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J Glob Oncol. 2018 Sep;(4):1-6. doi: 10.1200/JGO.17.00081. Epub 2017 Nov 16.

Decreasing Histology Turnaround Time Through Stepwise Innovation and Capacity Building in Rwanda.

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Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.



Minimal turnaround time for pathology results is crucial for highest-quality patient care in all settings, especially in low- and middle-income countries, where rural populations may have limited access to health care.


We retrospectively determined the turnaround times (TATs) for anatomic pathology specimens, comparing three different modes of operation that occurred throughout the development and implementation of our pathology laboratory at the Butaro Cancer Center of Excellence in Rwanda. Before opening this laboratory, TAT was measured in months because of inconsistent laboratory operations and a paucity of in-country pathologists.


We analyzed 2,514 individual patient samples across the three modes of study. Diagnostic mode 1 (samples sent out of the country for analysis) had the highest median TAT, with an overall time of 30 days (interquartile range [IQR], 22 to 43 days). For diagnostic mode 2 (static image telepathology), the median TAT was 14 days (IQR, 7 to 27 days), and for diagnostic mode 3 (onsite expert diagnosis), it was 5 days (IQR, 2 to 9 days).


Our results demonstrate that telepathology is a significant improvement over external expert review and can greatly assist sites in improving their TATs until pathologists are on site.

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