Rules and organisation for the future of molecular pathology

Understanding of the molecular mechanisms of disease constantly increases. As a result, the concept of pathology is changing. Today, as a discipline, pathology is the study of the etiology and pathogenesis of disease through analysis of both the morphological and molecular modifications of cells and tissues, and as a profession it involves using the knowledge of the etiopathogenesis of the disease to make a diagnosis and provide prognostic and therapeutic information. Molecular Pathology (MP) is today universally acknowledged as the modern face of Pathology and more frequently it is defined as the Pathology of the future. In addition to covering the two classic areas of diagnosis and prognosis, MP has also allowed Pathologists to be involved in the therapeutic process. It is considered a relevant component of Molecular Medicine and of the so-called Personalized Medicine. The development of the two main branches of molecular biology, genomics and proteomics, has given strong input to immunohistochemistry (IHC), which is today an integral part of Molecular Pathology. All the methods capable of studying genes and proteins are considered tools of MP and these can be divided into two: 1) Molecular Biology, where nucleic acids and proteins are analyzed after their extraction, 2) Molecular Morphology, where they are studied in situ, with techniques such as IHC, FISH or SISH, etc. Opportunely, IHC can be considered as in situ proteomics. The ever more extensive use of Molecular Pathology and its current role in predicting response to specific drugs and requires high standard laboratories and very qualified personnel. As a consequence, the organization of the laboratories and "who has to do what" is an important topics of discussion.

The involvement of Pathologist in the therapeutic process requires the development of a biomolecular culture and intense collaboration with Clinical Oncologists. The Pathologist has to know exactly what information to ask for, which techniques are used, how to interpret the molecular data and to include them in the final report. Moreover, the "microenvironment" of a Pathology Department will change, in relation to various types of professional experiences: pathology, molecular genetics, proteomics, etc. intense educational programmes all over Europe are necessary for the achievement of this goal.