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Computational Pathology and Telepathology: Poster#069TELEMEDICINE IN NORTH AFGHANISTAN CONNECTING REMOTE AREA WITH INTERNATIONAL MEDICAL CENTRES

Background: Afghanistan is lacking of human resources in all medical fields due to 30 years of military conflict. Rural and remote areas, in particular, have poor medical health care and standards. There are only three major hospitals in the northern provinces providing medical service for more than 2 million inhabitants on a low medical level, caused mainly by poor diagnostic facilities in the pathology, radiology, dermatology and laboratory sections. Therefore the GIZ (Gesellschaft fuer Internationale Zusammenarbeit) and the KfW (Kreditanstalt fuer Wiederaufbau) launched a telemedicine project starting off with telepathology in 2010 and expanding to teleradiology in 2011, to teledermatology in a second step in 2013, and recently covering also teletraumatology and telepsychiatry. The project started in Mazar E Sharif and was extended to Kunduz and Taloqan. All peripheral stations have been connected via IPATH Basel with international experts rep. centres to get valid second opinions of high diagnostic accuracy. Material and methods: More than 1600 cases have been submitted via the Internet to European pathologists and cytologists, in addition to 100 radiological and 10 dermatological cases to experts in the respective fields. Out of this material 300 of the latest cases of pathology and cytology were analysed with respect to: 1) information quality: number and quality of images, additional macro and X-ray images, clinical information and the primary diagnosis; 2) diagnostic accuracy of the experts classifying in secure, suggestive and non-diagnostic assessment; 3) diagnostic accuracy of the inexperienced clients measuring the concordance between client sender and expert; 4) radiology and dermatology cases were not analysed in this study. Results and conclusion: The restrospective analysis showed: 1) there was a predominance of cytologal cases of more than 50% (FNA) over histologal cases; 2) most cases were dealing with GI tract (oesophageal lesions) followed by breast tumours (cancer) and lymph node lesions (TB); 3) the diagnostic assessment of the experts was secure in 70%, suggestive in 20% and no diagnosis was given in 10% of the cases due to insufficient information; 4) diagnostic total concordance was seen in 55%, acceptable concordance in 10% and discrepancy in 35% of the cases. The authors conclude: 1) telepathology and telecytology are based on simple techniques; 2) structured and optimal information is required to achieve high diagnostic accuracy of the experts; 3) telepathology and telecytology are optimal tools to increase diagnostic and therapeutic quality in medical health care in Afghanistan.