Crossing Borders for Pathology Capacity Building in a Regional Setting: A Pediatric Oncology Initiative

Barriers to accurate histopathologic diagnosis in lower middle-income countries (LMIC) undermine appropriate patient outcomes. We report the results of a regional LMIC twinning initiative, with the support of a high-income country institution, for building capacity in histopathologic diagnosis of pediatric cancers.

A pathology review initiative was conducted between July 2019 and June 2024, where 6 cases per month from a developing center in Syria were reviewed regionally at an established center in Lebanon. Cases for which no diagnosis could be made were sent to St Jude Children's Research Hospital for a third read. Monthly meetings were held to discuss diagnoses and reasons for discrepancies. Biannual capacity building meetings were held to discuss opportunities for improvement.

A total of 81 cases were reviewed, of which 44 were extracranial solid tumors, 29 brain tumors, and eight hematologic malignancies. Of these, 77 were of sufficient quality, and seven were sent for a third read. Among the 70 cases with a regional final diagnosis, 53 (76%) were concordant, 12 (17%) had major discrepancies, and 5 (7%) had minor discrepancies. Reasons for discrepancies were morphologic interpretation (n = 9, 52%), combined interpretation and immunohistochemistry (n = 4, 24%), and unavailability of specific immunostains (n = 4, 24%). The highest number of discrepancies were in brain tumors, followed by solid tumors. Several opportunities were identified for local improvement and patient safety, including focused pathologist training and specific assay development.

Our results demonstrate the feasibility of a supported regional south-south twinning initiative in building capacity for accurate pediatric oncology histopathology. Beyond knowledge transfer, it revealed areas for local improvement including specific local laboratory processes, technical training, and local reporting tools.