The role of pathology in personalised medicine

The role of a pathologist in diagnostic process of neoplastic diseases follows new trends of development in recent two decades. On one side pathologists are still traditionally focused on a diagnostic process as such which keeps improving classifications of neoplasms together with an improved assessment of the tumor grade and stage of the disease. Beside that, pathologists together with biologists are now challenged by new tasks in diagnostic-therapeutic process which gives the oncologic treatment a new dimension in using targeted molecule-oriented diagnostics. As new molecules become available as target sources of anti-neoplastic treatment and they are used by clinical oncology, pathologists and biologists are addressed with an increasing frequency to follow this trend and to use technologies capable of analysis at the level of individual molecules both at the protein and at the nucleic acid level. The authors will demonstrate the development of the targeted diagnostics at two different levels as so called personalized approach to the treatment. The first one uses analysis of genes and proteins which become potential targets of the newly developed drugs and biological agents if the expression of the particular molecule is present or its mutational status justifies the oncologist to introduce the specific treatment. The other trend of personalized approach utilizes detection of the minimal disseminated disease in certain types of malignancies and this enables individualized patient approach of treatment strategy directly according to the actual status.

To fulfill this task, pathologists must see the patient not only through the microscope but with an interdisciplinary approach. They should share their experience, advantage of understanding the tissue investigation through classical microscopic techniques and associated specialized laboratory methods with further specialists who are able to address individual tasks of the contemporary medicine. As this approach is directed towards individual patient´s disease profile, all the subjects involved in this process should work as a united team and with a close contact with clinical oncologists.