Design and Implementation of the Retinoblastoma Collaborative Laboratory

Abstract

Purpose: The purpose of this work was to describe the design and implementation of a digital pathology laboratory, the Retinoblastoma Collaborative Laboratory (RbCoLab) in Kenya.

Method: The RbCoLab is a central lab in Nairobi that receives retinoblastoma specimens from all over Kenya. Specimens were processed using evidence-based standard operating procedures. Images were produced by a digital scanner, and pathology reports were disseminated online.

Results: The lab implemented standard operating procedures aimed at improving the accuracy, completeness, and timeliness of pathology reports, enhancing the care of Kenyan retinoblastoma patients. Integration of digital technology to support pathology services supported knowledge transfer and skills transfer. A bidirectional educational network of local pathologists and other clinicians in the circle of care of the patients emerged and served to emphasize the clinical importance of cancer pathology at multiple levels of care. A 'Robin Hood' business model of health care service delivery was developed to support sustainability and scale-up of cancer pathology services.

Discussion: The application of evidence-based protocols, comprehensive training, and collaboration were essential to bring improvements to the care of retinoblastoma patients in Kenya. When embraced as an integrated component of retinoblastoma care, digital pathology offers the opportunity for frequent connection and consultation for development of expertise over time.

Keywords: Cancer; Digital pathology; Global health; Implementation; Kenya; Pathology; Retinoblastoma; Translation.

Fig. 1

Outcomes of timely, accurate pathology compared to consequences of untimely, inaccurate pathology. In the presence of timely and accurate pathology, the risk of tumor spread can be assessed, and if justified, subsequent treatment may be applied in a timely manner as the evidence-based guidelines indicate. When pathology is late, unreliable, or absent, the treating physician is left without any evidence to guide clinical decision-making. An assumption of risk leads to treating all patients, even those who are truly not at risk. These patients incur treatment costs that they would not otherwise have to incur, and hospital resources are strained unnecessarily. If the physician assumes no risk, then some patients will be undertreated and run the risk of recurrence, metastasis, and death.

Fig. 2

RbCoLab operations. Specimen collection kits were provided to all ophthalmologists who treat retinoblastoma patients. Kits were sent to the lab after surgery. The laboratory technicians documented the specimen in a logbook and scanned the pathology request form to be uploaded into the digital system. The technicians followed evidence-based SOPs to process the tissue and prepare stained slides. The pathologist read the slides and prepared a report. The report was uploaded onto the digital system. Select slides that complemented the report (i.e., clearly showed a reported feature) were marked by the pathologist and scanned by the technicians to be uploaded into the system. A copy of the report was also e-mailed to the ophthalmologists to alert them that the digital record was available for viewing. The ophthalmologists could access the digital record at any time using their unique login and password.