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Mpunga T, Hedt-Gauthier BL, Tapela N, Nshimiyimana I, Muvugabigwi G, Pritchett N, Greenberg L, Benewe O, Shulman DS, Pepoon JR, Shulman LN, Milner DA. Implementation and Validation of Telepathology Triage at Cancer Referral Center in Rural Rwanda. J Glob Oncol 2016; 2:76-82. [PMID: 28717686 PMCID: PMC5495446 DOI: 10.1200/jgo.2015.002162] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Connecting a cancer patient to the appropriate treatment requires the correct diagnosis provided in a timely manner. In resource-limited settings, the anatomic pathology bridge to efficient, accurate, and timely cancer care is often challenging. In this study, we present the first phase of an anatomic telepathology triage system, which was implemented and validated at the Butaro District Hospital in northern rural Rwanda. Methods Select cases over a 9-month period in three segments were evaluated by static image telepathology and were independently evaluated by standard glass slide histology. Each case via telepathology was classified as malignant, benign, infectious/inflammatory, or nondiagnostic and was given an exact histologic diagnosis. Results For cases triaged as appropriate for telepathology, correlation with classification and exact diagnosis demonstrated greater than 95% agreement over the study. Cases in which there was disagreement were analyzed for cause, and the triage process was adjusted to avoid future problems. Conclusion Challenges to obtaining a correct and complete diagnosis with telepathology alone included the need for immunohistochemistry, assessment of the quality of images, and the lack of images representing an entire sample. The next phase of the system will assess the effect of telepathology triage on turnaround time and the value of on-site immunohistochemistry in reducing that metric and the need for evaluation outside of telepathology.
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Affiliation(s)
- Tharcisse Mpunga
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Bethany L Hedt-Gauthier
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Neo Tapela
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Irenee Nshimiyimana
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Gaspard Muvugabigwi
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Natalie Pritchett
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lauren Greenberg
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Origene Benewe
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - David S Shulman
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - James R Pepoon
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lawrence N Shulman
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Danny A Milner
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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Pantanowitz L, Sinard JH, Henricks WH, Fatheree LA, Carter AB, Contis L, Beckwith BA, Evans AJ, Lal A, Parwani AV. Validating whole slide imaging for diagnostic purposes in pathology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med 2013; 137:1710-22. [PMID: 23634907 PMCID: PMC7240346 DOI: 10.5858/arpa.2013-0093-cp] [Citation(s) in RCA: 397] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT There is increasing interest in using whole slide imaging (WSI) for diagnostic purposes (primary and/or consultation). An important consideration is whether WSI can safely replace conventional light microscopy as the method by which pathologists review histologic sections, cytology slides, and/or hematology slides to render diagnoses. Validation of WSI is crucial to ensure that diagnostic performance based on digitized slides is at least equivalent to that of glass slides and light microscopy. Currently, there are no standard guidelines regarding validation of WSI for diagnostic use. OBJECTIVE To recommend validation requirements for WSI systems to be used for diagnostic purposes. DESIGN The College of American Pathologists Pathology and Laboratory Quality Center convened a nonvendor panel from North America with expertise in digital pathology to develop these validation recommendations. A literature review was performed in which 767 international publications that met search term requirements were identified. Studies outside the scope of this effort and those related solely to technical elements, education, and image analysis were excluded. A total of 27 publications were graded and underwent data extraction for evidence evaluation. Recommendations were derived from the strength of evidence determined from 23 of these published studies, open comment feedback, and expert panel consensus. RESULTS Twelve guideline statements were established to help pathology laboratories validate their own WSI systems intended for clinical use. Validation of the entire WSI system, involving pathologists trained to use the system, should be performed in a manner that emulates the laboratory's actual clinical environment. It is recommended that such a validation study include at least 60 routine cases per application, comparing intraobserver diagnostic concordance between digitized and glass slides viewed at least 2 weeks apart. It is important that the validation process confirm that all material present on a glass slide to be scanned is included in the digital image. CONCLUSIONS Validation should demonstrate that the WSI system under review produces acceptable digital slides for diagnostic interpretation. The intention of validating WSI systems is to permit the clinical use of this technology in a manner that does not compromise patient care.
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Affiliation(s)
- Liron Pantanowitz
- From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Pantanowitz, Contis, and Parwani); the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Dr Sinard); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Dr Henricks); the College of American Pathologists, Northfield, Illinois (Ms Fatheree); the Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (Dr Carter); the Department of Pathology, North Shore Medical Center, Salem, Massachusetts (Dr Beckwith); the Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada (Dr Evans); the Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts (Dr Otis); and University Hospital, London Health Science Center, London, Ontario, Canada (Dr Lal)
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