Re-evaluation of challenging telepathological diagnoses in support of a hospital in Tanzania

The State of Telepathology in Africa in the Age of Digital Pathology Advancements: A Bibliometric Analysis and Literature Review

Telepathology emerges as a vital tool, offering significant promise for enhancing pathology services in Africa, a region historically challenged by healthcare access and resource limitations. This review explores the development, adoption, and impacts of telepathology in Africa through a comprehensive bibliometric analysis and literature review. A methodical search in PubMed for publications up to 2024 revealed 119 pertinent studies, out of which 47 met the inclusion criteria for a focused review on telepathology's role in African healthcare settings. This research has charted a clear trajectory of growing interest in telepathology, as evidenced by the annual increase in related publications and robust international collaboration. It underscores the expanding utility of telepathology in diagnostics, education, and research within Africa, particularly in domains like dermatopathology, neuropathology, and, notably, oncology. The integration of artificial intelligence into telepathology presents new frontiers for enhancing diagnostic accuracy and efficiency. However, the review also identifies persistent challenges such as infrastructural inadequacies, a shortage of skilled professionals, and regulatory hurdles. The study highlights the indispensable role of international partnerships in advancing telepathology in the region. This review proposes a strategic pivot toward "leapfrogging," an approach that allows Africa to skip traditional developmental hurdles by directly adopting cutting-edge technologies and practices.

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

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.