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The integration of molecular diagnostics with therapeutics represents an opportunity for pathologists to emerge as leaders in personalized medicine, according to Jared N. Schwartz, MD, PhD, Pathology and Lab Medicine at Presbyterian Healthcare in Charlotte, North Carolina, USA. He gave a presentation at the second annual Molecular Summit on the integration of imaging and diagnostics, held in Philadelphia, Pennsylvania, earlier this year, which highlighted a new role for pathologists in the era of personalized medicine.
Diagnosis: past and present
The way pathologists make a diagnosis hasn’t really changed in a very long time, explained Schwartz. “Diagnoses are made based on what we see on through a microscope. An experienced pathologist can look at a sample on a slide and determine whether the cells are malignant or not malignant,” he said.
The mapping of the human genome, though, is producing unprecedented changes in today's healthcare. “We now have a whole-genome approach to molecular diagnostics,” said Schwartz. Molecular diagnostics categorize disease at the DNA level by determining how genes and proteins are interacting in a cell to cause that disease. Molecular diagnostics integrated with therapeutics allows for the detection of disease predisposition, screening, earlier disease diagnosis, and prognosis assessment, as well as optimal dosage and route of administration.
Opportunities and challenges
This convergence of molecular imaging and diagnostics offers an opportunity for pathologists to play a key role in patient care. Pathologists are the ones who are essentially writing the patient’s prescription, explained Schwartz, adding that when pathologists make a diagnosis of a malignancy, they are triggering a lengthy course of events for the patient that could involve surgery, chemotherapy, radiation therapy, and more. Earlier diagnoses and more precise prognosis assessment may spare the patient both time and unnecessary tests or treatment.
Being a core member of the healthcare team also comes with its share of challenges. Quality control is one challenge, noted Schwartz, as is lack of standardization. “When the treatment team is located in different buildings or different cities, we have to find a way to all work together,” said Schwartz. “A systems solution is required.”
Molecular imaging and tests can provide the decisive information needed for diagnosis and treatment
Pathologists are in a position to directly impact patient care
Quality control and standardization are challenges that need to be overcome