The importance of accurate diagnosis for conservation of resources
1 / 23

The Importance of Accurate Diagnosis for Conservation of Resources - PowerPoint PPT Presentation

  • Uploaded on
  • Presentation posted in: General

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.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.

Download Presentation

The Importance of Accurate Diagnosis for Conservation of Resources

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript

TheImportance of Accurate Diagnosis forConservation of Resources


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


  • 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, 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


  • 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.


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?


Pathologists and hematologists do notnecessarilyspeakthesamelanguage

Pathologist: severeMDS

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

Correctinterpretation of pathologyreports of trialcasesstraightforwardcases


Small blueroundcelltumor

Clearcutdiagnosis, no needforfurtherdiscussion

Clinico-pathologicaldialogueisnecessaryfordecisionmaking in equivocalcases

Inflammatorycells, no evidence of Burkitt‘s

Fewcells suggestive of Burkitt‘s


  • 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

  • Login