Central Pathology Review / iPath (2016)
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Program: Pathology
Coordinators: Martine Raphaell, Sidnei Epelman
Other INCTR Participants: Lorenzo Leoncini,KK Naresh
Collaborators: Institute of Cancer (France)
Branch(es): AMCC; Brussels
Location: Multiple Continent
Country(s): Brasil; Senegal,
Institutions: Santa Marcelina Hospital Pathology Dept
University Hospital of Dakar
University of Nancy
Background Information: In 2013, INCTR Brazil and TUCCA began central review of the pathologic diagnoses of brain tumors made by institutions throughout the country. To date, 526 cases have been reviewed. An important initial finding was that there was lack of concordance in 62% of the cases. This meant that there was a negative impact on appropriate treatment and, consequently, outcome on 40% of the discordant cases. It is anticipated that the central review will be expanded to other institutions and that molecular testing will be introduced in prospective clinical trials. Lastly, learning and training programs will be defined based on the new WHO classification of central nervous system tumors. For more information about this project, contact: inctr@inctrbrasil.org.
Objectives: To improve diagnosis of brain tumors through the formation of an group of expert pathologists who focus on a particular type of tumour and have all of the tumors of this type reviewed by the expert group.
Methods: A set of tumors is reviewed by several pathologists, including the pathologist on site (i.e the pathologist responsible for diagnosis of routine surgical cases or a s et of tumors from patients involved in clinical trials. If there is disagreement among the group members, a consensus diagnosis is provided, and if necessary changes made to the protocol that is used for the diagnosis of a set of tumours (e.g., brain tumours, lymphomas). Such reviews may be done on site, on materials sent to the reviewing hospital - either by mail or electronically (iPATH). iPath is a web based program developed at the University of Basel for the purposes of pathology training, histopathology review and consultation.
Progress: Central review is currently being conducted in three main areas: 1. haematological neoplasms (African countries) and 2, Brain Tumours (Latin American countries). 3. All Neoplasms (iPATH)

Haematological neoplasms
To date, 526 cases of brain tumours have been reviewed. An important initial finding was that there was lack of concordance in 62% of the cases. This meant that there was a negative impact on appropriate treatment and, consequently, outcome on 40% of the discordant cases.

Haematopoietic Tumours
A team of pathologists who are part of INCTR’s Pathology Program performed a central pathology review for patients entered on the INCTR study, “The Treatment and Characterization of Burkitt Lymphoma in Africa”. This review was done by a determination of the concordance between the original histopathology diagnosis and the consensus diagnosis made by this expert panel of pathologists. The reviews were performed on-site and provided an opportunity for the team to assess and evaluate diagnostic services and resources.

AMCC, INCTR’s French Branch provides support via iPath to assist in the diagnosis in hematopathology. Since 2010, more than 200 cases from adult and children, were registered into the group of Francophone Africa, 68% of cases were hematopoietic tumours. In addition, i-Path was used to characterize the cytology of lymphoproliferative disorders in Senegal in a project of PhD thesis with at the University Hospital Aristride Le Dantec and Cheick Anta Diop University in Dakar (63 cases including B and T cell lymphoproliferative disorders were enrolled. ) Additionally, AMCC will be assisting with diagnostic support for a project of protocol to treat diffuse large B cell lymphomas in adults at the University hospital of Dakar in connexion with. The University Hospital of Nancy, France and the National Institute of Cancer of France (INCa). will also be a partner in this treatment protocol. For more information about iPath, contact: contact@amcc-cancer.org.
Future Plans: It is anticipated that the central review will be expanded to other institutions and that molecular testing will be introduced in prospective clinical trials. Learning and training programs will be defined based on the new WHO classification of central nervous system tumors. It is hoped that this program will be associated with a training program in pathology conducted by meetings and webinars. For more information about this project, contact: inctr@inctrbrasil.org.
Duration: Indefinite
Publications:
Month: 01
Year: 2016
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