Teleoncology: current evidence and new models Second opinion in Hematopathology The experience of Francophone Africa using telepathology

Track2 : Closing the gap : quality cancer treatment and diagnosis for all Session 106M-T2

Martine Raphaël

Disclose any conflits of interest

« We speak about the loneliness of a long distance runner, but there may be no one more lonelier than a surgical pathologist working solo ...

Easy access to consultation is a prerequisite for accurate diagnosis and accordingly for optimal patient care, clinical trials, epidemiology, biology, research and training Stephen Sternberg Surgical Pathology preface to the first ed. 1989

INCTR COMMUNITY ON IPATH : Support for Pathology and Hematology in low resource countries and remote places by providing a platform for second opinion by online consultations using telepathology

Second opinion in Hematopathology The experience of Francophone Africa using telepathology

2008, October Meeting in Paris, to identify locally available services and needs

2009, January AIP meeting, Kinshasa : Presentation of the interest of telepathology Visit of pathology laboratories: Kinshasa, Lubumbashi

2009 Equipment: Microscope, digital camera, computer

2010, November Agreement INCTR/AMCC/INCa, integrative part of the pathology program of INCTR

2014, January Convention CNHU-HKM Cotonou, Benin/AMCC

Telemedicine pilot, MAEE/CNES/Heathl Ministry Benin

Telepathology and second opinion in Hematopathology in Sub-Saharan African Francophone Countries (1)

October 2009 up to now 202 cases for second opinion

2012 – 2015 Research project, PhD thesis

University Cheikh Anta Diop, Dakar, Senegal

59 cases of Lymphoproliferative disorders Cytology, Flow cytometry, cytogenetics A total of 261 cases for second opinion

Telepathology and second opinion in Hematopathology in Sub-Saharan African Francophone Countries (2)

• iPath, software application developed at Basel University 10 years ago K Brauchli, M Oberholzer

• Open source, internet-based platform, simple and easy to handle • Case-based collaboration platform to share information within user groups in the domains of consultation, teaching and research • Maintenance and updated done by Basys Data GmbH , Basel • December 2016 : integrating Swinfen Charitable Trust, London • Coordination of the program supported by INCTR (N Hurwitz, M Hubler)

Telepathology and second opinion in Hematopathology in Sub-Saharan African Francophone Countries, iPath software

Currently active groups Pathology, Australia Haematology Group , Coordination: Wendy Erber Pathology, Indian and Pacific Ocean Rim Hematology Group, Coordination: Wendy Erber Hematopathology, general Consultations in hematopathology from other areas, not mentioned below Coordination: S.Hoeller, U.Mickys, Pathology, Anglophone Africa, Coordination: N.Hurwitz Pathology, Francophone Africa, Coordination: M.Raphael Pathology, Liverpool International Pathology Partnership, Crdination: Tim Helliwell Clinical Oncology Coordination: N.Hurwitz

Telepathology and second opinion in Hematopathology in Sub-Saharan African Francophone Countries

Senegal Dakar Democratic Republic of Congo Kinshasa, Lubumbashi Cameroon Yaounde Benin Cotonou Mali Bamako Congo Brazzaville Ivory Coast Abidjan

Telepathology and second opinion in Hematopathology in Sub-Saharan African Francophone Countries

Centers in Sub-Saharan Anglophone Africa : Kenya, Tanzania, Ethiopia, Uganda, Nigeria

Telepathology and second opinion in Hematopathology in Sub-Saharan African Francophone Countries

Cases, Clinical informations, echography, cytology, histology, immuno

202 registered cases, 195 analyzed cases (october 2016)

99 adults, 96 children

Diagnosis nb of cases %

Not available 33 17

Cytology 148 76

Histology 47 24 Reactive process, dysmyelopoiesis 23 12 Non hematopoietic tumour 40 20

Telepathology and second opinion in Hematopathology in Sub-Saharan African Francophone Countries

Hematological malignancies : 132 cases 68% Leukemias 70 cases Acute leukemias/Lymphoblastic Lymphoma 44 Myeloid/Myelomonocytic 20 Lymphoblastic LA/LB 24

Myelodysplastic Syndromes 6

Chronic Myeloid Leukemia 8

Chronic Lymphocytic leukemia/Lymphoma 6

Hairy cell leukemia 5

Adult T cell Leukemia 1

Telepathology and second opinion in Hematopathology in Sub-Saharan African Francophone Countries

Hematological malignancies : 132 cases 68% Non Hodgkin Lymphomas 54 cases

Burkitt Lymphoma 40

Diffuse Large B Cell Lymphoma 13

T-cell lymphoma 1

Myeloma/plasmacytoma 8

Telepathology and second opinion in Hematopathology in Sub-Saharan African Francophone Countries

B-cell lymphoproliferative disorders 48 cases Chronic Lymphocytic Leukemia 42

leukemic phase of small cell lymphomas 6

marginal zone, mantle cell

T-cell lymphoproliferative disorders 15 cases Sezary syndrome 6

Adult T- cell Leukemia HTLV1 6

Prolymphocytic 2

CD30+ 1

Telepathology and second opinion in Hematopathology in Sub-Saharan African Francophone Countries, PhD thesis

Abibatou Sall Fall PhD Thesis, Dakar November, 2015

Second opinion in Hematopathology Lymphoproliferative disorders in Senegal

B-cell lymphoproliferative disorders 48 cases

Chronic Lymphocytic Leukemia 42

leukemic phase of small cell lymphomas 6

marginal zone, mantle cell

T-cell lymphoproliferative disorders 15 cases

Sezary syndrome 6

Adult T- cell Leukemia HTLV1 6

Prolymphocytic 2

CD30+ 1

PhD thesis

Abibatou Sall Fall PhD Thesis, Dakar November, 2015

Telepathology and second opinion in Hematopathology in Sub-Saharan African Francophone Countries,

New technology/Digital Pathology Whole slide imaging Improvement of communications Development of telemedicine

Forward to the next steps

Second opinion in Hematopathology The experience of Francophone Africa using telepathology

INCa Christine Berling

University of Basel BasysData GmbH Monika Hubler Special thanks Nina Hurwitz

INCTR Pathology program Ian Magrath Lorenzo Leoncini Kikkeri Naresh Nina Hurwitz

Hematology University hospital A Le Dantec Dakar Abibatou Sall Fall Awa Toure

AMCC (Alliance Mondiale Contre le Cancer) Martine Raphaël Elisabeth Auberger Elisabeth Dupont