................................................................................................................................. .............................................................. .............................................................. RESEARCH Original article Q Telecytology in East Africa: a feasibility study of forty cases using a static imaging system Neeta Kumar*, Satya Vara Prasad Busarla † , Shahin Sayed*, Jesca Muthoni Kirimi ‡ , Patricia Okiro § , Samuel Mukono Gakinya*, Zahir Moloo* and Aliyah R Sohani ** *Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya; † Department of Pathology, Aga Khan Hospital, Kisumu, Kenya; ‡ Department of Pathology, Aga Khan Hospital, Dares Salaam, Tanzania; § Department of Pathology, Aga Khan Hospital, Mombasa, Kenya; **Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, USA Summary We conducted a pilot study to assess the feasibility of telecytology as a diagnostic tool in difficult cases originating from a hospital in East Africa. Forty cytology cases considered difficult by a referring pathologist were posted on a telepathology website. Six pathologists independently assessed the static images. Telecytology diagnoses were compared with the consensus diagnoses made on glass slides and also with the histogical diagnoses when available. The diagnostic agreement of the six pathologists was 71–93% and tended to be higher for pathologists with more experience. Reasons for discordance included poor image quality, presence of diagnostic cells in thick areas of smears, sampling bias and screening errors. The consensus diagnoses agreed with histological diagnoses in all 17 cases in which a biopsy was performed. Diagnostic accuracy rates (i.e. telecytology diagnosis vs. histological diagnosis) for individual pathologists were 65–88%. To ensure diagnostic accuracy both referring and consulting pathologists must have adequate training in cytology, image acquisition and image-based diagnosis and the diagnostic questions of importance must be clearly communicated by the referring pathologist when posting a case. Introduction Telepathology is an excellent medium for expert consultation and education for solo pathologists practising in remote and rural areas where sub-specialist pathologists are not available. 1 In Africa, the lack of cytopathologists means that a limited number of surgical pathologists provide comprehensive cytology services, including performance and interpretation of fine needle aspirations (FNAs) and cervical smear screening, in addition to their heavy histopathology workload. There is often the need for expert input from an experienced surgical pathologist or cytopathologist, and telecytology offers a potential solution. 2 The Aga Khan University (AKU) Hospital in Nairobi is the regional teaching and referral centre for three other hospitals in Kisumu and Mombasa, Kenya and in Dar es Salaam, Tanzania, where the pathology laboratories are manned by solo pathologists with varying levels of experience in cytopathology. Glass slides of difficult cases are frequently sent via courier for second opinion to four histopathologists and one cytopathologist based at the AKU Hospital in Nairobi. The breakage of slides during transport is a recurring problem, as are the prolonged turnaround times and high courier costs. A static telepathology system linking all four institutions was installed in 2009. It has been used mainly for histopathology teleconsultations, but relatively infrequently for cytology cases. 3,4 We conducted a pilot study to assess the feasibility of telecytology as a diagnostic tool in difficult cases originating from one of hospitals. Methods The study was conducted over a period of four months starting in August 2010. The study did not require ethics approval. The telecytology equipment comprised a digital colour camera (Olympus Q-color 3, 3.2 megapixel, Olympus America Inc., Center Valley, PA, USA) mounted on a microscope (Olympus BX51) and connected to a PC with an Accepted 24 June 2011 Correspondence: Aliyah R Sohani, Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, WRN 219, Boston, MA 02114, USA (Fax: þ1 617 643 6415; Email: arsohani@partners.org) Journal of Telemedicine and Telecare 2012; 18: 7–12 DOI: 10.1258/jtt.2011.110308