Accurate Real-Time Diagnosis of Lymphoproliferative Disorders in Malawi Through Clinicopathologic Teleconferences

Abstract

Our multidisciplinary approach can be a model for strong pathology services that provide direct, real-time support to clinical care and research in SSA.

Quantifying bias in survival estimates resulting from loss to follow‐up among children with lymphoma in Malawi

“…Of these, 100 (83%) had Burkitt lymphoma (BL) and 21 (27%) Hodgkin lymphoma (HL), the two commonest pediatric lymphoma subtypes in SSA. However, we acknowledge that less frequent non‐Hodgkin lymphoma subtypes might be diagnosed locally as BL given limited immunohistochemistry and absent molecular diagnostic tools, despite major efforts by our group to improve diagnostic pathology in Lilongwe . Baseline characteristics are shown in Table .…”

“…However, we acknowledge that less frequent non-Hodgkin lymphoma subtypes might be diagnosed locally as BL given limited immunohistochemistry and absent molecular diagnostic tools, despite major efforts by our group to improve diagnostic pathology in Lilongwe. 12,13 Baseline characteristics are shown in There are various approaches to address bias from LTFU in resource-limited settings, where retaining patients in longitudinal studies is difficult. One approach is to exclude LTFU cases from survival analyses, but this may increase bias if LTFU is not independent of the risk of death.…”

Plasma Epstein-Barr virus DNA for pediatric Burkitt lymphoma diagnosis, prognosis and response assessment in Malawi

“…All enrolled cases were confirmed using a novel weekly telepathology consultative platform involving 2–4 pathologists in Malawi and the United States who rendered a consensus opinion, after review of cytology slides or hematoxylin and eosin stained tissue sections. This model has been described in detail previously and demonstrated excellent concordance with subsequent United States review . Manual IHC for biopsy specimens or centrifuged cell blocks was performed locally, including CD3, CD20, CD30, CD45, CD138, Ki‐67, BCL2, and terminal deoxynucleotidyl transferase (TDT).…”

“…This model has been described in detail previously and demonstrated excellent concordance with subsequent United States review. [23][24][25] Manual IHC for biopsy specimens or centrifuged cell blocks was performed locally, including CD3, CD20, CD30, CD45, CD138, Ki-67, BCL2, and terminal deoxynucleotidyl transferase (TDT). Other stains including synaptophysin and AE1/AE3 were used to distinguish lymphomas from neuroendocrine or epithelial tumors respectively when morphology was uncertain.…”

Targetable subsets of non-Hodgkin lymphoma in Malawi define therapeutic opportunities

“…6 The Department of Histopathology at the University of Malawi College of Medicine (UOMCOM) in Blantyre, Malawi processes ;3000 specimens per year, and pathologic diagnoses are based solely on interpretation of hematoxylin and eosin (H&E)-stained sections. 8,9 Most cases diagnosed as lymphoma at UOMCOM are categorized as Burkitt lymphoma (BL) or non-BL NHL. The majority of treated persons in SSA with non-BL NHL receive CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy.…”