Developing Digitally

I’d like to share a story from my personal experience that highlights the benefits of telepathology by illustrating how its absence negatively impacted a patient’s care.

A while ago, a case reached us from a remote area four days after the surgical removal of an axillary mass from a 13-year-old boy. By the time we received the sample, it was improperly fixed. We changed the formalin immediately and then processed it – but, when we got the slides, it came out as partly autolyzed Hodgkin lymphoma. We had to provide a guarded opinion, so we advised marker studies (even though marker studies will not usually give adequate results in an inadequately fixed specimen). It’s well known that Hodgkin lymphoma, if diagnosed in a timely manner, is associated with excellent outcomes, because it is a highly radiosensitive tumor. Now imagine the frustration of the patient, the clinician, and the pathologist – all caused by issues that could be easily addressed with digital pathology!

These issues are still common in developing parts of the world due to the scarcity of pathologists and labs in rural areas, which often house the majority of the population. Delayed diagnosis is associated with increased patient morbidity and mortality. My key message? This story is not a one-off. Pathologists working in developing regions have many such tales – but, the more we can increase access to digital pathology, the less often we may hear them in future.