1 / 23

The Importance of Accurate Diagnosis for Conservation of Resources

The Importance of Accurate Diagnosis for Conservation of Resources . N.Hurwitz Department of Pathology University of Basel and International Network for Cancer Treatment and Research (INCTR). Definition.

bishop
Download Presentation

The Importance of Accurate Diagnosis for Conservation of Resources

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. TheImportance of Accurate Diagnosis forConservation of Resources N.Hurwitz Department of Pathology University of Basel and International NetworkforCancer Treatment and Research (INCTR)

  2. Definition • Accuratediagnosis in lowresourcesettings:diagnosticaccuracyadapted to locallyavailabletherapeuticoptions • Auxillarydiagnosticmethodsshouldbeonlyappliediftheirresultsare relevant fortherapeuticconsiderations • Example: leukemiaimmuno-phenotyping ?cytogenetics in hematologicmalignancies ?Prognosticmarkers ?

  3. Hightech histology lab Department of Pathology University of Basel compared to simple manualhistology lab, Department of PathologyKenyatta University Hospital

  4. High qualityhistology in bothlabs. (potential to save resources)

  5. Waste of resources, in supportforlowresourcecountriescausedby lack of communicationExample: evaluation of BMA forHoniara BMA,correctprocedure BMA, dilutedwithblood

  6. Costly lack of communication, notonly in lowresourcecountries Switzerland: Consultationcase: • 70 y/m lymphocytosis, massive splenomegaly • Spleen and bonemarrow: infiltratebysmalllymphoidcells, in bonemarrowintrasinusoidal. • IHC: CD20+, CD 79a + , CD3-Flowcytometry: in addition CD 103+ DD splenic marginal zonelymphoma / HCL

  7. Price for immunohistochemistry:1000$ still no diagnosis

  8. CD103 maybecome non specificallypositveafterprolongedstorage A phonecall to thehematologistsolvedtheproblem

  9. Consultation on ipath,J.Githang’a, E.Walong Dpt. of Pathology Kenyatta Hospital, Nairobi)3 year old girl referred to the Ophthalmology Unit: Left sided proptosis - 10 days Hotness of body Joint pains Sore throat Anemia, Thrombocytopenia. Interdisciplinarycommunication, a cheaptool to improvediagnosis

  10. Dg. on biopsy of orbital mass: neoplasia, mostprobablymalignant

  11. BoneMarrowAspirate • Diagnosis: AL, probably AML

  12. WorkinghypothesisafterInterdisciplinary online discussion AL, AML mostprobablywithextramedullaryleukemicinfiltrate in orbital soft tissues

  13. Diagnosis after IHC performed at private laboratory in Nairobi • Resultsimmunohistochemistry:LCA: positive  CD 3: positive  CD 20: negative  TdT: positive  KI-67: 100%  Diagnosticveridict:Precursor T cellLymphoma/Leukemia

  14. Final Diagnosis after IHC work-up at the Department of Pathology, University of Basel (Dr.Tzankov) • Immunophenotype of tumorcells: CD45+, CD43+, CD34+, CD3dim+, TdT+/- (25%), PAX-5+/-, MPO dim+/-, focally; all other T- and B-cellmarkers negative. Diagnosis:AcuteLeukemiaBiphenotypic

  15. Interpretation of isolatedresults of specialinvestigationscanlead to severediagnosticerrors

  16. Pathologists and hematologists at theKenyatta Hospital:Conclusion: wehave to improveourcommunication

  17. Results from a Survey made in Italy on collaboration Hematology-Pathology Are the clinico-pathological meetings useful?

  18. Have you set up clinico-pathological meetings for the evaluation of bone marrow diseases in your unit?

  19. Communicationisonlypossibleifpeopleunderstandeachother‘slanguageCommunicationisonlypossibleifpeopleunderstandeachother‘slanguage

  20. Pathologists and hematologists do notnecessarilyspeakthesamelanguage Pathologist: severeMDS Hematologist: I haveneverheardthis term.I want to knowifthereblasts, ifyes, howmany (RAEB II)

  21. Correctinterpretation of pathologyreports of trialcasesstraightforwardcases Burkitt‘slymphoma Small blueroundcelltumor Clearcutdiagnosis, no needforfurtherdiscussion

  22. Clinico-pathologicaldialogueisnecessaryfordecisionmaking in equivocalcases Inflammatorycells, no evidence of Burkitt‘s Fewcells suggestive of Burkitt‘s

  23. Conclusions • Most importantfactors to improvediagnositcaccuracy and reduction of costs • Proper tissuetissueprocessing • Regularclinico-pathologiccommunication (substituteforspecialinvestigations) • Reliableregularcommnication (responding to e-mails) has to beconsidered in theplanning of projectsbased on online communication (ipath). • Online communication as a tool to increasethe of localprofessionallevel • Successfullprojects such as St Jude‘soutreachproram, reportregular online communicationweekly, daily(RibhiHazin, Ibrahim Qaddoumi, Teleoncology: current and futureapplicationsforimprovingcancercareglobally, LancetOncol 2010; 11: 20

More Related