Accurate Real-Time Diagnosis of Lymphoproliferative Disorders in Malawi Through Clinicopathologic Teleconferences:  A Model for Pathology Services in Sub-Saharan Africa.
OBJECTIVE
The incidence of lymphoproliferative disorders (LPDs) is increasing in sub-Saharan Africa (SSA) due to population growth, aging, and human immunodeficiency virus (HIV). Despite significant burden, resources for diagnosis and treatment of LPDs are limited, with little infrastructure to deliver modern pathology services. Diagnostic and therapeutic decisions are therefore frequently made without tissue confirmation, leading to high rates of misdiagnosis and inappropriate treatment.


METHODS
We have established a laboratory in Malawi to support clinical and research efforts at a national teaching hospital. Consensus real-time diagnoses are rendered by local pathologists after weekly clinicopathologic teleconferences involving clinicians and pathologists from the United States and Malawi. Additional ancillary studies are then performed in the United States prior to final diagnosis.


RESULTS
We report our first 2 years' experience and demonstrate high concordance between real-time diagnoses in Malawi and final diagnoses in the United States (5% major discordance rate for formalin-fixed, paraffin-embedded samples). In addition, we describe characteristics of pathologically confirmed LPDs in Malawi, highlighting differences by HIV status.


CONCLUSIONS
Our multidisciplinary approach can be a model for strong pathology services that provide direct, real-time support to clinical care and research in SSA.
From the Department of Pathology and Laboratory Medicine, Division of Hematopathology.
Nathan D
ND
Montgomery
UNC Project-Malawi, Lilongwe, Malawi.
N George
NG
Liomba
UNC Project-Malawi, Lilongwe, Malawi.
Coxcilly
C
Kampani
UNC Project-Malawi, Lilongwe, Malawi.
Robert
R
Krysiak
UNC Project-Malawi, Lilongwe, Malawi.
Christopher C
CC
Stanley
University of Malawi College of Medicine, Blantyre, Malawi.
Tamiwe
T
Tomoka
University of Malawi College of Medicine, Blantyre, Malawi.
Steve
S
Kamiza
UNC Project-Malawi, Lilongwe, Malawi.
Bal M
BM
Dhungel
Program in Global Oncology, Lineberger Comprehensive Cancer Center, and UNC Project-Malawi, Lilongwe, Malawi.
Satish
S
Gopal
From the Department of Pathology and Laboratory Medicine, Division of Hematopathology Program in Global Oncology, Lineberger Comprehensive Cancer Center, and Yuri.Fedoriw@unchealth.unc.edu.
Yuri
Y
Fedoriw
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000473:pathology; D008295:Malawi; D008297:Male; D008875:Middle Aged; D019113:Telepathology
Lymphoproliferative disorders; Resource-limited setting; Sub-Saharan Africa; Telepathology