{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T13:11:23Z","timestamp":1790082683636,"version":"4.0.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":245,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Makerere University Research and Innovation Fund","id":[{"id":"https:\/\/ror.org\/03dmz0111","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Breast cancer remains a leading cause of morbidity and mortality among Ugandan women, particularly in rural areas where pathology infrastructure and specialist access are limited. This study aimed to improve diagnostic efficiency and accuracy by digitizing breast cancer slides and implementing a web-based histopathology system to support remote diagnostics. A total of 100 glass slides from core breast biopsy samples were digitized using an Aperio AT2 slide scanner. A web-based breast histology information management system (BHIMS) was developed to store and provide remote access to these digital slides. Two experienced pathologists independently evaluated the slides using both conventional microscopy and the digital platform. Assessments focused on key morphological features, including cancer diagnosis, type, grade, mitosis, lymphatic invasion, nuclear pleomorphism, and tubule formation. Inter- and intra-observer agreement was analyzed using kappa statistics. Digital pathology showed high inter- and intra-observer reliability, particularly for cancer diagnosis and type. Slightly lower agreement was noted for nuanced features such as mitosis and lymphatic invasion. Conventional microscopy yielded stronger observer agreement and confidence, especially for mitotic count and invasion. Digital pathology offers a promising approach to improve breast cancer diagnosis in resource-limited settings. The BHIMS system enabled remote access and collaborative review of cases, supporting decentralized pathology services. However, broader adoption will require investment in high-resolution scanners, reliable internet, data storage, and training of pathologists. With these enhancements, digital pathology could significantly strengthen cancer care delivery in rural Uganda.<\/jats:p>","DOI":"10.1093\/oodh\/oqag034","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:49:07Z","timestamp":1788457747000},"source":"Crossref","is-referenced-by-count":0,"title":["Leveraging digital pathology to enhance breast cancer diagnosis in low-resource settings: a cross-sectional study of major histopathology laboratories in Uganda"],"prefix":"10.1093","volume":"4","author":[{"given":"Agnes R","family":"Semwanga","sequence":"first","affiliation":[{"name":"Department of Information Systems, Makerere University College of Computing and Information Sciences , University Road P.O. Box 7062, Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Serubugo","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Makerere University School of Public Health , New Mulago Hill Road, Mulago P.O. Box 7072, Kampala ,","place":["Uganda"]},{"name":"Department of Pathology, School of Biomedical Sciences, Makerere University College of Health Sciences , Pathology-Microbiology Building Upper Mulago Hill Road, Mulago P.O. Box 7072, Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent M","family":"Kiberu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Makerere University School of Public Health , New Mulago Hill Road, Mulago P.O. Box 7072, Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hawa","family":"Nalwoga","sequence":"additional","affiliation":[{"name":"Department of Pathology, School of Biomedical Sciences, Makerere University College of Health Sciences , Pathology-Microbiology Building Upper Mulago Hill Road, Mulago P.O. Box 7072, Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn K","family":"Kahiigi","sequence":"additional","affiliation":[{"name":"Department of Information Systems, Makerere University College of Computing and Information Sciences , University Road P.O. Box 7062, Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazarius M","family":"Tumwesigye","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Makerere University School of Public Health , New Mulago Hill Road, Mulago P.O. Box 7072, Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Kalungi","sequence":"additional","affiliation":[{"name":"Uganda National Cancer Institute , Upper Mulago Hill Road P.O. Box 3935, Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"2026092208261438200_ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.16925\/2357-6014.2019.03.01","article-title":"Predictive analysis of breast cancer using machine learning techniques","volume":"15","author":"Agrawal","year":"2019","journal-title":"Ing Solidaria"},{"key":"2026092208261438200_ref2","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1136\/jclinpath-2020-206764","article-title":"Diagnostic concordance and discordance in digital pathology: a systematic review and meta-analysis","volume":"74","author":"Azam","year":"2021","journal-title":"J Clin Pathol"},{"key":"2026092208261438200_ref3","doi-asserted-by":"publisher","first-page":"20552076211020240","DOI":"10.1177\/20552076211020240","article-title":"Diagnostic digital pathology implementation: learning from the digital health experience","volume":"7","author":"Betmouni","year":"2021","journal-title":"Digit Health"},{"key":"2026092208261438200_ref4","doi-asserted-by":"publisher","first-page":"e0219601","DOI":"10.1371\/journal.pone.0219601","article-title":"Breast cancer care in Uganda: a multicenter study on the frequency of breast cancer surgery in relation to the incidence of breast cancer","volume":"14","author":"Ekdahl Hjelm","year":"2019","journal-title":"PLoS ONE"},{"key":"2026092208261438200_ref5","doi-asserted-by":"publisher","first-page":"151","DOI":"10.5858\/arpa.2016-0025-RA","article-title":"The diagnostic concordance of whole slide imaging and light microscopy: a systematic review","volume":"141","author":"Emily","year":"2017","journal-title":"Arch Pathol Lab Med"},{"key":"2026092208261438200_ref6","doi-asserted-by":"publisher","first-page":"e71890","DOI":"10.7759\/cureus.71890","article-title":"Transforming diagnostics: a comprehensive review of advances in digital pathology","volume":"16","author":"Fatima","year":"2024","journal-title":"Cureus."},{"key":"2026092208261438200_ref7","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/s12957-015-0632-4","article-title":"Breast cancer survival experiences at a tertiary hospital in sub-Saharan Africa: a cohort study","volume":"13","author":"Galukande","year":"2015","journal-title":"World J Surg Oncol"},{"key":"2026092208261438200_ref8","first-page":"222","article-title":"Whole slide imaging equivalency and clinical implementation of digital pathology: recommendations from the College of American Pathologists","volume":"143","author":"Hanna","year":"2019","journal-title":"Arch Pathol Lab Med"},{"key":"2026092208261438200_ref9","first-page":"13","article-title":"Evaluating four of the most popular open source and free data mining tools","volume":"3","author":"Harmouch","year":"2015","journal-title":"IJASR Int J Acad Sci Res"},{"key":"2026092208261438200_ref10","doi-asserted-by":"publisher","first-page":"3697","DOI":"10.3390\/jcm9113697","article-title":"Digital pathology: advantages, limitations and emerging perspectives","volume":"9","author":"Jahn","year":"2020","journal-title":"J Clin Med"},{"key":"2026092208261438200_ref11","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1002\/ijc.32406","article-title":"Breast cancer survival in sub-Saharan Africa by age, stage at diagnosis and human development index: a population-based registry study","volume":"146","author":"Joko-Fru","year":"2020","journal-title":"Int J Cancer"},{"key":"2026092208261438200_ref12","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1186\/s12951-022-01640-1","article-title":"The recent advancements in the early detection of cancer biomarkers by DNAzyme-assisted aptasensors","volume":"20","author":"Kamali","year":"2022","journal-title":"J Nanobiotechnol"},{"key":"2026092208261438200_ref13","doi-asserted-by":"publisher","first-page":"S10","DOI":"10.1186\/1746-1596-6-S1-S10","article-title":"Interactive and automated application of virtual microscopy","volume":"6","author":"Kayser","year":"2011","journal-title":"Diagn Pathol"},{"key":"2026092208261438200_ref14","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s12960-020-0454-5","article-title":"Uganda\u2019s laboratory human resource in the era of global health initiatives: experiences, constraints and opportunities\u2014an assessment of 100 facilities","volume":"18","author":"Kiwanuka","year":"2020","journal-title":"Hum Resour Health"},{"key":"2026092208261438200_ref15","doi-asserted-by":"publisher","first-page":"5334","DOI":"10.3390\/cancers14215334","article-title":"The role of deep learning in advancing breast cancer detection using different imaging modalities: a systematic review","volume":"14","author":"Madani","year":"2022","journal-title":"Cancers."},{"key":"2026092208261438200_ref16","first-page":"239","article-title":"Breast carcinoma malignancy grading by bloom\u2013Richardson system shows poor interobserver agreement among experienced pathologists","volume":"124","author":"Meyer","year":"2005","journal-title":"Am J Clin Pathol"},{"key":"2026092208261438200_ref17","doi-asserted-by":"publisher","first-page":"36","DOI":"10.4103\/2153-3539.83746","article-title":"Review of the current state of whole slide imaging in pathology","volume":"2","author":"Pantanowitz","year":"2011","journal-title":"J Pathol Inform"},{"key":"2026092208261438200_ref18","doi-asserted-by":"publisher","first-page":"095005","DOI":"10.1088\/1361-6560\/ad37ea","article-title":"Comparison of semi-automatic and manual segmentation methods for tumor delineation on head and neck squamous cell carcinoma (HNSCC) positron emission tomography (PET) images","volume":"69","author":"Philip","year":"2024","journal-title":"Phys Med Biol"},{"key":"2026092208261438200_ref19","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/j.hoc.2023.05.015","article-title":"Providing diagnostic pathology services in low and middle-income countries","volume":"38","author":"Ruhangaza","year":"2024","journal-title":"Hematol Oncol Clin North Am"},{"key":"2026092208261438200_ref20","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/PAS.0000000000000948","article-title":"Whole slide imaging versus microscopy for primary diagnosis in surgical pathology: a multicenter blinded randomized noninferiority study","volume":"42","author":"Sanjay","year":"2018","journal-title":"Am J Surg Pathol"},{"key":"2026092208261438200_ref21","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1111\/his.12879","article-title":"Validation of digital pathology imaging for primary histopathological diagnosis","volume":"68","author":"Snead David","year":"2016","journal-title":"Histopathology."},{"key":"2026092208261438200_ref22","doi-asserted-by":"publisher","DOI":"10.1002\/bimj.19680100122","volume-title":"Survey Sampling","author":"Wiegand","year":"1965"},{"key":"2026092208261438200_ref23","doi-asserted-by":"publisher","first-page":"20211033","DOI":"10.1259\/bjr.20211033","article-title":"Understanding breast cancer as a global health concern","volume":"95","author":"Wilkinson","year":"2022","journal-title":"Br J Radiol"},{"key":"2026092208261438200_ref24","first-page":"563","article-title":"Digital pathology access and adoption in clinical practice: a systematic review","volume":"71","author":"Williams","year":"2018","journal-title":"J Clin Pathol"},{"key":"2026092208261438200_ref25","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s13000-025-01610-9","article-title":"An update on applications of digital pathology: primary diagnosis; telepathology, education and research","volume":"20","author":"Zia","year":"2025","journal-title":"Diagn Pathol"}],"container-title":["Oxford Open Digital Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/oodh\/advance-article-pdf\/doi\/10.1093\/oodh\/oqag034\/70948039\/oqag034.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/oodh\/article-pdf\/doi\/10.1093\/oodh\/oqag034\/70948039\/oqag034.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/oodh\/article-pdf\/doi\/10.1093\/oodh\/oqag034\/70948039\/oqag034.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:26:19Z","timestamp":1790079979000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/oodh\/article\/doi\/10.1093\/oodh\/oqag034\/8785050"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":25,"URL":"https:\/\/doi.org\/10.1093\/oodh\/oqag034","relation":{},"ISSN":["2754-4591"],"issn-type":[{"value":"2754-4591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026]]},"published":{"date-parts":[[2026]]},"article-number":"oqag034"}}