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Table 2 Requirements for breast cancer pathologies depending on the tier according to Sayed S. et al. [9], and Fleming KA et al. [11]

From: Breast cancer pathology services in sub-Saharan Africa: a survey within population-based cancer registries

  Tier 21 Tier 3/ Tier 4 (Includes Tier 2 Capabilities)2,3
Population served 50,000–200,000 3–6 million
Staff 1 general pathologist, 6 laboratory technicians and pathology assistants 4 pathologists, 2 clinical scientists, 20 technicians and pathology assistants
Communication infrastructure Paper, electronic, or (preferred) laboratory information system Electronic or laboratory information system
Diagnostic Anatomic pathology: FNAC, tissue biopsies, and surgical excisions-processing, H&E stain, and interpretation Anatomic pathology: special stains, including immunohistochemistry
Public health Report to other registries Hospital-based registry/ population-based registry
Accreditation Progressing towards accreditation, such as SLIPTA National or international accreditation, such as ISO 15189 or other
Equipment FNAC and biopsy fixation, microscope, tissue processor, microtome for anatomic pathology, refrigerator Automated tissue processor, immunohistochemistry station, freezer
  1. 1 Tier 2: Laboratories in district hospitals that receive specimens from their own patients and receive referrals from tier 1 facilities
  2. 2 Tier 3: Laboratories in regional or provincial hospitals that receive specimens from their own patients and receive referrals from tier 1 and 2 facilities
  3. 3 Tier 4: Laboratories in national or teaching hospitals that receive specimens from their own patients and receive referrals from tier 1, 2 and 3 facilities
  4. Abbreviations: FNAC Fine-needle aspiration cytology, H&E Hematoxylin and Eosin, ER Estrogen, PR Progesterone, SLIPTA Stepwise Laboratory Quality Improvement Process Towards Accreditation