Skip to main content
Top
Published in:

26-06-2023 | Pathology | 2023 SAGES Oral

Increasing access to pathology services in low- and middle-income countries through innovative use of telepathology

Authors: Krsna Kothari, Joseph Okello Damoi, Nebras Zeizafoun, Penninah Asiimwe, Katie Glerum, Moses Bakaleke, Angelica Giibwa, Melissa Umphlett, Michael Marin, Linda P. Zhang

Published in: Surgical Endoscopy | Issue 9/2023

Login to get access

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 Jinja, 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.
Literature
2.
go back to reference 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-xCrossRefPubMed 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-xCrossRefPubMed
3.
go back to reference 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):141–150CrossRefPubMed 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):141–150CrossRefPubMed
6.
go back to reference 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_21CrossRef 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_​21CrossRef
Metadata
Title
Increasing access to pathology services in low- and middle-income countries through innovative use of telepathology
Authors
Krsna Kothari
Joseph Okello Damoi
Nebras Zeizafoun
Penninah Asiimwe
Katie Glerum
Moses Bakaleke
Angelica Giibwa
Melissa Umphlett
Michael Marin
Linda P. Zhang
Publication date
26-06-2023
Publisher
Springer US
Keyword
Pathology
Published in
Surgical Endoscopy / Issue 9/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-023-10220-9

Other articles of this Issue 9/2023

Surgical Endoscopy 9/2023 Go to the issue
SPONSORED

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

  • Webinar | 06-02-2024 | 20:00 (CET)

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by:
  • Viatris
Developed by: Springer Healthcare
Watch now