Improving the histopathologic diagnosis of pediatric malignancies in a low-resource setting by combining focused training and telepathology strategies.
BACKGROUND
Accurate diagnosis is critical for optimal management of pediatric cancer. Pathologists with experience in pediatric oncology are in short supply in the developing world. Telepathology is increasingly used for consultations but its overall contribution to diagnostic accuracy is unknown.


METHODS
We developed a strategy to provide a focused training in pediatric cancer and telepathology support to pathologists in the developing world. After the training period, we compared trainee's diagnoses with those of an experienced pathologist. We next compared the effectiveness of static versus dynamic telepathology review in 127 cases. Results were compared by Fisher's exact test.


RESULTS
The diagnoses of the trainee and the expert pathologist differed in only 6.5% of cases (95% CI, 1.2-20.0%). The overall concordance between the telepathology and original diagnoses was 90.6% (115/127; 95% CI, 84.1-94.6%).


CONCLUSIONS
Brief, focused training in pediatric cancer histopathology can improve diagnostic accuracy. Dynamic and static telepathology analyses are equally effective for diagnostic review.
Department of Pathology, Instituto Materno-Infantil de Pernambuco, Recife, Pernambuco, Brazil.
Teresa C
TC
Santiago
Jesse J
JJ
Jenkins
Francisco
F
Pedrosa
Catherine
C
Billups
Yuri
Y
Quintana
Raul C
RC
Ribeiro
Ibrahim
I
Qaddoumi
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004493:Education; D005260:Female; D006295:Health Resources; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000175:diagnosis*; D011361:Professional Competence; D012017:Referral and Consultation; D019113:Telepathology; D055815:Young Adult