This article summarizes key observations from the peer-reviewed study “Telepathology in Nigeria: Experiences, gains and challenges in resource-constrained settings.”
Authors: Olugbenga Akindele Silas, Fatimah Abdulkareem, Jorge Eduardo Novo, Yinan Zheng, Drew R. Nannini, Demirkan B. Gursel, Rose Anorlu, Jonah Musa, Firas H. Wehbe, Atiene S. Sagay, Folasade T. Ogunsola, Robert L. Murphy, Lifang Hou, Jian-Jun Wei
Journal: Annals of Global Health, Volume 88, Issue 1, 2022
DOI: https://doi.org/10.5334/aogh.3673
Nigeria illustrates the challenges of pathology services in resource-limited settings. The country has approximately 105 pathologists for a population of about 200 million people, reflecting the broader shortage of pathology personnel across Sub-Saharan Africa. Because pathology laboratories are concentrated mainly in major cities, many patients in rural communities have limited access to diagnostic services, and clinicians may need to make treatment decisions without confirmed pathology reports.
In this context, telepathology has been proposed as a way to advance pathology consulting beyond individual laboratories. By transmitting pathology images and related clinical data through telecommunications systems, pathologists in different locations can review cases, provide second opinions, and collaborate on diagnosis remotely.
Telepathology refers to the use of telecommunications technology to share pathology images for diagnosis, research, and education. Several approaches exist, including static image capture, whole slide imaging, dynamic tele-microscopy, and robotic tele-microscopy.
Static images require minimal infrastructure but rely on the operator selecting relevant fields for capture. Whole slide imaging allows remote pathologists to examine an entire specimen digitally at different magnifications. Dynamic systems transmit real-time microscope images, while robotic systems allow remote control of microscope components.
In resource-limited environments, selecting a telepathology solution often involves balancing diagnostic capability with infrastructure limitations and cost.
The telepathology program in the study was developed through collaboration between Northwestern University in the United States and two Nigerian institutions: Jos University Teaching Hospital (JUTH) and Lagos University Teaching Hospital (LUTH).
Funding support enabled the purchase of telepathology equipment and the development of a shared digital pathology workflow. The system included a portable digital slide scanner (Grundium Ocus MGU-00003), slide viewing software, and a secure cloud-based server used to store and transfer pathology images.
Training was an essential part of implementation. Pathologists, laboratory technicians, and computer operators at the Nigerian institutions participated in virtual training sessions led by collaborators at Northwestern University. These sessions addressed slide scanning, image acquisition, patient data protection, and digital pathology interpretation.
Standard procedures were also developed for specimen handling, image storage, and secure sharing of clinical information across the collaborating institutions.
Using the digital slide scanner, whole slide images of tissue specimens were captured at multiple magnifications. Image files were stored locally and uploaded to a secure cloud server for remote access by collaborators. This workflow enabled pathologists in Nigeria and the United States to review the same pathology images without transporting physical glass slides, supporting digital pathology review, collaborative diagnosis, and centralized quality assurance.
The telepathology infrastructure was used primarily to support research on cervical cancer and HIV-associated malignancies. Tissue samples processed at the Nigerian institutions were scanned locally and uploaded for review by international collaborators. Digital pathology also enabled the creation of image archives for research, training, image annotations, and future image analysis studies.
Since implementation of the telepathology system, digital imaging has become an important component of pathology workflows at the participating institutions. Over 200 cervical cancer cases were digitized and reviewed through the system by pathologists from Nigeria and the United States. Remote consultation enabled collaborative evaluation of tumor characteristics such as tumor type, grade, and other pathologic features, while digital slides also allowed accurate measurement of tumor dimensions and capture of images for research and educational purposes.
Another important benefit was improved turnaround time for collaborative pathology review. Cases that previously required physical slide transport could be evaluated within three to five days through digital sharing. The digital archive created through this process has also become a valuable educational resource for pathologists, trainees, and researchers who can access de-identified slides for study and reference.
The telepathology system also contributed to improvements in training and international collaboration. Pathologists and laboratory staff in Nigeria gained experience with digital pathology workflows while interacting with specialists from collaborating institutions.
This environment supported knowledge transfer and professional development without requiring international travel. Trainees and laboratory technicians could review digital slides, participate in case discussions, and learn from external experts.
Telepathology also simplified international research collaboration. Digital slides could be reviewed synchronously or asynchronously by investigators in different locations, eliminating the need to transport physical specimens.
For clinicians, improved turnaround time allowed treatment decisions to be based on more timely pathology reports, which may contribute to improved patient care and management.
Despite its benefits, the study also identified challenges associated with implementing telepathology in resource-constrained environments.
These challenges included selecting compatible viewing software and managing different image formats, as well as infrastructure limitations affecting workflow. Scanning a slide typically required five to ten minutes, while uploading images could take 10 to 30 minutes depending on internet speed. Reliable electricity was also necessary for scanning and uploading, requiring backup generators in some settings. In addition, transitioning from conventional workflows to telepathology required training for pathologists, technicians, and IT staff.
The study suggests that telepathology can support pathology services in regions with limited diagnostic resources. By enabling remote consultation and digital archiving, telepathology allows pathologists in different locations to collaborate more effectively.
In settings with limited specialist availability, telepathology networks can provide immediate access to second opinions while supporting training and research collaboration.
While the initial cost of equipment and infrastructure may be significant, the long-term benefits may include improved diagnostic quality, reduced logistical barriers, and expanded access to pathology services.
This study highlights how telepathology can help address gaps in pathology services in resource-constrained settings. By enabling remote review of pathology images and collaboration between institutions, digital workflows allow pathologists to share expertise while supporting clinical diagnosis, research, and training.
The implementation in Nigeria also illustrates the practical considerations of deploying telepathology systems. Despite infrastructure and training challenges, telepathology solutions can expand access to specialist consultation and strengthen pathology services in underserved regions.
A curated collection of digital pathology studies and references is available on Grundium’s website.
