The importance of accurate diagnosis for conservation of resources
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The Importance of Accurate Diagnosis for Conservation of Resources . N.Hurwitz Department of Pathology University of Basel and International Network for Cancer Treatment and Research (INCTR). Definition.

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The Importance of Accurate Diagnosis for Conservation of Resources

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TheImportance of Accurate Diagnosis forConservation of Resources

N.Hurwitz

Department of Pathology University of Basel and International NetworkforCancer Treatment and Research (INCTR)


Definition

  • Accuratediagnosis in lowresourcesettings:diagnosticaccuracyadapted to locallyavailabletherapeuticoptions

  • Auxillarydiagnosticmethodsshouldbeonlyappliediftheirresultsare relevant fortherapeuticconsiderations

  • Example: leukemiaimmuno-phenotyping ?cytogenetics in hematologicmalignancies ?Prognosticmarkers ?


Hightech histology lab Department of Pathology University of Basel compared to simple manualhistology lab, Department of PathologyKenyatta University Hospital


High qualityhistology in bothlabs. (potential to save resources)


Waste of resources, in supportforlowresourcecountriescausedby lack of communicationExample: evaluation of BMA forHoniara

BMA,correctprocedure

BMA, dilutedwithblood


Costly lack of communication, notonly in lowresourcecountries

Switzerland: Consultationcase:

  • 70 y/m lymphocytosis, massive splenomegaly

  • Spleen and bonemarrow: infiltratebysmalllymphoidcells, in bonemarrowintrasinusoidal.

  • IHC: CD20+, CD 79a + , CD3-Flowcytometry: in addition CD 103+

    DD splenic marginal zonelymphoma / HCL


Price for immunohistochemistry:1000$ still no diagnosis


CD103 maybecome non specificallypositveafterprolongedstorage

A phonecall to thehematologistsolvedtheproblem


Consultation on ipath,J.Githang’a, E.Walong Dpt. of Pathology Kenyatta Hospital, Nairobi)3 year old girl referred to the Ophthalmology Unit:

Left sided proptosis - 10 days

Hotness of body

Joint pains

Sore throat

Anemia, Thrombocytopenia.

Interdisciplinarycommunication, a cheaptool to improvediagnosis


Dg. on biopsy of orbital mass: neoplasia, mostprobablymalignant


BoneMarrowAspirate

  • Diagnosis: AL, probably AML


WorkinghypothesisafterInterdisciplinary online discussion

AL, AML mostprobablywithextramedullaryleukemicinfiltrate in orbital soft tissues


Diagnosis after IHC performed at private laboratory in Nairobi

  • Resultsimmunohistochemistry:LCA: positive  CD 3: positive  CD 20: negative  TdT: positive  KI-67: 100%  Diagnosticveridict:Precursor T cellLymphoma/Leukemia


Final Diagnosis after IHC work-up at the Department of Pathology, University of Basel (Dr.Tzankov)

  • Immunophenotype of tumorcells:

    CD45+, CD43+, CD34+, CD3dim+, TdT+/- (25%), PAX-5+/-, MPO dim+/-, focally; all other T- and B-cellmarkers negative.

    Diagnosis:AcuteLeukemiaBiphenotypic


Interpretation of isolatedresults of specialinvestigationscanlead to severediagnosticerrors


Pathologists and hematologists at theKenyatta Hospital:Conclusion:

wehave to improveourcommunication


Results from a Survey made in Italy on collaboration Hematology-Pathology

Are the clinico-pathological meetings useful?


Have you set up clinico-pathological meetings for the evaluation of bone marrow diseases in your unit?


Communicationisonlypossibleifpeopleunderstandeachother‘slanguage


Pathologists and hematologists do notnecessarilyspeakthesamelanguage

Pathologist: severeMDS

Hematologist: I haveneverheardthis term.I want to knowifthereblasts, ifyes, howmany (RAEB II)


Correctinterpretation of pathologyreports of trialcasesstraightforwardcases

Burkitt‘slymphoma

Small blueroundcelltumor

Clearcutdiagnosis, no needforfurtherdiscussion


Clinico-pathologicaldialogueisnecessaryfordecisionmaking in equivocalcases

Inflammatorycells, no evidence of Burkitt‘s

Fewcells suggestive of Burkitt‘s


Conclusions

  • Most importantfactors to improvediagnositcaccuracy and reduction of costs

    • Proper tissuetissueprocessing

    • Regularclinico-pathologiccommunication (substituteforspecialinvestigations)

  • Reliableregularcommnication (responding to e-mails) has to beconsidered in theplanning of projectsbased on online communication (ipath).

  • Online communication as a tool to increasethe of localprofessionallevel

  • Successfullprojects such as St Jude‘soutreachproram, reportregular online communicationweekly, daily(RibhiHazin, Ibrahim Qaddoumi, Teleoncology: current and futureapplicationsforimprovingcancercareglobally, LancetOncol 2010; 11: 20


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