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

TheImportance of Accurate Diagnosis forConservation of Resources

N.Hurwitz

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


Definition

Definition

  • Accuratediagnosis in lowresourcesettings:diagnosticaccuracyadapted to locallyavailabletherapeuticoptions

  • Auxillarydiagnosticmethodsshouldbeonlyappliediftheirresultsare relevant fortherapeuticconsiderations

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


The importance of accurate diagnosis for conservation of resources

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


High quality histology in both labs potential to save resources

High qualityhistology in bothlabs. (potential to save resources)


The importance of accurate diagnosis for conservation of resources

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

BMA,correctprocedure

BMA, dilutedwithblood


Costly lack of communication not only in low resource countries

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

Price for immunohistochemistry:1000$ still no diagnosis


A phone call to the hematologist solved the problem

CD103 maybecome non specificallypositveafterprolongedstorage

A phonecall to thehematologistsolvedtheproblem


Interdisciplinary communication a cheap tool to improve diagnosis

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 most probably malignant

Dg. on biopsy of orbital mass: neoplasia, mostprobablymalignant


Bone marrow aspirate

BoneMarrowAspirate

  • Diagnosis: AL, probably AML


Working hypothesis after interdisciplinary online discussion

WorkinghypothesisafterInterdisciplinary online discussion

AL, AML mostprobablywithextramedullaryleukemicinfiltrate in orbital soft tissues


Diagnosis after ihc performed at private laboratory in nairobi

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

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 isolated results of special investigations can lead to severe diagnostic errors

Interpretation of isolatedresults of specialinvestigationscanlead to severediagnosticerrors


The importance of accurate diagnosis for conservation of resources

Pathologists and hematologists at theKenyatta Hospital:Conclusion:

wehave to improveourcommunication


Results from a survey made in italy on collaboration hematology pathology

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

Are the clinico-pathological meetings useful?


The importance of accurate diagnosis for conservation of resources

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


Communication is only possible if people understand each other s language

Communicationisonlypossibleifpeopleunderstandeachother‘slanguage


Pathologists and hematologists do not necessarily speak the same language

Pathologists and hematologists do notnecessarilyspeakthesamelanguage

Pathologist: severeMDS

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


Correct interpretation of pathology reports of trial cases straight forward cases

Correctinterpretation of pathologyreports of trialcasesstraightforwardcases

Burkitt‘slymphoma

Small blueroundcelltumor

Clearcutdiagnosis, no needforfurtherdiscussion


Clinico pathological dialogue is necessary for decision making in equivocal cases

Clinico-pathologicaldialogueisnecessaryfordecisionmaking in equivocalcases

Inflammatorycells, no evidence of Burkitt‘s

Fewcells suggestive of Burkitt‘s


Conclusions

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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