ID #207 Global Landscape of Pediatric Neuropathology Resources in LMICs: Results from the PANORAMA+ Study

Abstract Background Accurate diagnosis of pediatric CNS tumors increasingly relies on molecular characterization, as mandated by the 2021 WHO Classification of CNS Tumors. However, the capacity to implement these standards in low- and middle-income countries (LMICs) remains poorly characterized. The PediAtric Neuro-Oncology seRvices AssessMent Aid Neuropathology (PANORAMA+) study aimed to evaluate the current landscape of neuropathology capacity in these settings. Methods We conducted a cross-sectional survey of clinicians and pathologists practicing in LMICs between November 2025 and January 2026. The survey assessed workforce capacity, access to diagnostic technologies (IHC, FISH, sequencing, methylation), and barriers to neuropathologic care. Results We analyzed 37 responses from institutions in upper-middle-income (40.5%), lower-middle-income (54.1%), and low-income (5.4%) countries across Asia (48.6%), Africa (27.0%), Latin America (21.6%), and Europe (2.7%). At these institutions, the average number of new pediatric CNS tumor cases per year is 84.4. Fewer than half of institutions (43.2%) had a dedicated neuropathologist. While basic immunohistochemistry was more widely available (Ki-67: 83.8%; p53: 70.3%; INI1: 62.2%), advanced molecular capabilities were scarce. Only 4 institutions (10.8%) had access to DNA methylation profiling, and 8 (21.6%) to sequencing. Consequently, specific molecular subgrouping was limited. For example, only 10.8% could molecularly subgroup medulloblastoma, and 37.8% could identify H3 K27 alterations. Crucially, only 37.8% of institutions utilized pathology reports aligned with the 2021 WHO classification, while 29.7% considered the classification “unsuitable” for their setting. Barriers to care were profound: 19 institutions (51.4%) relied on outsourced testing, and in 17 (45.9%), families were required to pay out-of-pocket to cover neuropathology services. Conclusions Pediatric neuropathology resources in LMICs are significantly constrained, creating a widening gap between global diagnostic standards and local realities. Targeted training initiatives, international collaboration, and expanded access to affordable diagnostic technologies are critical to reducing disparities in pediatric neuro-oncologic care.