The experience of introducing telepathology in Mongolia

Batchimeg Tsedenbal; Enkhee Ochirjav; Ariun-Uils Gankhuyag; Bolortuya Dorj; Saruul Gerelchuluun; Baljinnyam Delegnyam; Gankhuu Gankhuyag; Undarmaa Erdene; Uyanga Gotov; Enkhtuya Sharkhuu; Yukio Takeshima; Kouki Inai

doi:10.1016/j.jpi.2023.100317

The experience of introducing telepathology in Mongolia

J Pathol Inform. 2023 May 11:14:100317. doi: 10.1016/j.jpi.2023.100317. eCollection 2023.

Affiliations

¹ Department of Training, Research, and Foreign Affairs, National Center for Pathology, Ulaanbaatar, Mongolia.
² Department of Pathology Care and Service, National Center for Pathology, Ulaanbaatar, Mongolia.
³ Reference Laboratory, National Center for Pathology, Ulaanbaatar, Mongolia.
⁴ Department of Quality Control, National Center for Pathology, Ulaanbaatar, Mongolia.
⁵ Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁶ Pathologic Diagnostic Clinic, Hiroshima, MNES Inc, Japan.

Abstract

Background: Anatomical pathology care services play an essential role in cancer diagnosis through histological analysis, effective treatment of patients, and determination of prognosis. Therefore, quality control is necessary for the diagnosis of pathology. Based on this need, telepathology technology is rapidly developing in the world. This study aimed to share the experience of implementing telepathology case consultation between Mongolian and Japanese expert pathologists.

Methods: The study included 173 cases that required telepathology consultation, which was complicated and doubtful in diagnosis, submitted by Mongolian pathologists between May 2019 and April 2022. The scanned digital slides were transmitted with the help of the LOOKREC cloud-based system, and the expert pathologists of Hiroshima University Hospital, Japan, browsed the images through the data on the internet and their advice and made a mutual diagnosis.

Results: During the study period, 173 cases were consulted. Out of 58.4% of all cases, consultation reports were released in 2022. The majority of the cases in 2020 had a mean standard deviation turn-around time of 4.2±6.2 days. The most cases were from the lung and mediastinum were 29.4%, followed by head and neck at 12.6%, the bone at 11.9%, lymph nodes at 8.4%, GIT at 7.7%, soft tissues at 6.3%, etc. Comparing the sample submission of biopsy and cytology was significantly higher in the under 10 years of an experienced group than over 10 years of an experienced group (p<.005). The diagnostic agreement between submitter Mongolian pathologists and expert Japanese pathologists was 82.7%, and disagreement was 17.3% of all cases, with a sensitivity of 67.3% and specificity of 85.5%.

Conclusions: Telepathology could save many lost opportunities and play an essential role in developing quality control and surgical pathology in Mongolia. This digital technology and the appropriate strategy and policy of the government could accelerate the overall pathology field development.

Keywords: Digital pathology; Telepathology; Whole slide imaging.