Abstract
Introduction
In low- and middle-income countries (LMICs), surgical care can be limited by access to pathology services. In Uganda, the pathologist-to-population ratio is less than 1 to 1 million people. The Kyabirwa Surgical Center in **ja, Uganda, created a telepathology service in collaboration with an academic institution in New York City. This study demonstrated the feasibility and considerations of implementing a telepathology model to supplement the critical pathology needs of a low-income country.
Methods
This was a retrospective, single-center study of an ambulatory surgery center with pathology capability using virtual microscopy. The remote pathologist (also known as a telepathologist) controlled the microscope and reviewed histology images transmitted across the network in real time. In addition, this study collected demographics, clinical histories, the surgeon’s preliminary diagnoses, and the pathology reports from the center’s electronic medical record.
Results
Nikon’s NIS Element Software was used as a dynamic, robotic microscopy model with a video conferencing platform for communication. An underground fiber optic cable established Internet connectivity. After a two-hour tutorial session, the lab technician and pathologist were able to proficiently use the software. The remote pathologist read (1) pathology slides with inconclusive reports from external pathology labs, and (2) tissues labeled by the surgeon as suspicious for malignancy, which belonged to patients who lacked financial means for pathology services. Between April 2021 and July 2022, tissue samples of 110 patients were examined by a telepathologist. The most common malignancies on histology were squamous cell carcinoma of the esophagus, ductal carcinoma of the breast, and colorectal adenocarcinoma.
Conclusion
With the increasing availability of video conference platforms and network connections, telepathology is an emerging field that can be used by surgeons in LMICs to improve access to pathology services, confirming histological diagnosis of malignancies to ensure appropriate treatment.
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References
Seed Global Health (2019) South-South collaboration: transforming pathology training and practice in Uganda. Seed Global Health. https://seedglobalhealth.org/2019/04/22/transforming-pathology-training-and-practice-in-uganda/#:~:text=Uganda%20has%20less%20than%2030. Accessed 22 Apr 2019
Farmer P, Frenk J, Knaul FM, Shulman LN, Alleyne G, Armstrong L, Atun R, Blayney D, Chen L, Feachem R, Gospodarowicz M, Gralow J, Gupta S, Langer A, Lob-Levyt J, Neal C, Mbewu A, Mired D, Piot P, Reddy KS (2010) Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet 376(9747):1186–1193. https://doi.org/10.1016/s0140-6736(10)61152-x
Montgomery ND, Tomoka T, Krysiak R, Powers E, Mulenga M, Kampani C, Chimzimu F, Owino MK, Dhungel BM, Gopal S, Fedoriw Y (2018) Practical successes in telepathology experiences in Africa. Clin Lab Med 38(1):141–150
Stefan DC, Siemonsma F (2010) Delay and causes of delay in the diagnosis of childhood cancer in Africa. Pediatr Blood Cancer 56(1):80–85. https://doi.org/10.1002/pbc.22714
Ogwang MD, Zhao W, Ayers LW, Mbulaiteye SM (2011) Accuracy of Burkitt lymphoma diagnosis in constrained pathology settings: importance to epidemiology. Arch Pathol Lab Med 135(4):445–450. https://doi.org/10.1043/2009-0443-EP.1
Rahman M, Rahman M, Matsuyama R, Tsunematsu M, Islam R, Ahmed A, Banu B, Hossain S, Rahman Sarker M, Monjur F, Roshid M, Islam M, Kakehashi M (2022) Feasibility and acceptability of telepathology system among the rural communities of Bangladesh: a pilot study. J Fam Med Primary Care 11(6):2613. https://doi.org/10.4103/jfmpc.jfmpc_1876_21
Gimbel DC, Sohani AR, Prasad Busarla SV, Kirimi JM, Sayed S, Okiro P, Nazarian RM (2012) A static-image telepathology system for dermatopathology consultation in East Africa: the Massachusetts General Hospital Experience. J Am Acad Dermatol 67(5):997–1007. https://doi.org/10.1016/j.jaad.2011.12.036
Wamala D, Katamba A, Dworak O (2011) Feasibility and diagnostic accuracy of Internet-based dynamic telepathology between Uganda and Germany. J Telemed Telecare 17(5):222–225. https://doi.org/10.1258/jtt.2010.100609
He X, Wang L, Wang L, Gao J, Cui F, Ma Q, Zhang W, Wang L, Zhai Y, Zhao J (2021) Effectiveness of a cloud-based telepathology system in China: large-sample observational study. J Med Internet Res 23(7):23799. https://doi.org/10.2196/23799
Niyonzima N, Wannume H, Kadhumbula S, Wasswa H, Osinde G, Mulumba Y, Tusabe T, Kalungi S, Orem J (2020) Strengthening Laboratory Diagnostic Capacity to Support Cancer Care in Uganda. Am J Clin Pathol 156(2):205–213. https://doi.org/10.1093/ajcp/aqaa218
Scheel JR, Giglou MJ, Segel S, Orem J, Tsu V, Galukande M, Okello J, Nakigudde G, Mugisha N, Muyinda Z, Anderson BO, Duggan C (2020) Breast cancer early detection and diagnostic capacity in Uganda. Cancer 126(S10):2469–2480. https://doi.org/10.1002/cncr.32890
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Krsna Kothari, Dr. Joseph Okello Damoi, Dr. Nebras Zeizafoun, Penninah Asiimwe, Katie Glerum, Dr. Moses Bakaleke, Dr. Angelica Giibwa, Dr. Melissa Umphlett, Dr. Micheal Marin, and Dr. Linda Zhang have no conflicts of interests or financial ties to disclose.
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Kothari, K., Damoi, J.O., Zeizafoun, N. et al. Increasing access to pathology services in low- and middle-income countries through innovative use of telepathology. Surg Endosc 37, 7206–7211 (2023). https://doi.org/10.1007/s00464-023-10220-9
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DOI: https://doi.org/10.1007/s00464-023-10220-9