1373. Brain Tumor Patterns in Rural Haiti: A CT-Based Study
Authors: Ernest Barthelemy, MD; Yannis Valtis, MD; Margaret Cochran, MD; Louine Martineau, MD; Kee Park, MD; Jeffrey Mendel, MD; Aaron Berkowitz, MD, PhD (New York, NY)
Lack of neuroimaging in low-income countries(LICs) poses barriers to understanding the local neuro-oncologic disease burden. We report on the frequency of brain tumors found in a three-year retrospective review of head CTs performed at a public referral hospital in rural Haiti.
We reviewed 3614 reports from head CTs performed between 7/2013 and 1/2016. Scans mentioning the terms, “tumor,” “cancer,” “malignancy,” “malignant,” or “mass” were analyzed. We excluded reports without evidence of tumors. We extracted demographics, radiological findings, and tumor type to generate descriptive statistics on neuro-oncologic disease.
Among 279 scans selected for preliminary study, we excluded 45 with no evidence of tumor and 51 with soft
tissue tumors not involving the skull or brain. 183 scans remained in the final analysis (35%male;age,median=42.8,IQR=26.8,55.1), representing 5% of all scans and 10% of abnormal scans. Children(age<18) accounted for 14% of patients. Excluding uncertain diagnoses and soft tissue skull lesions, the 4 most common brain tumor categories included meningiomas(22;12.0%), metastases(17;9.3%), unspecified intra-axial(17;9.3%) and sellar masses(15;8.1%). Primary brain tumors were more prevalent among children. Among brain metastases, half resulted from presumed primary breast cancer and most of the remainder had no known primary at the time of imaging. Using data from a recent model of operative proportions of neurosurgical diseases in LMICs, we estimate that 142(78%) of these patients had indications for neurosurgical intervention.
In this large radiological cohort form an LIC in the Caribbean, we noted adult and female predominance. Brain tumors were common, and included at least 11 different categories of primary brain tumors, and 3 known categories metastatic lesions. These data highlight opportunities for neurosurgical and oncological capacity-building in Haiti and other LICs.