Pathology and telepathology in Cambodia

• Published in: Pathology Vol. 46; p. S8
• Main Authors: Vathana, Chhut Serey, Stauch, Gerhard
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 2014
• ISSN: 0031-3025; 1465-3931
• DOI: 10.1097/01.PAT.0000454070.17687.cf

Cambodia is one of underserved countries in Southeast Asia and is still suffering from its terrible history in the last 30 years when no pathologist survived from the genocide of Khmer Rouge regime. Today only 8 pathologists, mostly under qualified, are on service for more than 14 million inhabitants. There are 8 laboratories diagnosing 25,000 to 27,000 histological specimens and non-gynecological cytology, and 24,000 to 25,000 Pap smear screening per year. All laboratories are commonly providing routine histology with most on HE, Giemsa, PAP, and PAS staining. Two laboratories have a capability to provide some immunohistochemistry staining, mostly for only some markers to differentiate lymphomas and carcinomas. At present, no frozen section and no autopsy can be done in Cambodia. All these 8 laboratories are concentrated in the capital city and there is no pathology laboratory in provinces. Four laboratories have established a telepathology or personally have connection to outside world via E-mail. We have two intentions to send the cases to experts: one is to confirm our own diagnosis, second is to discuss the difficult and complex cases with senior experts to get a hint of reliable diagnosis. One lab has built up a clinico-pathological teleconference (CPC) in order to get a good connection and discussion for difficult cases. However, we still have challenging to the limits of teleconsultation due to the available experts time even the optimal clinical information, macro-images, X-rays, CT-scans, MRI are together submitted with microscopic images. There is a gap between newly established therapeutic facility, (e.g., hormone therapy in breast cancer, chemotherapy in soft tissue tumor) and the poor histological and immunohistochemistry methods in the country. Another problem is a personal isolation of Cambodian pathologists with low economic situation who cannot frequently attend international meeting outside of the country. Therefore the training level of Cambodian pathologists cannot be adapted to the standard which is demanded worldwide for sufficient tumor therapy.