Analysis of Anatomical pathology laboratory capabilities in eastern Democratic Republic of Congo

The objective of this study was to evaluate the infrastructure and diagnostic capacity of pathology laboratories in eastern Democratic Republic of Congo (DRC). A multi-site study was conducted using a mixed methods approach to analyse laboratory equipment, human resources and diagnostic performance. Data were collected from February to April 2023 in eastern DRC. The results show a concentration of laboratories in urban areas covering a population of 3 provinces (South Kivu, North Kivu and Haut Katanga), leaving 9 provinces with no diagnostic coverage and a population of over 26.8 million people. The analysis revealed a significant gap in anatomical pathology laboratory services. Major deficiencies were identified, including the lack of immunohistochemistry, which is only available at the Panzi General Referral Hospital in South Kivu Province, the absence of computerised sample tracking systems and non-standardised quality control protocols. Human resources are also insufficient, with most laboratories operating with a single pathologist and minimal histotechnician support. Histopathology accounted for 73.4% of processed samples, with inflammatory and infectious lesions comprising 41.2% of diagnoses. The most common malignancies were cervical cancer (16.6%), prostate cancer (14.1%), breast cancer (13.9%), and colorectal cancer (3.0%). Limited cytological analyses, particularly the absence of fine-needle aspiration procedures, further hinder diagnostic accuracy. These findings underscore the urgent need to expand and equip pathology laboratories, implement standardized quality assurance measures, and establish continuous training programs for laboratory personnel. Addressing these deficiencies is critical to improving cancer diagnostics and broader healthcare services in the DRC.