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For global adoption, studies in currently under-represented populations \u2013 where the potential gains from AI may also be greatest \u2013 are needed. We present the first external validation study in a Middle Eastern setting, focusing on diagnosis and Gleason grading of prostate cancer. We digitised 339 prostate glass slides from Kurdistan, Iraq, representing a consecutive series of 185 patients from 2013 to 2024. Each slide was scanned on three digital pathology scanners, generating 1,017 whole-slide images. Task-specific and foundation AI models demonstrated AI-pathologist grading concordance similar to pathologist-pathologist concordance (Cohen\u2019s quadratically weighted kappa 0.801 vs. 0.799). Cross-scanner concordance was high (kappa\u2009&gt;\u20090.90) for all AI models across three scanners. The demonstrated robust performance on a low-cost compact scanner could enable validation studies in non-digitalised settings and cost-effective AI adoption in laboratories with limited sample volumes. The publicly shared dataset supports further research to facilitate broader adoption of AI pathology.<\/jats:p>","DOI":"10.1007\/s00428-026-04742-5","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T10:16:04Z","timestamp":1791627364000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Validation of diagnostic artificial intelligence models for prostate pathology in a Middle Eastern cohort"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0471-5172","authenticated-orcid":false,"given":"Peshawa J.","family":"Muhammad Ali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2894-6319","authenticated-orcid":false,"given":"Navin","family":"Vincent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saman S.","family":"Abdulla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han N.","family":"Mohammed Fadhl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Blilie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin","family":"Szolnoky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia Anna","family":"Mielcarz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyi","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nita","family":"Mulliqi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulbasit K.","family":"Al-Talabani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9470-4783","authenticated-orcid":false,"given":"Kimmo","family":"Kartasalo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"key":"4742_CR1","doi-asserted-by":"publisher","first-page":"100933","DOI":"10.1016\/j.landig.2025.100933","volume":"7","author":"LA Shaktah","year":"2026","unstructured":"Shaktah LA, Carrero ZI, Hewitt KJ et al (2026) Application of artificial intelligence and digital tools in cancer pathology. 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Digital scanning and processing of the samples at Karolinska Institutet was approved by the Swedish Ethical Review Authority (permit 2019\u201305220). The samples were de-identified before shipping to Karolinska Institutet. Informed consent was waived by the ethical review board due to the use of de-identified prostate specimens in a retrospective setting. This study complies with the Helsinki Declaration.","order":1,"name":"Ethics","label":"Compliance with ethical standards","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"N.M. and K.K. are shareholders of Clinsight AB. Other authors declare no competing interests.","order":2,"name":"Ethics","label":"Conflict of interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}