Department of Dermatology, Oregon Health and Sciences University, Portland, OR, USA.
Ministry of Health of Botswana, Gaborone, Botswana.
Int J Dermatol. 2019 Jun;58(6):707-712. doi: 10.1111/ijd.14305. Epub 2018 Nov 21.
Despite widespread antiretroviral coverage in Botswana, Kaposi's sarcoma (KS) remains among the most common malignancies. To date, adult KS in Botswana is not well characterized. The diagnosis relies on clinical suspicion that is often confirmed by histopathology given the implications of treatment; however, this poses a significant resource burden.
We conducted a retrospective review of the cohort of patients biopsied for possible KS at Princess Marina Hospital, the main dermatology referral site in Botswana, from September 2008 through June 2015 to describe the demographics, human immunodeficiency virus (HIV) characteristics, and clinical presentations of these patients. Histopathologic diagnoses were reviewed, and positive predictive value (PPV) was used to characterize the accuracy of clinical suspicion of KS.
A total of 441 patients received 450 biopsies where KS was on the differential diagnosis, and 239 patients (54%) were ultimately diagnosed with KS. The KS cohort was more likely to be male (58% vs. 37%, P < 0.001), HIV positive (94% vs. 85%, P < 0.05), and have lower CD4 counts at the time of biopsy (274 cells/μl vs. 362 cells/μl, P < 0.05). The PPV of clinical suspicion of KS was 58%. When KS was not histopathologically diagnosed, clinically benign diseases were found in 17%, medically significant conditions requiring alternative therapies in 78%, and life-threatening diseases in 5%.
Our study reinforces the risk factors in development of KS. The poor PPV supports the important role of histology in KS diagnosis to both ensure appropriate treatment and prevent overtreatment. Improved accessibility to biopsy and augmentation of local dermatopathologic services would likely improve diagnostic accuracy and treatment.
尽管博茨瓦纳广泛开展了抗逆转录病毒治疗，但卡波西肉瘤（KS）仍是最常见的恶性肿瘤之一。迄今为止，博茨瓦纳的成人 KS 尚未得到很好的描述。该诊断依赖于临床怀疑，由于治疗的影响，通常通过组织病理学来确认；然而，这给资源带来了很大的负担。
我们对 2008 年 9 月至 2015 年 6 月在博茨瓦纳主要皮肤科转诊医院 Princess Marina 医院接受 KS 可能活检的患者队列进行了回顾性研究，以描述这些患者的人口统计学、人类免疫缺陷病毒（HIV）特征和临床表现。回顾了组织病理学诊断，并用阳性预测值（PPV）来描述临床怀疑 KS 的准确性。
共有 441 名患者接受了 450 次 KS 鉴别诊断活检，其中 239 名患者（54%）最终被诊断为 KS。KS 队列更可能为男性（58%比 37%，P<0.001）、HIV 阳性（94%比 85%，P<0.05）和活检时 CD4 计数较低（274 个/μl 比 362 个/μl，P<0.05）。临床怀疑 KS 的 PPV 为 58%。当 KS 未通过组织病理学诊断时，在 17%的患者中发现了临床良性疾病，在 78%的患者中发现了需要替代治疗的有医学意义的疾病，在 5%的患者中发现了危及生命的疾病。
我们的研究强化了 KS 发病的危险因素。较差的 PPV 支持组织病理学在 KS 诊断中的重要作用，这既能确保适当的治疗，又能防止过度治疗。提高活检的可及性并增加当地皮肤科病理服务，可能会提高诊断准确性和治疗效果。
