What's up in Whatsapp - Telecytopathology Experience Connecting Rural Districts of Punjab to a Tertiary Care Center in India

ABSTRACT

Introduction: The telemedicine center of our hospital provides expert consultation services to two rural districts of Punjab. The aim of this study was to assess its utility in Fine needle aspiration Cytology (FNAC) diagnostic service. Material(s) and Method(s) A 2-year retrospective audit from April 2020-2022 covering the COVID pandemic time was carried out on all cases of telecytopathology consultation files of the E-sanjeevani platform. A total of 75 cases whose FNAC smear images clicked by android smartphones with 48MP cameras and sent by Whatsapp to the E-Sanjeevani administrator were included. The images along with brief case clinical details were e-mailed for expert opinion to the cytopathologist (RS). The image quality, ability to provide a diagnosis, site-wise differences and comparison of the referral and expert review diagnosis was made. Result(s) The ages of the patients ranged from 4-80 years (2 children, 73 adults), with 25 males and 50 females. The sites of FNA performed at the district hospital were lymph nodes (22), breast (21), thyroid (15), soft tissue (8), salivary gland (2), skin (4), lip (2) and glans penis(1). The number of Whatsapp images evaluated ranged from 3-20 with median of 11 per case. They were in JPEG file format with size ranging from 40-163kb. Image quality was rated visually as good, medium, and poor in 46 (61%), 21m (28%) and 8(11%) cases respectively. There was no distortion of images upon enlarging them for better visualization on a large monitor. Best accuracy was obtained in breast and lymph nodes FNA. Soft tissue FNA was difficult to interpret and was inconclusive in 3/8 cases. Conclusion(s) Telecytopathology by Whatsapp is simple, quick, feasible and very useful to provide expert opinion in FNAC of various sites thereby enabling the pathologist in the district hospital setting. [Formula presented] Copyright © 2022