The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania.
<h4>Introduction</h4>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 i...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0266649 |
| _version_ | 1811296439917084672 |
|---|---|
| author | Alex Mremi Nina Karnøe Bentzer Bariki Mchome Joseph Mlay Jan Blaakær Vibeke Rasch Doris Schledermann |
| author_facet | Alex Mremi Nina Karnøe Bentzer Bariki Mchome Joseph Mlay Jan Blaakær Vibeke Rasch Doris Schledermann |
| author_sort | Alex Mremi |
| collection | DOAJ |
| description | <h4>Introduction</h4>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.<h4>Methods</h4>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).<h4>Results</h4>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.<h4>Conclusions</h4>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. |
| first_indexed | 2024-04-13T05:49:32Z |
| format | Article |
| id | doaj.art-7353c92bae6246c7ad8429ba133cdd8d |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-13T05:49:32Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-7353c92bae6246c7ad8429ba133cdd8d2022-12-22T02:59:51ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01174e026664910.1371/journal.pone.0266649The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania.Alex MremiNina Karnøe BentzerBariki MchomeJoseph MlayJan BlaakærVibeke RaschDoris Schledermann<h4>Introduction</h4>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.<h4>Methods</h4>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).<h4>Results</h4>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.<h4>Conclusions</h4>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.https://doi.org/10.1371/journal.pone.0266649 |
| spellingShingle | Alex Mremi Nina Karnøe Bentzer Bariki Mchome Joseph Mlay Jan Blaakær Vibeke Rasch Doris Schledermann The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania. PLoS ONE |
| title | The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania. |
| title_full | The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania. |
| title_fullStr | The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania. |
| title_full_unstemmed | The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania. |
| title_short | The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania. |
| title_sort | role of telepathology in diagnosis of pre malignant and malignant cervical lesions implementation at a tertiary hospital in northern tanzania |
| url | https://doi.org/10.1371/journal.pone.0266649 |
| work_keys_str_mv | AT alexmremi theroleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT ninakarnøebentzer theroleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT barikimchome theroleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT josephmlay theroleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT janblaakær theroleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT vibekerasch theroleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT dorisschledermann theroleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT alexmremi roleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT ninakarnøebentzer roleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT barikimchome roleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT josephmlay roleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT janblaakær roleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT vibekerasch roleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania AT dorisschledermann roleoftelepathologyindiagnosisofpremalignantandmalignantcervicallesionsimplementationatatertiaryhospitalinnortherntanzania |