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Gynecologic pathology services in low- and middle-income countries
  1. Ekaternia Olkhov-Mitsel1,
  2. Fang-I Lu1,2,
  3. Anna Gagliardi3 and
  4. Anna Plotkin1,2
  1. 1 Division of Anatomic Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  2. 2 Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
  3. 3 Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Dr Anna Plotkin, Division of Anatomic Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; anna.plotkin{at}


Objective The International Gynecologic Cancer Society (IGCS) offers multidisciplinary conferences to underserved communities. Mentor pathologists have become an integral part of these tumor boards, as pathology services in low-to-middle-income countries are often inadequate and disjointed. The IGCS Pathology Working Group conducted a survey to assess barriers to quality pathology services in low-to-middle-income countries and identified potential solutions.

Methods A 69-question cross-sectional survey assessing different aspects of pathology services was sent to 15 IGCS Extension for Community Healthcare Outcomes (ECHO) training sites in Africa, Asia, Central America, and the Caribbean. Local gynecologic oncologists distributed the survey to their pathology departments for review. The responses were tabulated in Microsoft Excel.

Results Responses were received from nine training sites: five sites in Africa, two in Asia, one in Central America, and one in the Caribbean. There were no pathologists with subspecialty training in gynecologic pathology. Most (7/9, 78%) surveyed sites indicated that they have limited access to online education and knowledge transfer resources. Of the eight sites that responded to the questions, 50% had an electronic medical system and 75% had a cancer registry. Synoptic reporting was used in 75% of the sites and paper-based reporting was predominant (75%). Most (6/7, 86%) laboratories performed limited immunohistochemical stains on site. None of the sites had access to molecular testing.

Conclusions Initial goals for collaboration with local pathologists to improve diagnostic pathology in low- and middle-income countries could be defining minimal gross, microscopic, and reporting pathology requirements, as well as wisely designed educational programs intended to mentor local leaders in pathology. Larger studies are warranted to confirm these observations.

  • pathology
  • gynecology

Data availability statement

Data are available upon reasonable request.

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  • Contributors EO-M, AP: writing – original draft, review and editing. EO-M: methodology; formal analysis. F-IL, AG, AP: conceptualization; data curation. AP: supervision. EO-M, F-IL, AG, AP: writing – drafting, review and approval of final version. AP is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.