Diagnostic and Cost Benefits of Tissue Microarray Technology for Multiplex Biomarker Testing in Molecular Oncology: A Libyan Perspective
DOI:
https://doi.org/10.54361/LJMR.20.1.24Keywords:
tissue microarray, cost-effectiveness, immunohistochemistry, molecular diagnostics, cancer biomarkersAbstract
Background: Tissue microarray (TMA) technology allows simultaneous testing of multiple tissue samples on a single slide, significantly reducing reagent consumption, slide use, and overall diagnostic costs. In resource-limited settings such as Libya, high pathology expenses hinder access to essential biomarker testing in oncology. This study assesses the diagnostic value and cost-effectiveness of TMA for key biomarkers, including PD-L1, KRAS, BRAF, MSI, MMR, HER2, and p53.Methods: A total of 396 confirmed cancer cases (breast, colorectal, and lung) were included. TMAs were manually constructed using 1.5 mm tissue cores, with 72 cores per block. Immunohistochemistry and molecular analyses were performed for PD-L1, HER2, p53, ALK, MMR proteins (MLH1, MSH2, MSH6, PMS2), KRAS, BRAF, MSI, and gene fusions. Costs for traditional full-slide testing were compared to TMA-based testing in Libyan Dinar (LYD). Due to non-normal data distribution, the Wilcoxon Signed-Rank Test was used to evaluate cost differences. Results: TMA implementation resulted in a 92.6% reduction in total diagnostic costs, decreasing overall expenditure from 289,750 LYD to 21,475 LYD. All biomarkers demonstrated substantial cost savings, with reduced variability in test pricing post-TMA. Non-parametric analysis confirmed a significant difference between pre- and post-TMA costs (p = 0.005). Diagnostic quality and marker expression assessment remained consistent across all TMA-tested samples.Conclusion: TMA is a highly cost-effective platform for multiplex biomarker testing in oncology and provides a practical solution for laboratories in resource-constrained health systems. By enabling large-scale, standardized testing with minimal reagent waste, TMAs can expand access to essential cancer biomarkers, reduce financial barriers, and support more timely and equitable cancer diagnosis in settings such as Libya.
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Copyright (c) 2026 Najah Bobtina , Enas Shaafi , Mohamed K A Elkawafi, Mohammed A Almabrouk , Faraj Z Alfallah , Anwaar E Salem , Mariam G. Bosafita , Yousef M Ali Hasen , Moutaz F Gebril , Boubaker A Elamamy , Malak M Alkrgli , Ahmed Benhasouna , Faraj A Bleiblo , Souad A Moftah , Salem Aldrsy , Ahmed A Alhaddad, Ahmed S Mikeal , Mahmoud A Aloriby (Author)
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