Implementation of digital pathology in a low-resource setting: opportunities and challenges

Abstract Background Digital pathology (DP) offers significant advantages in diagnostic efficiency and reproducibility. However, its implementation in low-resource settings remains challenging due to cost, infrastructure limitations, and workflow constraints. Objective To describe the implementation and validation of a digital pathology workflow in a high-volume laboratory in Northeastern Brazil, highlighting strategies for deployment in a low-cost environment. Methods A midrange scanner (MoticEasyScan®) was integrated with the laboratory information system (apLIS®) to support whole slide imaging (WSI) for hematoxylin and eosin (H p < 0.05). Challenges included limited scanner throughput, storage demands (~ 12 TB/quarter), and variable monitor quality. Despite these constraints, the laboratory successfully digitized 60% of its routine workload, facilitating case review, image sharing, and research expansion. Conclusion This study demonstrates the feasibility of implementing digital pathology in resource-limited settings using cost-effective solutions and workflow optimization. The validated process offers a scalable model for similar laboratories, with potential to integrate artificial intelligence tools in future diagnostic applications.