by Deogratias Ruhangaza, Andrew G. Evans, and Elizabeth A. Morgan Diagnosing hematological malignancies in rural Rwanda using digital pathology applications: a collaboration between a local pathologist and US-based volunteer hematopathologists by Deogratias Ruhangaza, Andrew G. Evans, and Elizabeth A. Morgan BloodAdv Volume 1(Suppl):14-17 December 8, 2017 © 2017 by The American Society of Hematology

Deogratias Ruhangaza et al. Blood Adv 2017;1:14-17 © 2017 by The American Society of Hematology

Deogratias Ruhangaza et al. Blood Adv 2017;1:14-17 © 2017 by The American Society of Hematology

Deogratias Ruhangaza et al. Blood Adv 2017;1:14-17 © 2017 by The American Society of Hematology

Case workflow. Case workflow. All cases submitted for hematopathology work-up at Butaro District Hospital were reviewed by the local pathologist (D.R.) and then triaged for additional review (51%). The majority (73%) of triaged cases were first reviewed by telepathology: ∼50% were finalized without further work-up, and the other half were shipped to BWH for additional IHC. The remaining triaged cases (27%) were sent directly to BWH when the local pathologist deemed additional molecular or IHC testing would be required for diagnosis. Deogratias Ruhangaza et al. Blood Adv 2017;1:14-17 © 2017 by The American Society of Hematology

Final diagnoses. Final diagnoses. All patients (n = 254) included 142 males (56%) and 112 females (44%) with a mean age of 30 years (range, 1-75 years). Diagnoses included ∼25% nonneoplastic (e.g. reactive lymphadenitis or staging marrows) and ∼75% neoplastic entities. Chronic myeloid leukemia (CML) diagnosis was confirmed by BCR-ABL testing performed at BWH or, starting in December 2016, local testing in Rwanda. Remaining entities include plasma cell neoplasm (PCN) (4%), BL (2%), and nonheme malignancy (2%). ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CHL, classical Hodgkin lymphoma; NHL, non-Hodgkin lymphoma. Deogratias Ruhangaza et al. Blood Adv 2017;1:14-17 © 2017 by The American Society of Hematology

Impact of review method on turnaround time. Impact of review method on turnaround time. Cases reviewed by telepathology only had a mean turnaround time (TAT) of 12 days (range, 1-28 days). Once uploaded, volunteers reviewed 92% of cases in <24 hours. Cases sent to BWH had a longer TAT, as expected, due to shipping logistics. Diagnoses of cases reviewed by telepathology or requiring additional work-up at BWH were similar, with the exception of CML (Figure 2). Deogratias Ruhangaza et al. Blood Adv 2017;1:14-17 © 2017 by The American Society of Hematology