimal effect on patient management, as all the false positive and negative diagnosis' were picked up at intra operative frozen sections, and hence no over or under treatment was given to the patients due to these FNA results. CONCLUSION: Fine needle aspiration breast biopsy is an efficient tool and yields a definitive diagnosis, and its use for routine diagnosis must be encouraged since it has high positive (93.9%) and negative (85.7%) predictive values.