To evaluate the feasibility and clinical impact of international outsourcing of molecular diagnostics for CNS tumors in a limited-resource setting.
Approach:
Study Design: Retrospective review of CNS tumor cases at King Hussein Cancer Center (KHCC) in Jordan that underwent outsourced molecular testing at the Hospital for Sick Children in Toronto, Canada, from 2021 to 2023.
Tests Conducted: Four types of molecular tests were ordered: medulloblastoma subgrouping, TruSight pan-cancer RNA sequencing, low-grade fusion gene analysis, and C19MC fluorescence in situ hybridization (FISH).
Data Collection: Recorded turnaround time (TAT), cost, conclusive result rate, impact on diagnosis, and identification of actionable therapeutic targets for each case.
Key Findings:
A total of 105 patients underwent outsourced molecular tumor testing, with 87% being pediatric and a median age of 10 years.
Of the 119 samples that reached the reference laboratory, 109 (92%) yielded conclusive molecular results, with the highest rate in medulloblastoma (94%) and the lowest in ependymoma (33%).
The median overall turnaround time was 26 days, and the total expenditure was 153,506 US Dollars.
Molecular testing led to a change in diagnosis in 4% of cases, with actionable targets identified in 27% of tumors.
Interpretation:
International outsourcing of molecular diagnostics is a strategy for CNS tumor management in limited-resource settings, facilitating access to precision therapy.
Limitations:
The study is retrospective and may not capture all variables influencing outcomes.
Outsourcing may not be sustainable long-term without investment in local infrastructure.
Conclusion:
Outsourcing molecular diagnostics can enhance access to targeted therapies in resource-limited settings, but permanent solutions require regional capacity building.
