As a practicing pathologist in India, I see a plethora of daily challenges that differ from those of my colleagues in more developed countries. I work in a private laboratory owned by me father, delivering histopathology, cytopathology, hematopathology, and clinical pathology. Each year, we process specimens from over 60,000 patients. Many of our cases involve tuberculosis, breast carcinoma, and leukemias. Alongside my work and learning, I also enjoy pathology education, regularly sharing cases on my Instagram page and on X.
In a low-income country, cost is the primary challenge for patient care. For pathologists, limited resources mean fewer tools to work with when making a diagnosis. However, because the primary goal of a correct diagnosis does not change, these constraints only serve to encourage innovation and adaptation.
For example, we developed our own Pap stain that can be de-stained for acid-fast bacilli (AFB) detection, producing excellent results. AFB detection in cytopathology is an important asset for developing countries. With proper skill and optimal conditions – such as a microscope with yellow light – we have achieved results comparable to PCR, with less than 1 percent difference in correlation. When clinicians request AFB status from tissue, we often divide the specimen: one part for histopathology, the other for PCR.
We sometimes encounter challenges with older clinicians who may not be as up to date with newer approaches. In one case, liquid-based cytology revealed squamous cell carcinoma and koilocytes. We suggested HPV testing, but the clinician deferred it to a tertiary care hospital. We explained the value to the patient, performed molecular HPV testing on the same liquid-based cytology sample, and confirmed HPV-16 positivity.
Unfortunately, not all patients can afford immunohistochemistry. In one instance, we distinguished between clear cell and chromophobe renal cell carcinoma using only Periodic acid-Schiff (PAS) staining. Cost constraints are significant – even fine needle aspiration cytology (FNAC) and biopsy reporting are often done for under $10, and sometimes for free.
And these financial hardships correlate to patients presenting late. Often patients delay care in favor of self-medication, hoping symptoms will resolve, only to later be diagnosed with malignancy. I remember a patient with massive lymphadenopathy who explained that, as a daily wage laborer, missing work for testing meant his family would go without food. His FNAC confirmed metastatic squamous cell carcinoma, and we decided not to charge him for the testing – it was the least we could do.
We also see patients traveling long distances, sometimes spending more on travel than on testing. To reduce their burden, we provide FNAC reports within an hour and offer digital report downloads.
These are just the experiences in my laboratory, but I’m sure other developing country pathologists are well accustomed to adapting with limited resources. From refining microscopy skills, to integrating clinical and radiological correlation in their work, these strategies are essential to ensuring accurate diagnosis despite the constraints. It can be argued that pathologists in these environments are among the most resourceful and skilled at their craft.
Newsletters
Receive the latest pathologist news, personalities, education, and career development – weekly to your inbox.
