Telepathology expert consultation platform-implementation and lessons from a tertiary hospital in Tanzania

Cancer is a leading cause of mortality worldwide, yet access to specialized pathology services remains limited in many low- and middle-income countries, including Tanzania. Telepathology offers a practical means to expand diagnostic capacity and improve timely cancer care. Through a partnership with the American Society for Clinical Pathology (ASCP) and Duke University, Kilimanjaro Christian Medical Centre (KCMC) implemented a telepathology consultation platform to provide expert review for diagnostically challenging cases.

This cross-sectional observational study analyzed challenging pathology cases submitted for teleconsultation between September 2018 and March 2025. Whole-slide images were reviewed by pathologists from Duke University, Radboud University Medical Centre, Princess Máxima Center, ASCP-Tanzania, and the Medical College of Wisconsin. Diagnostic concordance between local and expert interpretations was measured. Turnaround time (TAT) and subspecialty variation were analyzed using descriptive statistics and χ2 testing.

A total of 1266 cases were reviewed, representing 16 different subspecialties. Hematopathology (28.4%), head and neck pathology (17.1%), and soft tissue pathology (9.9%) were the most frequently consulted. The overall concordance rate was 44.79% (567/1266), with a partial concordance rate of 19.75% (250/1266) and a discordance rate of 32.78% (415/1266). Concordance varied significantly across subspecialties (χ2(15) = 31.90, P = .0066). The mean TAT was 18.3 days, with a downward trend from 2018 to 2025.

Implementation of telepathology at KCMC is feasible and provides a sustainable model for expanding access to expert pathology consultation in resource-limited settings. Despite modest concordance rates, telepathology enhanced diagnostic accuracy, education, and quality assurance, while TATs improved over the study period. Continued investment is needed in digital infrastructure.