Leveraging Digital Histopathology to Build Capacity and Collaboration Toward the Diagnosis of Pediatric Solid Tumors in Mexico.
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PURPOSE: Pediatric pathology in Mexico remains limited by an uneven distribution of specialized training and constrained resources, which can affect the accuracy of pediatric malignancy diagnosis. This study aimed to evaluate national diagnostic capacity for common organ-based pediatric solid tumors-renal tumors, neuroblastic tumors, and hepatic neoplasms-through a retrospective hybrid central pathology review. A secondary objective was to identify targeted areas for capacity building and strengthen collaborative networking. MATERIALS AND METHODS: A hybrid retrospective pathology review (2005-2023) was conducted across eight institutions that treat pediatric oncology patients. Eligible cases included off-therapy patients age 0-18 years diagnosed with renal, hepatic, or neuroblastic tumors. Paraffin blocks, slides, clinical data, and original pathology reports were submitted. Cases underwent conventional pathology review, digital slide scanning, and joint virtual evaluation. Final diagnoses were compared between original, conventional central pathology review, and digital review, and individualized feedback was provided to each institution. RESULTS: A total of 162 specimens were reviewed, including 584 original stained slides, 940 paraffin blocks, and 1,168 digitized slides. At least 54 online review sessions were conducted, and 24 virtual feedback sessions were held. Overall diagnostic concordance across original, central, and digital evaluations was 80% for renal tumors, 90.9% for neuroblastic tumors, and 92.1% for hepatic neoplasms. Common limitations included inconsistent/inadequate sampling and incomplete/erroneous subclassification and reporting. CONCLUSION: Findings confirm strong baseline diagnostic capabilities for common pediatric solid tumors across participating Mexican centers, while highlighting specific gaps in sampling, reporting standardization, and access to ancillary testing. The project facilitated the creation of a pediatric pathology network, demonstrating that a hybrid centralized-digital review model can strengthen specialized pediatric pathology capacity in resource-limited settings.