Browsing by Author "Liyanage, S.K."

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An audit of lymph node retrieval and histopathology reporting of pancreaticoduodenctomy specimens undertaken at a tertiary care referral center
(College of Pathologists of Sri Lanka, 2017) Siriwikum, L.B.D.J.; Samarakoon, N.K.; Liyanage, S.K.; Mahendra, B.A.G.G.; Ratnayake, R.M.U.S.; Hewavisenthi, S.J.de S.
Pancreaticoduodenectomy (PD) is currently the main surgical option for malignancies in the ampullary region, which includes ampulla of Vater tumours (AVT), distal bile duct tumours (DBDT), periampullary duodenal tumours (DT) and tumours of the head of the pancreas (PT). Nodal status and many other important pathological features have a significant impact on tumour prognosis and therapy. The aim of this study was to determine the total number of lymph nodes (LNs) retrieved from PD specimens, whether grouping of LNs improves the total yield and to assess the level completeness of histopathology reporting of PD specimens. Forty two PD requests and histopathology reports were assessed to determine the total number of LNs retrieved and whether the LN were grouped (G)or non-grouped (NG). The significance of difference in the number of LNs in the two groups were assessed using the Wilcoxon signed rank test. The tumours were subcategorized as AVT, DBDT, DT and PT and the reports were audited against the respective minimum data sets of the Royal College of Pathologists of United Kingdom to determine the overall completeness and the parameters poorly reported in the reports. The overall median LN yield was 14.5 and the median LN yield was 15 and 10 in G and NG respectively which was statistically significant. The completeness of the histopathology reporting was 63.6%- 77.3% in AVT (n-18), 73.9% - 95.6% in DBDT (n-5), 68.1% - 90.1% in DT (n-8), 70.8% - 83.3% in PT (n-11). The lengths of the bile duct, lesser and greater curvature of the stomach, tumour differentiation, involvement of resection margins and named blood vessels were poorly reported. In conclusion, the total LN retrieval improved by grouping according to the Union of International Cancer Control (UICC) protocol. Histopathology reporting of some of the data items requires improvement. Hence adoption of a pro forma for synoptic reporting and establishment of national guidelines on reporting and handling of specimens is recommended.
Bile reflux and quality of life after modified retrocolic posterior gastric gastrojejunostomy in whipple procedure
(College of Surgeons of Sri Lanka, 2015) Rajapaksha, R.W.M.A.L.; Liyanage, C.A.H.; Hewavisenthi, S.J.D.S.; Liyanage, S.K.; Bandara, L.M.P.M.; Siriwardana, R.C.
INTRODUCTION: Perioperative outcome of Whipple surgery has greatly improved. Quality of life has become an important issue in long-term survivors. Delayed gastric emptying and bile reflux are common concerns. Modified retrocolic posterior gastric gastrojejunostomy with mesocolic stich has been unit's standard practice. Study was designed to assess macro and microscopic bile reflux and dyspepsia related quality of life in long-term survivors. MATERIAL AND METHODS: Out of 42 patients operated from June 2012, twenty long-term survivors were selected after excluding once with recurrence and ones who had chemotherapy during last six months. All underwent gastroscopy. Macroscopic bile reflux was grouped in to four categories. Six gastric biopsies were taken from standard sites. Microscopic bile reflux index (BRI) was calculated in stained specimens. BRI score of more than 14 was considered significant. Validated Nepean dyspepsia index-short form (NDI-SF) was used to assess the severity of dyspepsia related quality of life and compared with age and gender matched control. RESULTS: The median age was 48.5 years (21- 69). Median survival of the group was 37 months (6-40). Endoscopically, 18/20 (90%) had macroscopic bile reflux (83.3% yellowish bile lake, 16.7% greenish bile lakes). None had stomal ulcers or macroscopic inflammation. Mean Bile reflux index score was 13.22 (SD: 9.46). Mean dyspepsia score of Whipple group was 23.1 (SD 8.88). In controls, mean dyspepsia score was 20 (SD 8.2), showing no significant difference (p =0.245). CONCLUSION: Though there was macroscopic bile reflux, clinical symptoms and microscopic changes were minimal. Modified technique had good long-term results.
Design and development of a web based histopathology reporting system
(Sri Lanka Medical Association, 2017) Ediriweera, D.S.; Hettiarachchi, W.G.; Mahendra, B.A.G.G.; Liyanage, S.K.; Ratnayake, R.M.U.S.; Hewavisenthi, S.J.de.S.
INTRODUCTION & OBJECTIVES: The current histopathology reporting system in the unit has only basic features including report generation and limited data retrieval. Thus a newer system was required to address the issues faced in histopathology reporting, chiefly a prolonged turnaround time caused by lack of clinical data, inability to track delays in sample processing, delays in data entry and report dispatch. More efficient data retrieval for research purposes and monitoring of postgraduate training were also considered important. The aim of the study was to design and develop a generic histopathology reporting system that facilitates the generation of timely reports and helps in research and postgraduate training. METHODS: A software framework was designed and developed into a functional web based histopathology reporting system (WBHPRS) which can be easily customizable to different settings. This was designed using MySQL and PHP. Data entry was facilitated by using drop down menus and prompts. Standard templates for reports with the option to edit were uploaded enabling quick report generation. RESULTS: A WBHPRS has the ability to capture data throughout the process of generating a report, thus enabling the tracking of the specimen from surgery to dispatch of the report. The system also provides facilities for more efficient data retrieval due to a modified coding system. It facilitates postgraduate supervision enabling the trainer to determine the time taken, quality and quantity of work done by the trainees. CONCLUSION: This system has vastly enhanced features that will improve the timeliness of reporting and provide additional features useful in research and postgraduate training.
Implementation of an Online Histopathology Reporting System in the Department of Pathology, Faculty of Medicine, University of Kelaniya
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Hettiarachchi, W.G.; Ediriweera, E.P.D.S.; Mahendra, B.A.G.G.; Liyanage, S.K.; Hewavinsenthi, S.J.D.S.; Ratnayake, R.M.U.S.
The Department of Pathology, Faculty of Medicine, University of Kelaniya provides histopathology reporting for the Colombo North Teaching Hospital (NCTH) as an honorable service. The department currently uses a standalone Microsoft access database to generate reports and it has limited data retrieval capabilities. A newer system was required to address the issues faced, mainly a prolonged turnaround time caused by lack of clinical data, inability to track delays in sample processing, delays in data entry and report dispatch. More efficient data retrieval for research purposes and monitoring of postgraduate training were also considered important. The aim of the work was to implement anonline histopathology reporting system that has facility to track the reporting stage, postgraduate evaluation and data retrieval for researches. Every report is attached with a diagnostic code that can be used in research purposes. A web-based application was developed that has ability to capture data at each step from specimen receiving from the surgery theatre until dispatch of reports. The system has developed to easily customizable to different settings. Thus, it has facility to add new reporting templates, anatomical sites, surgical specimens or diagnostic codes to system through web forms. Data entry was facilitated by using drop down menus and prompts. Standard templates for reports with option to edit were uploaded enabling quick report generation. It facilitates postgraduate supervision by enabling the trainer to determine the time taken, quality and quantity of work done by the trainees. Mainly open source scripting languages and databases were used to developed the system: PHP, HTML 5, CSS Javascript, Ajax and MySQL. The system hosted on the faculty intranet and available 24/7 from anywhere at the faculty. The system supports both windows and androids operating systems and the system can be accessed in desktop and tablet computers using any commonly used modern web browsers.
Quality of life and impact of bile reflux after retro colic retro gastric gastrojejunostomy in Whipple surgery
(Biomed Central, 2017) Siriwardana, R.C.; Lokubandara, R.W.M.A.; Hewavisenthi, S.J.de S.; Liyanage, S.K.; Jayatunga, D.S.P.; Liyanage, C.A.H.
Background: Delayed gastric emptying and bile reflux are common concerns in long-term survivors after Whipple surgery. The study was designed to assess modified retro colic retro gastric gastrojejunostomy in reducing macro and microscopic bile reflux and impact on dyspepsia related quality of life in long-term survivors. Methods: Out of 43 patients operated, 23 long-term survivors were included. All underwent gastroscopy and bile reflux was grouped as normal, yellowish bile lakes and presence of greenish bile lakes. Six standard gastric biopsies were taken. Microscopic bile reflux index (BRI) was calculated and a score more than 14 was considered significant. Validated Nepean dyspepsia index-short form (NDI-SF) was used to assess the severity of dyspepsia-related quality of life and compared with age and gender-matched control. Results: The median age was 48 (21–70) years. Median survival of the group was 37 months (6–40). Endoscopically, 20/23 (87%) had macroscopic bile reflux (74% yellowish bile lakes, 13% greenish bile lakes). None had stomal ulcers or macroscopic inflammation. Mean bile reflux index score was 9.7 (range 1.77–34). Mean NDI–SF score of Whipple group was 23.1 (SD 8.88). In controls, mean score was 19.9 (SD 8.23), showing no significant difference (p = 0.245). Conclusions: Though there was macroscopic bile reflux, clinical symptoms and microscopic changes were minimal. The modified technique had good long-term results.
Quantification of mucosal eosinophils in histologically normal ileal, colonic and rectal biopsies
(Faculty of Graduate Studies, University of Kelaniya, 2015) Liyanage, S.K.
Introduction: Increased gastrointestinal tissue eosinophils are noted secondary to many known disease entities and also due to primary eosinophilic gastrointestinal disorders. There is no general agreement with regard to the normal range of eosinophils in the intestinal mucosa. This study was carried out in a population of adults suspected of having irritable bowel syndrome (IBS). Objectives: To quantify the normal eosinophil counts in different segments of the lower gastrointestinal tract (LGIT). Methodology: The ileal, serial segmental colonic and rectal biopsies of 25 patients, suspected as having IBS, whose endoscopic findings and the routine histological findings were normal, were included in the study. Eosinophils were counted in up to 10 high power fields (HPFs) in each of these biopsies including ileum(174HPFs), caecum(185HPFs), ascending colon(AC- 165HPFs), transverse colon(TC-182HPFs), descending colon(DC-177HPFs), sigmoid colon(SC-192HPFs) and rectum (183HPFs). Using the data analysis software ‗Stata‘, the 95th percentile was obtained and taken as the upper normal limit /cut off level for mucosal eosinophils in each of these sites. Results: The 95th percentile values for the mucosal eosinophils were, ileum-20/HPF, caecum- 20/HPF, AC-15/HPF, TC-12/HPF, DC-12/HPF , SC-11/HPF and rectum-6/HPF. Conclusion: There is a variability in the normal eosinophil counts in different segments of the LGIT. This study showed that it is necessary to have different upper normal limits for mucosal eosinophil counts in each segment of the bowel rather than a single value for the entire LGIT. Discussion – A population suspected of having IBS were used to establish the normal eosinophil counts in different segments of the LGIT, because IBS is known to be a functional disorder and the routine histological examination reveals no mucosal abnormality. It has also been proven that this population reveals no increase in mucosal eosinophils and therefore, in the local settings, was considered as the best possible sample to represent the normal population in this study.
A Retrospective Study on Perinatal Post Mortems
(Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2016) Liyanage, S.K.; Mahendra, G.; Ratnayake, S.; Hewavisenthi, J.
A detailed post mortem examination is the key to the recognition of pathologies related to perinatal deaths. Post mortem findings assist the clinical team in confirming their clinical and radiological findings and the family for future pregnancy planning. However, this facility is still underutilized in Sri Lanka. Furthermore, examination of the placentas is an important aspect in recognizing the cause of perinatal death. The department of pathology, faculty of medicine, University of Kelaniya provides the perinatal pathology service to the Obstetrics and Gynaecology unit and the neonatal unit of the Teaching Hospital Ragama. This study was carried out in view of improving and expanding the perinatal pathology service provided by the department. Objectives were (1). To identify the number of perinatal post mortems (PPMs) reported over a period of six years. (2). To identify the number of PPMs that showed multiple congenital anomalies (3). To identify the number of PPMs accompanied by a placenta and the number of placentas with identifiable pathology. This was a retrospective study on already reported PPMs in the Department of Pathology, Faculty of medicine, University of Kelaniya, From January 2011 to August 2016. The PPM databases maintained in the department were used to extract data. A total of 118 PPMs were reported (2011-17, 2012-16, 2013- 17, 2014-21, 2015-31, 2016-16). 65 % (75/118) were premature deliveries. 56% (67/118) were performed following intrauterine deaths. 14 % (16/118) of PPMs showed multiple congenital anomalies. Placentas ware submitted for examination in 31 PPMs (31/118) and clinically significant placental pathologies were noted in 7/31 placentas (23%). 76/118 (64%) showed no gross abnormality in the fetus/baby and placenta was not available for examination in 72% (55/76). Major congenital anomalies were detected in 14% of PPMs. In majority of the PPMs, the placenta was not available for examination, therefore cannot exclude the possibility of placental pathology which might have led to the death.
A Retrospective study on perinatal post-mortems
(University of Kelaniya, Sri Lanka, 2016) Liyanage, S.K.; Mahendra, B.A.G.G.; Ratnayake, R.M.U.S.; Hewavisenthi, S.J.
A post-mortem examination is the key to the recognition of pathologies related to perinatal deaths. A perinatal death could be related to fetal, maternal or placental factors. A complete perinatal post-mortem (PPM) includes examination of the dead body and the placenta. The PPM findings assist the clinical team in confirming their clinical findings and uncover the additional pathologies, and the family for future pregnancy planning. This study was carried out to identify the number of perinatal post mortems (PPMs) reported during the study period, the number of PPMs with multiple congenital anomalies and the number of PPMs accompanied by a placenta and the number of placentae with identifiable pathology. This study was on already reported PPMs in a tertiary care center from January 2011- August 2016. Multiple congenital anomalies were noted in 14% (16/118) of the PPMs. Placentae were submitted for examination in 26% (31/118) with clinically significant placental pathologies in 23% (7/31). In 64% (76/118) of PPMs there were no gross abnormality in the fetus/baby. The placenta was not available for examination in 72% (55/76) and therefore, the possibility of placental pathology, which might have led to the death, could not be excluded.