Accuracy of Clinical Suspicion and Pathologic Diagnosis of Kaposi Sarcoma in East Africa
Open accessAbstract
BACKGROUND: HIV-associated Kaposi sarcoma (KS) is one of the most common malignancies in sub-Saharan Africa. The diagnosis is often based on clinical suspicion, without histopathologic confirmation. When biopsies are performed, the accuracy of interpretation by local pathologists is poorly understood. We assessed the accuracy of clinical suspicion and pathologic diagnosis of KS in 2 East African countries. METHODS: At 2 large HIV care sites in Uganda and Kenya, we evaluated consecutive biopsies performed from October 2008 to January 2013 on HIV-infected adults with clinically suspected KS. Biopsies were interpreted by both local African pathologists and a group of US-based dermatopathologists from a high volume medical center. For the purpose of this analysis, the US-based dermatopathologist interpretation was used as the gold standard. Positive predictive value was used to characterize accuracy of local African clinical suspicion of KS, and concordance, sensitivity, and specificity were used to characterize accuracy of local pathologic diagnosis. RESULTS: Among 1106 biopsies, the positive predictive value of clinical suspicion of KS was 77% (95% confidence interval: 74% to 79%). When KS was not histopathologically diagnosed, clinically banal conditions were found in 35%, medically significant disorders which required different therapy in 59% and life-threatening diseases in 6%. Concordance between African pathologists and US-based dermatopathologists was 69% (95% confidence interval: 66% to 72%). Sensitivity and specificity of African pathologic diagnoses were 68% and 89%, respectively. CONCLUSIONS: Among East African HIV-infected patients, we found suboptimal positive predictive value of clinical suspicion of KS and specific, but not sensitive, histopathologic interpretation. The findings call for abandonment of isolated clinical diagnosis of KS in the region and augmentation of local dermatopathologic services.
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Diagnosis of Kaposi's sarcoma by exam alone has a 23% rate of misdiagnosis.
“Diagnosis by exam alone is strife with error, with 23% rate of misdiagnosis”
From Global Burden of Skin Disease: Inequities and Innovations (2017) · cites this paper as [47]
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- Authors
- Amerson, E., Woodruff, C. M., Forrestel, A., Wenger, M., McCalmont, T., LeBoit, P., Maurer, T., Laker-Oketta, M., Muyindike, W., Bwana, M., Buziba, N., Busakhala, N., Wools-Kaloustian, K., & Martin, J.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Amerson, Erin
- ORCID
- Venue
- JAIDS Journal of Acquired Immune Deficiency Syndromes
- Published
- 2016-03-01
- Volume
- 71
- Issue
- 3
- Pages
- 295-301
- ISSN
- 1525-4135 (ISSN-L)
- PMC
- PMC4770348
- OpenAlex
- W2441978434
- Cited by
- 56
- References
- 26
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2023: 7 · 2022: 7 · 2021: 4 · 2020: 6 · 2019: 4 · 2018: 5 · 2017: 8 · 2016: 5
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAIDS Journal of Acquired Immune Deficiency Syndromes (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Cancer Institute (D43CA153717, U54CA190153, R01CA119903)
- National Institute of Allergy and Infectious Diseases (U01AI069911, P30AI027763)
- Topics
- Health Sciences › Medicine › Oncology › Viral-associated cancers and disorders
- Health Sciences › Medicine › Surgery › Lymphadenopathy Diagnosis and Analysis
- Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
- Keywords
- AIDS-related Kaposi's sarcoma, clinical suspicion, histopathological diagnosis, diagnostic accuracy, positive predictive value, dermatopathology, interobserver concordance, sensitivity and specificity, HIV-infected adults, East Africa, Uganda, Kenya
- MeSH terms
- Biopsy, Humans, Kenya, Sarcoma, Kaposi, Sensitivity and Specificity, Uganda, HIV Infections
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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