Abstract :

Purpose: The diagnosis of CNS tumors requires a multidisciplinary team including oncologists, neurosurgeons, radiologists and pathologists. We review the impact of expanding diagnostic capacity on the identification and diagnosis of primary pediatric CNS tumors at Bugando Medical Centre (BMC), the regional cancer referral hospital in the lake zone region of Mwanza Tanzania.

Methods: Patients who presented to BMC from 2016-2022 and received a radiographic or pathologic diagnosis of primary brain or spinal cord tumor were included a CNS tumor registry. Collected data included basic demographics, most specific diagnosis, and diagnostic method. Data was measured and compared before and after initiating key capacity development milestones: 2018 – installation of CT scan, 2020 – arrival of neurosurgical specialist, 2021 – initiation of multidisciplinary tumor board and WhatsApp chat.

Results: A total of 7 spinal and 71 brain tumors were diagnosed among patients aged < 18yo, with (46%) female (n=31) and average age of 7 years. The number of cases per year increased from 3 in 2016, to 17 in 2022. Prior to availability of CT scan (2016-2017), there were an average of 2.5 cases/year, compared to 14.6/year in 2018-2022. With the arrival of the neurosurgeon in 2020, the number of diagnoses/year increased from 11 to 20 from the year prior, but only 50% of patients had a confirmed radiologic or histologic diagnosis. Following initiation of Multidisciplinary Tumor Board Discussion and WhatsApp group, 88% of patients registered in 2022 had a radiographic or histologic diagnosis.

Conclusion: This retrospective study demonstrated the step wise influence of key development milestones on the diagnostic capacity for CNS tumors in a LMIC. While introduction of CNS imaging allowed the identification of more tumors, the multidisciplinary team discussion of the imaging, clinical presentation and pathology results had the greatest overall impact on diagnostic capacity in our setting and should be a key component in future program development.