Telepathology and second opinion for cancer diagnosis in sub-Saharan French-speaking countries

Abstract

Many healthcare disparities can be described to explain cancer prevalence differences between developed and developing countries. Telepathology, telemedicine declination consisting in the transmission of digital images from a classical optical microscope combined with a digital camera linked to a computer, could offer a healthcare solution by enabling efficient communication between physicians and reinforcing multidisciplinary approaches. This study evaluated a pilot telepathology project using the ‘i-Path' platform in Sub-Saharan French-speaking countries. This is a descriptive retrospective study. This study was made in two steps: (1) quantitative description of the platform's use by the pathologists group and (2) qualitative evaluation of the users' perception of the pilot project. From October 2009 to March 2018, 226 cases were submitted; 86·3% of them (n = 195) were analyzable. More than 30 experts in surgical pathology of 12 different countries were involved in the network. The average turnaround-time was less than one day. The main highlighted obstacles were the lack of time to submit cases and internet connection problems. Discussions on i-Path lead to a useful second opinion for 67·7% (n = 132) of the cases. The major part of second opinion was in favor of lymphoma (32·6%). Regarding children, lymphoma represent half of the second opinion (50·7%). The inter-observers agreement between first interpretation and second opinion was $κ$ = 0·36, and $κ$ = 0·58 after excluding non-diagnosed cases at submission. Even if some improvements can be made, we concluded that the project was satisfying and workable and it could be extended to other applications. Key messages Dialogue between expert in multiple LMIC is feasible with telepathology network and, as 1st diagnosis assessment is not always sure, telepathology help for 2nd opinion. Centers' use of the telepathology system are different but the discussion between experts still provide a 2nd opinion in favor of a precise diagnosis.