Pathology has changed a lot in the last few years. Many advanced technologies such as Digital Atlas, etc. has paved way for the many enhancement in the accuracy of the analysis report.
The advances in cancer biomarkers and immunotherapies have added a new role for pathologists and laboratories. Finally there are some tools in our toolbox that allow for minimally invasive testing, predictive and prognostic assays with companion diagnostics, and therapies with far fewer systemic complications than conventional chemo and radiotherapies.
Among the hope and promise of these evolving companion diagnostics, with many active ongoing clinical trials, is trying to figure out the role of the pathologist to implement these assays in their laboratories and educate technicians and patients about the test results.
There is, however, recognition that while a particular tumor may not express, say a programmed cell death ligand, an individual patient may respond to anti-programmed cell death ligand inhibitors OR may express OR not express a particular biomarker in the absence or presence of “pre-sensitizing” adjuvant chemotherapy.
We start to create more questions and issues to address in a healthcare environment now keen on “accountable care organizations” and “population-based” approaches. And someone is going to have to communicate the nuances of the testing and results to the patients.
With lessons learned from the past with biomarkers in tissue, such as warm and cold ischemia, formalin-fixation time, technical issues and inter-observer issues, pathologists have addressed and worked with oncologists to standardize testing and reporting to patients.
It won’t be simple or easy, or perhaps welcomed by many pathologists, but anything worth doing is rarely simple or easy, and pathologists need to educate themselves for a new role for pathologists in 2017 and beyond.