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Am J Clin Pathol. 2016 Oct;146(4):423-30. doi: 10.1093/ajcp/aqw118. Epub 2016 Sep 4.

Accurate Real-Time Diagnosis of Lymphoproliferative Disorders in Malawi Through Clinicopathologic Teleconferences:  A Model for Pathology Services in Sub-Saharan Africa.

Author information

1
From the Department of Pathology and Laboratory Medicine, Division of Hematopathology.
2
UNC Project-Malawi, Lilongwe, Malawi.
3
University of Malawi College of Medicine, Blantyre, Malawi.
4
Program in Global Oncology, Lineberger Comprehensive Cancer Center, and UNC Project-Malawi, Lilongwe, Malawi.
5
From the Department of Pathology and Laboratory Medicine, Division of Hematopathology Program in Global Oncology, Lineberger Comprehensive Cancer Center, and Yuri.Fedoriw@unchealth.unc.edu.

Abstract

OBJECTIVES:

The incidence of lymphoproliferative disorders (LPDs) is increasing in sub-Saharan Africa (SSA) due to population growth, aging, and human immunodeficiency virus (HIV). Despite significant burden, resources for diagnosis and treatment of LPDs are limited, with little infrastructure to deliver modern pathology services. Diagnostic and therapeutic decisions are therefore frequently made without tissue confirmation, leading to high rates of misdiagnosis and inappropriate treatment.

METHODS:

We have established a laboratory in Malawi to support clinical and research efforts at a national teaching hospital. Consensus real-time diagnoses are rendered by local pathologists after weekly clinicopathologic teleconferences involving clinicians and pathologists from the United States and Malawi. Additional ancillary studies are then performed in the United States prior to final diagnosis.

RESULTS:

We report our first 2 years' experience and demonstrate high concordance between real-time diagnoses in Malawi and final diagnoses in the United States (5% major discordance rate for formalin-fixed, paraffin-embedded samples). In addition, we describe characteristics of pathologically confirmed LPDs in Malawi, highlighting differences by HIV status.

CONCLUSIONS:

Our multidisciplinary approach can be a model for strong pathology services that provide direct, real-time support to clinical care and research in SSA.

KEYWORDS:

Lymphoproliferative disorders; Resource-limited setting; Sub-Saharan Africa; Telepathology

PMID:
27594430
PMCID:
PMC5040876
DOI:
10.1093/ajcp/aqw118
[Indexed for MEDLINE]
Free PMC Article

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