Diagnostic and Educational Support to Pathologists in the Developing World through Telepathology
AR Sohani, H Chande, V Vyas. Massachusetts General Hospital, Boston; Muhimbili Hospital; Aga Khan Hospital, Dar es Salaam, Tanzania, United Republic of
Background: The practice of pathology in the developing world presents challenges in terms of limited resources, shortage of trained personnel and lack of continuing education programs. Telepathology holds great promise as a way to offer diagnostic support, 2nd opinions and ongoing training. We report our experience with a recently established static telepathology program between 2 hospitals in the United States and Tanzania, a country of 38 million people served by only 15 pathologists without access to immunohistochemistry (IHC) or molecular diagnostic testing.
Design: An Olympus BH-2 6-headed microscope and SPOT Insight digital camera were donated to an 80-bed Tanzanian multispecialty hospital with an average specimen volume of 800 cytology & surgical pathology cases/year. 2 local pathologists were given on-site training on image acquisition. Images were uploaded to the iPath open source telepathology server. A US pathologist reviewed images in consultation with subspecialist colleagues, in order to provide both diagnostic and educational support to submitting pathologists as the program's main objective.
Results: During the initial 5 months of the program, 15 cases were submitted for 2nd opinion consultation in subspeciality areas of cytology (4), GI (4), breast (2), head & neck (2), hematology (2) and soft tissue (1). Static images enabled a complete or partial diagnosis in 12 cases (80%). 4 entirely diagnostic cases included a soft palatal pleomorphic adenoma, a breast giant hamartoma, a rectal tonsil and a rectal cavernous hemangioma. 4 partially diagnostic cases were favored to be malignant and 4 were favored to be benign/reactive. Among the 8 partially diagnostic and 3 non-diagnostic cases, factors precluding a definitive diagnosis included absence of confirmatory IHC/flow cytometry (1 soft tissue, 2 hematology cases), air-drying (4 cytology cases), tangential tissue sectioning (1 head & neck case) and non-technical issues (3 cases). Responses posted to completely and partially diagnostic cases included a diagnosis, discussion of the differential diagnosis and additional information (e.g. gross findings, diagnostic pitfalls and/or publications about the entity).
Conclusions: Telepathology is well-suited to provide both diagnostic support and continuing education to pathologists in the developing world. Factors precluding a definitive diagnosis are mainly technical and can be overcome by additional training or building local capacity for basic ancillary testing.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 81, Wednesday Afternoon