September 2016 – Results of a two-year collaboration between Kamuzu Central Hospital and the University of North Carolina to establish a pathology laboratory in Lilongwe, Malawi, showing high concordance between real-time diagnoses in Malawi and final diagnoses in the US.
Accurate Real-Time Diagnosis of Lymphoproliferative Disorders in Malawi Through Clinicopathologic Teleconferences: A Model for Pathology Services in Sub-Saharan Africa.
Nathan D. Montgomery, N. George Liomba, Coxcilly Kampani, Robert Krysiak, Christopher C. Stanley, Tamiwe Tomoka, Steve Kamiza, Bal M. Dhungel, Satish Gopal, Yuri Fedoriw
Am J Clin Pathol October 2016;146:423-430
Objectives: The incidence of lymphoproliférative 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 ofLPDs 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 ofmisdiagnosis 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 ourfirst 2years’ experience and demonstrate high concordance between real-time diagnoses in Malawi andfinal diagnoses in the United States (5% major discordance rate forformalin-fixed, paraffin-embedded samples). In addition, we describe characteristics ofpathologically 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.