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

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


Journalplos one
Article typeJournal research article – Clinical research
Publication date – May – 2022
Authors – Alex Mremil, Nina Karnøe Bentzer, Bariki Mchome, Joseph Mlay, Jan Blaakær, Vibeke Rasch, Doris Schledermann
Keywordsmalignant cervical lesions, pathology services, Tanzania, telepathology
Open access – Yes
SpecialityObstetrics and Gynaecology, Surgical oncology
World region Eastern Africa
Country: Tanzania
Language – English
Submitted to the One Surgery Index on May 15, 2022 at 2:22 am
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.

OSI Number – 21597

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