ASCP CENTER FOR GLOBAL HEALTH

ASCP Partners for Cancer Diagnosis and Treatment Initiative Three years of fighting cancer, one patient at a time.

www.ascp.org/globalhealth

The American Society for Clinical Pathology (ASCP) is the largest organization of pathologists and laboratory professionals in the world. Our current programs and activities reach more than 100 countries outside of the U.S. through the Center for Global Health (CGH) and the ASCP Board of Certification (BOC). ASCP has been a primary laboratory partner implementing the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), receiving more than $50 million in funding to directly improve, strengthen, and capacitate HIV testing in laboratories around the world. In 2015, with the success of PEPFAR, we added a new focus to our efforts—cancer in low- and middle-income countries (LMICs).  Our mission at ASCP is to provide excellence in education, certification, and advocacy on behalf of the patients, pathologists and laboratory professionals across the globe. ASCP is patient-centered in all operations, programs, and activities. ASCP is committed to improving global health for all patients by exploring, identifying, and implementing innovative methods and partnerships that improve laboratory practices. Our goal is not simply to engage in a series of projects, but to create a sustainable presence in pathology and laboratory medicine around the world, which finds solutions for each challenge encountered. Our ability to design affordable systems, mobilize person power and apply dynamic technology in challenging environments makes us the innovation leader in pathology and laboratory medicine. Our board-certified pathologists’ and laboratory professionals’ willingness to offer their time and expertise pro bono demonstrates our membership’s unwavering commitment to global health. Our focus includes humanitarian efforts that lend expertise, physical resources, and extra hands where needed and international certification designed to help increase the overall quality of laboratory medicine. We make significant contributions to providing science education and creating opportunities for continuous knowledge exchange. ASCP works directly to address anatomic and clinical pathology service gaps. Through assessment, gap identification, and implementation planning, ASCP executes activities and programs with each country that meet their specific needs to fight disease now and make sustainable plans for the future. Using this model, ASCP has expanded with partners to multiple countries in Africa and around the world and now serves as the go to organization for impactful solutions in pathology.

2

ASCP CENTER FOR GLOBAL HEALTH

www.ascp.org/globalhealth

Why Is Cancer Now the Challenge the World Must Face? For the past 40 years, HIV, tuberculosis, and malaria

the process, disease goes undetected, and clinicians

have dominated the international global health agenda

feel ineffective and frustrated. This results in the

as these massive killers of children and adults ravaged

majority of cancers not being diagnosed until they

the poorest parts of the world. Through a cadre of

reach an advanced stage of disease.

funding programs, carefully designed interventions, and a unified voice to combat these diseases, HIV, tuberculosis, and malaria are on the decline. ASCP, along with a host of other partners, was a part of this long fight through our lab strengthening efforts with the U.S. Centers for Disease Control and Prevention, and PEPFAR. But with such great progress comes new challenges. For LMICs, that seemingly new challenge is the rising incidence of cancer.

Recognizing the value of pathology in this continuum, ASCP positioned itself to create sustainable solutions that improve outcomes and save lives. And, we were not alone. The National Cancer Institute launched the Center for Global Health. The American Cancer Society expanded to multiple international sites. The Clinton Health Access Initiative, BIO Ventures for Global Health, Health Volunteers Overseas, International Cancer Export Corps, and a long list of

In 2015, ASCP launched the Partners for Cancer

other nongovernmental organizations (NGOs) have

Diagnosis and Treatment in Africa initiative out of the

created, expanded, or deployed programs to combat

White House Office of Science and Technology Policy

cancer, all in the last decade. Industry partners,

in response to cancer’s massive burden in Africa and

international funding agencies, and other donors are

other LMICs.

beginning to take up the challenge. However, this is a

• Noncommunicable diseases (NCDs) are the leading cause of death in Sub-Saharan Africa today. • NCDs are increasing due to longer life expectancy. • Cancer is a major killer in Africa, with 80% mortality. • Lack of access to diagnostics delays diagnosis of curable diseases.

very long and brutal fight where we need everyone to take part. In 2017, the Union for International Cancer Control (UICC) launched the C/Can 2025 City Cancer Challenge, and the World Health Organization (WHO) at the World Health Assembly passed a Cancer Resolution. In 2018, WHO launched its first cancer

Across the spectrum of cancer care, all personnel

initiatives in cervical cancer and pediatric cancer. We

are lacking—from oncologists and surgeons to

now have a WHO Essential Diagnostics List, including

pathologists, laboratory professionals, and ancillary

tools for cancer, and a list of priority medical devices

supportive services. Without diagnostics, clinicians

for cancer management. The world is opening its eyes

are unable to effectively screen for cancer, diagnose

to the behemoth of cancer in the countries of our

disease, and develop care plans. Patients are lost in

poorest neighbors.

“

I am so happy that organizations around the world are now working on cancer in low- and middleincome countries. But, this is not a new problem. As a medical student in Malawi in 2000, sitting at the microscope in the surgical pathology laboratory at the University of Malawi College of Medicine, more than 80% of what crossed the scope was cancer. At that time, there was no oncologist, and patients had horrible, late-stage disease. On a trip two years later, I signed out 700 cases in four weeks, some of which were more than six months old. I was, in a way, writing autopsy reports, not surgical pathology diagnoses. In 2005, Partners in Health (PIH) began sending a trickle of cancer biopsies to Brigham and Women’s Hospital for which Dana-Farber would send back chemotherapy to treat these patients. If PIH used local pathology services at that time, it could take more than six months to get a diagnosis. By 2010, this was a flood of cases, and the cost was beginning to catch the eye of the Chief Financial Officer. These samples were coming from Rwanda and Haiti. Directed by Larry Shulman, MD, from Dana-Farber, my colleague, Jim Pepoon, HT(ASCP), and I traveled to Rwanda— we couldn’t go to Haiti because of cholera—and assessed an empty room at the newly built Butaro District Hospital in 2012. Six months later, we had installed a fully functioning laboratory. From 2012 to 2016, two technicians using a standard protocol photographed every case and uploaded them to iPath where they were triaged by a team of pathologists lead by myself and Jane Brock, MD, PhD. In March of 2016, the first Partners for Cancer Diagnosis and Treatment in Africa initiative site was launched at Butaro Hospital with whole slide imaging telepathology, an automated histology platform, and the arrival of a newly trained Rwandan pathologist, reducing the laboratory’s turnaround time to less than 72 hours. To date, more than 7,000 patients have been diagnosed and treated at Butaro Hospital.

THE MESSAGE IS SIMPLE. WE CAN DIAGNOSE AND TREAT PEOPLE WITH CANCER IN AFRICA AND OTHER LMICs. THERE IS NO BARRIER THAT CAN’T BE OVERCOME TO ACHIEVE THIS, AND THE ONLY THING HOLDING US BACK IS A UNIFIED, GLOBAL PROGRAM TO DEFEAT THIS DISEASE.

Dan Milner, MD, MSc(Epi), FASCP ASCP Chief Medical Officer

”

How Does ASCP Tackle Global Health Pathology Challenges? To assume that any particular solution, whether out of the box or successful in a prior location, will always be valuable in another location is a fallacy. Every population center that does not have an optimized cancer continuum will have a series of predictable, unique, and/or entirely unpredictable challenges that must be identified, rationalized, and, when possible, solved. This approach underlies the program for ASCP in global health where we begin with assessment (internal and external) and use root cause analysis to create a list of sustainable interventions tailored to a given site. The solutions are sometimes intuitive and require only funding to implement, while others require creative approaches and complex logistics to accomplish. Since the launch of Partners, we have engaged in a range of activities including the following: • In person site assessments, expert consultations, and training • Procurement, delivery, installation, and training for equipment • Procurement and delivery of educational aids for trainees • Recruitment, training, and support for pathology volunteers • Translation of pathology tools into multiple languages • Creation and support of global online resources • Foreign and domestic direct conference support • Foreign and domestic conference support for attendees (foreign and domestic) At the heart of this program is the provision of whole-slide image-based telepathology supported by teams of ASCP member volunteers remotely. When installed, this system allows pathologists in our collaborating sites to have access to 15+ pathology experts via the cloud across all diseases with a less than 24-hour turnaround time for consultations. But not every laboratory is ready for telepathology, and some laboratories need more advanced help. The assessment process is, therefore, crucial to designing a matching implementation plan for each site.



ASCP CENTER FOR GLOBAL HEALTH

5

What Have We Done Through Our Initiative? Measures of success in the dire situation of cancer at the moment are very easy to find, but very difficult to collect. With a mortality rate of 80% for all cancers and, for example, an incidence rate of 55 per 100,000 for cervical cancer, it is very easy to state that our goal should be less than 35% mortality (typical of the U.S. and ­Europe) and less than four per 100,000 for cervical cancer (U.S.). In pathology, the metric used most commonly for impact is turnaround; however, the value of turnaround is maximized in an intact pre- and post-­analytical system for cancer care. Despite these challenges, ASCP’s impact in the last three years has been immense.

In-Person Assessments (external) ASCP Staff and Member Volunteers—1 to 3 days per site • • • • • • • • • • • • •

Butaro, Rwanda Kigali, Rwanda Butare, Rwanda Kampala, Uganda Moshi, Tanzania Dar es Salaam, Tanzania Nairobi, Kenya Addis Ababa, Ethiopia Mbabane, eSwatini (Swaziland) Kinshasa, Democratic Republic of Congo Accra, Ghana Kumasi, Ghana Tamale, Ghana

• • • • • • • • • • • • • • •

Written Assessments (internal) ASCP Collaborators and Local Teams • Mbour, Senegal • Yaoundé, Cameroon • Gondor, Ethiopia

Abidjan, Cote D’Ivoire Monrovia, Liberia Gaborone, Botswana Antananarivo, Madagascar Lagos, Nigeria Ibadan, Nigeria Mirebalais, Haiti Port-au-Prince, Haiti Cali, Colombia Asuncion, Paraguay Kyiv, Ukraine Ho Chi Min City, Vietnam Hanoi, Vietnam Yangon, Myanmar Phnom Penh, Cambodia

In-Person Trainings (external) ASCP Staff and Member Volunteers—3 days to 4 weeks Africa • Kigali, Rwanda – Histology Training, IHC Training, Equipment Repair and Maintenance • Moshi, Tanzania – Histology Training, IHC Training, Practical Grossing Training • Dar es Salaam, Tanzania – IHC Training • Addis Ababa, Ethiopia – Quality Management in AP, Practical Grossing Training, IHC Training • Kinshasa, Democratic Republic of Congo – Histology Laboratory Setup and Training • Monrovia, Liberia – Histology Laboratory Setup and Training • Harper, Liberia – Clinical Pathology Laboratory Training • Gaborone, Botswana – Histology and Workflow Training • Abidjan, Cote D’Ivoire – Surgical Pathology Workshop • Lagos, Nigeria – Surgical Pathology Workshop Caribbean • Mirebalais, Haiti – Histology Laboratory Setup and Training, Practical Grossing Training South America • Cali, Colombia – Quality Management in Laboratories • Asuncion, Paraguay – Quality Management in Laboratories Asia • Ho Chi Min City, Vietnam – Lymphoma/Leukemia Workshop • Yangon, Myanmar – Quality Management, Surgical Pathology Training, Practical Grossing, Management • Phnom Penh, Cambodia - Surgical Pathology Training, Practical Grossing, Management

Equipment Deployments ASCP Staff With Collaborators

Direct Educational Support ASCP and Other Collaborator Online Courses

• Butaro, Rwanda – Automated Histology, Telepathology, Cytospin • Mirebalais, Haiti – Consumables, Telepathology • Kigali, Rwanda – Telepathology, Automated Immunohistochemistry and Reagents • Moshi, Tanzania – Telepathology, Automated Immunohistochemistry and Reagents, Histology Upgrades • Monrovia, Liberia – Complete Histology Laboratory Suite • Dar es Salaam, Tanzania – Telepathology, Automated Immunohistochemistry and Reagents • Addis Ababa, Ethiopia – Automated Immunohistochemistry and Reagents • Kampala, Uganda – Automated Immunohistochemistry and Reagents, Histology Upgrades • Kinshasa, DRC – Histology Upgrades • Oyo, Nigeria – Microtome

Book Donation Program ASCP Staff With Collaborative Donors • • • •

Rwanda Zambia Uganda Tanzania

• • • •

Ukraine Nigeria Kenya Ethiopia

Total Books: 522

Datasets Translation ASCP With International Collaboration on Cancer Reporting (ICCR) • 21 datasets into French, Spanish, and Portuguese

• Laboratory Management University Certificate Program Access (ASCP) • Leadership Institute Certificate Program Access (ASCP) • Digital Pathology Certificate Program Access (NSH)

Conference and Travel Support ASCP Staff, Member Volunteers, and Local Collaborators • Support for LMIC Attendees to APECSA, AORTIC, CUGH, ASCP, USCAP, AKLMSO, BHGI, MeLSAT, UICC • Support for Additional Training of LMIC Participants to Harvard, UCSF, Emory, Dartmouth, Duke • Support for ASCP Speakers to AORTIC, CUGH, ASCP, AKLMSO, BHGI, MeLSAT, ASCO (Azerbaijan) • Support for LMIC Conferences: AKMLSO, MeLSAT, WCLS, PIH, APECSA

ASCP CGH Global Health Travel Fellowships ASCP Residents/Fellows to ASCP Partners Sites 2018 • Jaime Singh, MD • Dana Razzano, MD • Robyn Ndikumana, MD • Jennifer Kasten, MD, MSc, FASCP • Priyadarshini Kumar, MD, FASCP

2019 • Victoria (Claire) Vaughan, MD • John Gross, MD, FASCP • Daniel Sullivan, MD • Erica Swenson, DO • Ezra Baraban, MD • Kelsey McHugh, MD, FASCP

Who Has Done the Work? The ASCP Center for Global Health works closely with the ASCP membership to design and execute all of our global health activities. This has led to focal and ongoing engagement of our members around the world, including the following:

45 Members for 4 Countries

21 Members to 8 Countries

11 Members to 10 Countries

Board Certified Pathologist Virtual (Telepathology) Volunteers

Certified Laboratory Professional In-Country Training Volunteers

Pathologist (Certified and in Training) In-Country Volunteers

In addition to the daily support from ASCP members for our clinical work in Butaro, I was able to travel and present our work at an international surgery meeting in Germany where our team received the award for best presentation for the entire meeting.

SUPPORTING PATHOLOGISTS FROM REMOTE, UNDERSERVED AREAS TO ATTEND INTERNATIONAL MEETINGS ALLOWS US TO BE UPDATED ON CURRENT PRACTICE AND SHARE OUR CHALLENGES AND INTERESTING CASES SO OTHERS CAN LEARN FROM US. Deogratias Ruhangaza, MD

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ASCP CENTER FOR GLOBAL HEALTH

Through the ASCP Global Health Travel Fellowship, I worked alongside pathologists and laboratorians at Makerere University in Uganda to institute new lab protocols, documents and processes; digitize three years’ worth of reports for research and quality monitoring; and teach residents...

IT WAS A CAREER-ALTERING OPPORTUNITY FOR ME, AND I FORMED SEVERAL SOLID PROFESSIONAL FRIENDSHIPS WHICH CONTINUE TO GROW. Jennifer Kasten, MD, MSc, FASCP

Through ASCP, I have traveled to the Democratic Republic of the Congo and JFK Hospital in Liberia to assess and set up histology laboratories as well as train the staff. I have been fortunate to present my work and experience at the Association of Pathologists of East, Central, and Southern Africa and the Medical Laboratory Scientists Association of Tanzania.

THIS PHENOMENAL SET OF EXPERIENCES CREATED GREAT NETWORKING OPPORTUNITIES FOR MY HISTOLOGY CONSULTING ACTIVITIES.

It was a privilege to work closely with Nigerian pathologists at our recent surgical pathology workshop in Lagos, Nigeria.

I LEARNED HOW THIS WELLTRAINED GROUP WORKS WITH FEWER RESOURCES THAN IN THE U.S. AND PROVIDES HIGH LEVELS OF DIAGNOSTICS WITH THE RESOURCES AVAILABLE. Nancy Joste, MD, FASCP

Linda Cherepow, HTL(ASCP) www.ascp.org/globalhealth

What Does It Really Mean? Histology Improvements Installations, Repairs, Upgrades, and Training, Including Immunohistochemistry The pathology laboratories that ASCP has improved and for which it has increased histology services represent catchment areas of almost 50 MILLION PEOPLE.

Pathology Education Resources Residency training programs in Rwanda, Uganda, Tanzania, and Nigeria have UP-TO-DATE ­TEXTBOOK LIBRARIES for residents and trainees. Pathologists in practice in Rwanda, Zambia, Uganda, Tanzania, Ukraine, Nigeria, Kenya, and ­Ethiopia have UP-TO-DATE TEXTBOOKS for clinical sign out. 175 INDIVIDUALS have accessed ASCP online certificate education in leadership, laboratory management, and digital pathology from Ghana, Kenya, Rwanda, Uganda, Malawi, Ethiopia, Tanzania, and Nigeria.

Telepathology MORE THAN 95% of all patients biopsied in Rwanda have access to ASCP consultants.

RWANDA

Butaro (3/16-3/19) 5,428 biopsies 1,973 cancers 406 ASCP consultations (21%)

MORE THAN 75% of all patients biopsied in Tanzania have access to ASCP consultants.

TANZANIA

Moshi (12/18 – 3/19) 1,230 biopsies 369 cancers 150 ASCP consultations (41%)

ICCR Translations Additional Language Access to Standardize Reporting ASCP With ICCR The ambitious International Collaboration on Cancer Reporting program aims to create standardized reporting templates for cancers around the world. However, in its original language (English) only one billion people would benefit. By translating the existing datasets into French, Spanish, and Portuguese, the total is now 2.5 BILLION PEOPLE. DISTANCIA DEL TUMOR AL MÁRGEN DE RESECCIÓN MÁS CERCANO (Nota 7)

ación

ombre Apellido/N de Familia s) Nombre(

Número

la solicitud Fecha de

DD – MM

pacientes dores de Identifica

Elementos

Bien diferenciado Moderadamente diferenciado Pobremente diferenciado

escritos

LES. Elementos

ICO

io laborator

– YYYY

DATOS DE ESTOS

(seleccione todas las que apliquen)

Tráquea Pared torácica Diafragma Esófago Corazón Grandes vasos Cuerpo vertebral Nervio frénico Mediastino Grasa mediastinal Pleura mediastinal Pericardio parietal Nervio laríngeo recurrente

TUMOR

ó LA MUESTRA IDAD EN No se proporcion LATERAL Derecha Izquierda DAS ICAS CONECTA a presentad Ninguna

URAS ANATÓM ESTRUCT as Presentad

ANTES S ACOMPAÑ Ganglios MUESTRA Ninguna presentada

linfáticos

Otros, especificar

cinoma ión de Adenocar situ (AIS) inoma in Mucinoso Adenocarc (MIA) No mucinoso nte invasivo inoma mínimame Mucinoso Adenocarc No mucinoso inoma Invasivo Adenocarc ANTE PREDOMIN PATRÓN

Clasificac TUMOR ÓN DEL UBICACI Lóbulo Medio Lóbulo superior r ubicación especifica Bronquio,

Lóbulo inferior

1) OS (Nota evaluarse LES SEPARAD No puede TUMORA NÓDULOS ES Ausentes s PRINCIPAL ) sincrónica s (Elemento sincrónica para cada primaria Primarias reportados deben ser

Escamoso Acinar Papilar ar Micropapil Sólido Invasivo Mucinoso

Presente Número

INVASIÓN DIRECTA DE ESTRUCTURAS ADYACENTES (Nota 10)

TUMOR

ía Bilobectom tomía Neumonec

Coloide Fetal Entérico

de tumores

Ubicación

Mismo lóbulo diferente Lóbulo ipsilateral ral Pulmón contralate

LA PLEURA ÓPICO DE MACROSC ESTO ASPECTO SUPERPU TUMOR

OTROS PATRONES

PATRÓN TIPO DE PATRÓN TIPO DE r

Otro, especifica

ENDO TIVA EXTENDI S OBSTRUC UMONITI 3) SIS/PNE usente ATLECTA HILAR (Nota evaluarse No puede A LA REGIÓN Ausente Presente August 2017

Resultado EML4-ALK (Proteína 4 asociada de equinodermo al microtúbulo - Linfoma quinasa anaplásico) Reordenamiento ausente Resultado indeterminado Reordenamiento presente Describir

No identificada No aplicable

No involucrado

No aplicable

Data molecular (Nota 17) Otro margen 2 (especificar p. ej. parénquima, pared torácica) Resultado del R-FCE Mutación ausente Involucrado

No involucrado

Mutación presente No aplicable Describir

Otro, especificar Exámen

Resultado

Resultado indeterminado

ESTATUS DE NÓDULOS LINFÁTICOS (Nota 15) ESTADIFICACIÓ N PATOLÓGICA Estación(es) examinada(s), especificar

(TNM 8.a edición) (Nota 18) m - Tumores primarios múltiples en un r - tumores recurrentes sitio único luego de un periodo y - clasificación sin enfermedad realizada tratamiento multimodal durante o luego de

Nódulos linfáticos regionales NX Nódulos linfáticos regionales no pueden N0 No existen ser evaluados metástasis de nódulos linfáticos N1 Metástasis regionales en nódulos linfáticos peribronquiales ipsilaterales y/o No involucrado en nódulos linfáticos ipsilaterales y hiliares T- Tumor nódulos intrapulmonares, nvolucrado solamente con micrometástasis primario la afectación por incluyendo TX Tumor primario extensión directa N2 Metástasis no puede ser evaluado, en nódulo(s) linfático(s) probado por la o tumor existencia de células ipsilaterales y/o mediastínicos esputo o lavados malignas en subcarinales bronquiales pero Estación 1 N3 Metástasis imágenes o broncoscopia no visualizado en nódulo(s) linfático(s) involucrada contralaterales, mediastínicos T0 Sin evidencia de hiliares contralaterales, tumor primario o escalénicos contralaterales, ipsilaterales Tis Número de nódulos Carcinoma in situa o supraclaviculares T1 linfáticos involucrados Tumor de 3 cm o menos en su M - Metástasis mayor dimensión, rodeado por pulmón a distancia Número total de nódulos o pleura visceral, No aplicable broncoscópica sin evidencia linfáticos provenientes de de invasión más M0 No existen proximal del bronquio lobar (es decir, metástasis a distancia este sitio no en el bronquio Extensión de la afectación pleural (Nota 13) M1 Existen metastasis principal)b T1mi Adenocarcinoma a distancia mínimamente NúmeroT1a no puede ser determinado invasivo c M1a Existencia PL1 Tumor de 1 cm de nódulo(s) tumoral(es) o menos en su mayor dimensión en un lóbulo contralateral; T1b separado(s) Tumor de más PL2 Estación 2 de 1 tumor con nódulos pero no más de pleurales o pericárdicos su mayor dimensión cm 2 cm en involucrada b e PL3 o pleural maligno o derrame pericárdico T1c Tumor de más de 2 M1b Única metástasis pero no más de Número de nódulos su mayor dimensión cm extratorácica en 3 cm en b M1c Múltiples linfáticos involucrados T2 metástasis extratorácicasun único órgano f Tumor de más de 3 cm pero no INVASIÓN PERINEURAL o en múltiples en un único órgano más de 5 cm; o tumor con cualquiera órganos Número total de nódulos % de las siguientes Presente Indeterminada No identificada • de características Involucra bronquio linfáticos provenientes a. Esto incluye principal independienteme adenocarcinoma la distancia de este sitio in situ y carcinoma nte de b. El infrecuente tumor la carina, pero escamoso in situ. sin involucrar la de cualquier tamaño • Invade superficial con pleura visceral carina Número no puede ser determinado de propagación su naturaleza invasiva • Asociado con bronquial, el cual OTROS PROCESOS NEUROPLÁSICOS atelectasis o neumonitis podría extenderse limitada a la pared también es clasificado cerca al bronquio que se extiende obstructiva (p. ej. tumorlet, NEH, AAH, displasia) principal, hasta la región como T1a c. Adenocarcinoma hilar, parte del pulmón Estación 3 solitario (no más o el pulmón entero afectando T2a grande), con un de 3 cm en su involucrada Tumor de más dimensión más patrón predominantemen de 3 invasión de no te lepídico y mayor dimensión. cm pero no más de 4 cm en más su cualquier enfoque. de 5 mm en su mayor dimensión con una Número T2b de nódulos Tumor de más desde de 4 cm pero no d. Los tumores linfáticos involucrados T2 con estas características más de 5 cm en mayor dimensión su de 4 cm o menos se clasifican T2a o si el tamaño Número T3 total deTumor nódulosde más si son no si es mayor de de 5 cm pero no 4 cm pero no más se puede determinar y T2b más de 7 cm en linfáticos provenientes mayorde dimensión o uno de 5 cm. su e. La mayoría que invada directamente %ENFERMEDAD PULMONAR NO NEOPLÁSICA de los derrames este sitio cualquiera de las pleurales (pericárdicos) de pulmón se deben siguientes: pleura con cáncer torácica parietal, pared a un tumor. Sin Número no puede ser determinado (incluyendo pacientes, los embargo, en algunos los tumores del múltiples exámenes nervio frénico, pleural (pericárdico) microscópicos % pericardio parietal; sulcus superior), del líquido o nódulo(s) tumoral(es) separado(s) en no es sanguinolento son negativos para el tumor, el mismo lóbulo y el líquido y que no T4 es un exudado. el tumor primario Tumor de más elementos y el de 7 juicio clínico determinan Cuando estos % invada directamentecm o de cualquier tamaño que está relacionado que el derrame con cualquiera de las como un descriptor el tumor, el derrame debe excluirseno diafragma, mediastino, siguientes: de clasificación. corazón, grandes f. Esto incluye tráquea, nervio la participación vasos, recurrente laríngeo, de un solo nódulo vertebral, carina; esófago, cuerpo no regional. nódulo(s) tumoral(es) ## Reproduced en un lóbulo Version 3.0 published August 2017 ISBN: 978-1-925687-04-0 Page 2ipsilateral of 3 separado(s) with permission. Source:Brierley diferente que del and Wittekind JD, Gospodarowicz C (eds) (2016). tumor primario UICC TNM MK Tumours, INVASIÓN LINFOVASCULAR (Nota 11) Presente

No identificada

Indeterminada

Involucrado

INVASIÓN PLEURAL VISCERAL (Nota 12) Presente

No identificada

Indeterminada

No puede evaluarse

8th Edition, Wiley-Blackwell.

3 Page 1 of 687-04-0

ISBN: 978-1-925 published Version 3.0

(si existen)

PATRÓN TIPO DE

(Nota 2)

ESTUDIOS COMPLEMENTA Involucrado con carcinoma invasivo No involucrado RIOS Involucrado solamente con carcinoma in situ No aplicable Marcadores inmunohistoquí Involucrado solamente con tejido micos (Nota 16) blando peribronquial Anticuerpos positivos

Anticuerpos negativos Involucrado No involucrado No aplicable Anticuerpos Involucrado solamente con tejido blando perivascular no concluyentes Conclusiones:

Otro margen 1 (especificar p. ej. parénquima, pared torácica)

Involucrado

. ALCANCE ENTARIOS COMPLEM gris son 4) mm en texto L (Nota ÓN TUMORA DIMENSI AL IO PRINCIP o RA BRONQU INVOLUC No identificad No es aplicable Presente evaluar No se puede (Nota 5) o CARINA No identificad IMPLICA No es aplicable Presente evaluar No se puede (Nota 6) de la TUMOR de Tumores GICO DE Tumores de la Clasificación TIPO HISTOLÓ Genética de los que apliquen) proveniente Patología y (Lista de valores de la Salud. (2015)) (seleccione todos n Mundial y Corazón. Organizació Carcinoide Pleura, Timo s del Pulmón, Típico escamosa de células Atípico Carcinoma ntes Queratiniza antes No queratiniz células grandes Basaloide crino de neuroendo Carcinoma grandes de células Carcinoma pequeñas de células Carcinoma inoma Adenocarc

MÁXIMA

ia

Lobectom

ESTATUS DE MARGEN QUIRÚRGICO (Nota 14) Margen Bronquial

Margen vascular

No aplicable Menos de 10% de tumores residuales viables Más del 10% de tumores residuales viables Historia de tratamiento desconocida

escritos

PRINCIPA

negro son en texto

QUIRÚRG MIENTO PROCEDI de cuña Resección tomía Segmentec Otros, especificar

de órden/de

Indiferenciado No aplicable

RESPUESTA A TERAPIA NEOADYUVANTE (Nota 9)

nacimien

Colabor

mm

GRADO HISTOLÓGICO (Nota 8)

ón r de Pulm de Cánce en inglés) siglas patología de Histo Cáncer (ICCR, por sus – YYYY para Reporte DD – MM Fecha de Guía paraInternacional de Reporte to

Version 3.0 published August 2017

Classification of Malignant

ISBN: 978-1-925687-04

-0

Page 3 of 3

Where Are We Going Next? Our overarching goal at ASCP in global health is 100% access to diagnostics and ­treatment for all patients everywhere. Our cancer focus is broad, as a ­histology slide can diagnose any ­cancer from all body sites. Our technical interventions have/can include(d) histology, immunohistochemistry, flow c ­ ytometry, clinical laboratory medicine, molecular diagnostics, and targeted therapies. If you have any interest in more details about our plans, project impact, specific fiscal needs, or other programs, please reach out to ASCP directly ([email protected]). We would love to have your financial support for our ongoing efforts and ideally need multiple, committed funders for three years to reach our goal budget of $5 million+ dollars for 2019-2021.

For 2019 to 2021, ASCP needs multi-funder support for the following priority areas: Expansion of our existing core program of diagnostic support to an additional 10+ countries • • • •

Histology, telepathology, immunohistochemistry Increase in potential access from the current 50 million people up to 400 million people Increase in secondary consultations from 50 pathologists to 450 pathologists Increase in our member engagement from 77 members to 250 members

Expansion of in-person expert consultations through our own initiatives and collaborative programs in parallel with implementation planning and execution of pathology creation or improvement • Increased impact from our current 50 million people to 400 million people Creation of a “Laboratory Boot Camp” program pairing laboratory professionals with selected field sites to provide one-week, intensive training in specific topics developed with the needs of the field sites as a priority • Medical laboratory scientists/technologists, pathologists’ assistants, histotechnologists, and cytotechnologists • Projected impact is 1,000 to 1,500 trained individuals in LMICs per year • Projected member engagement is 40 to 80 members per year Expansion and ongoing support of our translation program from Spanish, French, and Portuguese for the existing 21 datasets • Current impact is 2.5 billion people (English, French, Spanish, Portuguese) • Increased impact to 4.5 billion people (Russian, Chinese, and German) • ICCR to release 54 additional datasets (about 10 to 20 per year) from 2019 – 2024 Development, with several partners, of a self-sustaining, external quality assurance program for cancer diagnostics in Africa through shared resources and cross-subsidy funding • Project impact in first phase 113 million people

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ASCP CENTER FOR GLOBAL HEALTH

www.ascp.org/globalhealth

Total ASCP CGH Funding for Global Health Activities (2016 – 2019) ASCP CGH Global Health Project Activities (excluding PEPFAR)

$4,232,000*

ASCP CGH PEPFAR Activities

$7,053,892

*Exclusive of ASCP member volunteer hours contributed

ASCP Center for Global Health 33 West Monroe Street, Suite 1600 Chicago, IL 60603

312.541.4999 www.ascp.org/globalhealth [email protected]