Purpose: To describe the methodology and initial experience behind creation of an ultrasoundguided percutaneous breast core biopsy program in rural Uganda.
Methods and Materials: Imaging the World Africa (ITWA) is the registered non-governmental organization division of Imaging the World (ITW), a not-for-profit organization whose primary aim is the integration of affordable high-quality ultrasound into rural health centers. In 2013, ITWA began the pilot phase of an IRB-approved breast care protocol at a rural health center in Uganda. As part of the protocol’s diagnostic arm, an ultrasound-guided percutaneous breast core biopsy training curriculum was implemented in tandem with creation of regionally supplied biopsy kits.
Results: A surgeon at a rural regional referral hospital was successfully trained and certified to perform ultrasound-guided percutaneous breast core biopsies. Affordable and safe biopsy kits were created using locally available medical supplies with the cost of each kit totaling $10.62 USD.
Conclusion: Successful implementation of an ultrasound-guided percutaneous breast core biopsy program in the resource-limited setting is possible and can be made sustainable through incorporation of local health care personnel and regionally supplied biopsy materials. Our hope is that ITWA’s initial experience in rural Uganda can serve as a model for similar programs in the future.
Ultrasound-guided biopsy, resource-limited setting, breast cancer, Uganda
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© 2017 the Author(s). This open access article is distributed under a Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/).
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
The authors would like to recognize the collaborative support of Nawanyago Health Centre III and Kamuli Mission Hospital. This work was supported by the Stars in Global Health Grant from Grand Challenges Canada and the citizens of Canada.
Stark CR, DeStigter KK, Matovu A, Shadrack P. Ultrasound-guided Breast Biopsy in the Resource-limited Setting: An Initial Experience in Rural Uganda. Journal of Global Radiology 2017;3(1):1023. https://doi.org/10.7191/jgr.2017.1023. Retrieved from https://escholarship.umassmed.edu/jgr/vol3/iss1/4
Figure 1. Dr. Alphonsus Matovu and sonographer practicing ultrasound-guided core-biopsy on the breast phantom.
M1023_Figure2.jpg (57 kB)
Figure 2. Custom-made sterilizable reusable surgical drape.
M1023_Figure3.jpg (110 kB)
Figure 3. Dr. Christopher Stark with breast biopsy supplies.
M1023_Table 1_20170701.pdf (384 kB)
Table 1. Core-biopsy kit supply cost per unit. Conversion rate of 1 US dollar (USD) per 2515 Ugandan shillings (UGX).
M1023_Appendix A_20160701.pdf (462 kB)
Appendix A. Core biopsy supplies, equipment setup, patient preparation and biopsy procedure