Pathology - science for patients

Since the 19th century is pathology considered one of the crucial medical sciences. Unlike in the past, when the discipline was focused mainly on autopsies, since the last 50 years is the major part of the workload represented by surgical pathology, where the result of the pathological examination directly decides about the choice of appropriate treatment of living patients.

Recent development in pathology illustrates very well how quickly and progressively does change the current concept of modern medicine. Whereas in the last decades of 20th century was pathology virtually synonymous to sole morphological examination when microscopy (including all special techniques, such as electron microscopy, enzyme histochemistry and immunohistochemistry) played the most important role in establishing diagnosis in pathology, the start of new century is characterized by change of paradigm. Result of modern histopathological examination represents a synthesis of several tests - morphology (which still remains and for a long time yet will remain an important and irreplaceable part of the discipline) is nowadays supplemented by methods of molecular genetics (in situ hybridization, PCR, sequencing, CGH, etc.). Hence, the term molecular pathology seems to be the most appropriate designation of the discipline.

This development is mirroring the change of the clinical practice in many fields, probably most evident in oncology. As the oncologist today does not need for the decision about the choice of appropriate treatment only correct histological diagnosis (including grade, stage, evaluation of resection margins, etc.) but also much more detailed information about the molecular profile of the neoplasm, pathologist has to detect various prognostic and predictive markers (e.g. expression of hormonal receptors, proliferative activity, status of HER2 in breast carcinoma, or activating mutations of KRAS, NRAS and BRAF in metastatic colorectal carcinoma) and include these results in his final report.

The number of various molecular markers required to be detected by pathologists is increasing very quickly and perhaps in the near future, we will be facing several issues. One of them is the problem of sufficient amount of material (e.g. in lung cancer patients, where majority of cases is detected solely from small endobronchial/transthoracic biopsies). Another is economical issue, as the costs of such complex testing is steeply growing, although it still represents much lower figures than the costs of subsequent treatment based on the results of these tests. Still another issue might be the sufficient number of pathologists as the increasing precision and detailed growing number of tests presumes much more efforts of pathologist resulting in progressively increasing workload.

We live in an exciting period of history, when the new scientific achievements do change the practice of everyday modern medicine. However, if we will not identify and successfully solve the potential issues, the future progress may be limited by several factors. Modern pathology is a discipline which proved to be an integral part of the current multidisciplinary approach in diagnostics and treatment of the patients.

Supported by Charles University project PRVOUKP37/11