The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania

Abstract

Introduction Adequate and timely access to pathology services is a key to scale up cancer control, however, there is an extremely shortage of pathologists in Tanzania. Telepathology (scanned images microscopy) has the potential to increase access to pathology services and it is increasingly being employed for primary diagnosis and consultation services. However, the experience with the use of telepathology in Tanzania is limited. We aimed to investigate the feasibility of using scanned images for primary diagnosis of pre-malignant and malignant cervical lesions by assessing its equivalency to conventional (glass slide) microscopy in Tanzania. Methods In this laboratory-based study, assessment of hematoxylin and eosin stained glass slides of 175 cervical biopsies were initially performed conventionally by three pathologists independently. The slides were scanned at x 40 and one to three months later, the scanned images were reviewed by the pathologists in blinded fashion. The agreement between initial and review diagnoses across participating pathologists was described and measured using Cohen’s kappa coefficient (κ). Results The overall concordance of diagnoses established on conventional microscopy compared to scanned images across three pathologists was 87.7%; κ = 0.54; CI (0.49–0.57).The overall agreement of diagnoses established by local pathologist on conventional microscopy compared to scanned images was 87.4%; κ = 0.73; CI (0.65–0.79). The concordance of diagnoses established by senior pathologist compared to local pathologist on conventional microscopy and scanned images was 96% and 97.7% respectively. The inter-observer agreement (κ) value were 0.93, CI (0.87–1.00) and 0.94, CI (0.88–1.00) for conventional microscopy and scanned images respectively. Conclusions All κ coefficients expressed good intra- and inter-observer agreement, suggesting that telepathology is sufficiently accurate for primary diagnosis in surgical pathology. The discrepancies in interpretation of pre-malignant lesions highlights the importance of p16 immunohistochemistry in definitive diagnosis in these lesions. Sustainability factors including hardware and internet connectivity are essential components to be considered before telepathology may be deemed suitable for widely use in Tanzania.

Digital pathology world tour

“…Tanzania, Cameroon, Pakistan) where there is a critical shortage of pathology services necessary for clinical care. 16 – 21 Clinical applications addressed not only the benefit of digitizing slides in general surgical pathology, but also niche areas of practice such as telepathology for seeking second opinions (teleconsultation) in organ transplantation. 22 , 23 The critical need to provide remote care and education virtually in pathology during the COVID-19 pandemic acted as a catalyst for the adoption of DP around the world.…”

Histopathological evaluation of Onchocerca volvulus nodules by microscopy and by digital image analysis for the study of macrofilaricidal drug efficacy

“…A recent meta-analysis of 25 studies concluded equivalent performance of digital pathology in comparison with light microscopy for routine diagnosis of medical conditions ( 33 ). Digital image analysis is especially important in Africa and other areas of the world where well-trained pathologists are scarce ( 34 , 35 ). Slide scanners are more and more available in core facilities also in Africa, have similar energy requirements as microscopes, and scanning can be performed by any laboratory technician after a short training session.…”

Diagnostic validation of a portable whole slide imaging scanner for lymphoma diagnosis in resource-constrained setting: A cross-sectional study

“…These artifacts may occur during surgical removal, fixation, tissue processing, embedding and microtomy, staining, and mounting. 24 , 25 , 26 Therefore, training in the best practice of tissue processing and quality control is critical for successfully adopting and implementing digital pathology.…”