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| COMMENT |
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| Year : 2022 | Volume
: 2
| Issue : 1 | Page : 52-53 |
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The role of the pathologist in the next-generation era of molecular oncology
Amrit Kaur Kaler1, US Vishal Rao2
1 Department of Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
2 Centre for Academic Research, HCG Cancer Center, Bengaluru, Karnataka, India
| Date of Submission | 11-Aug-2021 |
| Date of Decision | 22-Oct-2021 |
| Date of Acceptance | 12-Mar-2022 |
| Date of Web Publication | 03-May-2022 |
Correspondence Address:
Dr. Amrit Kaur Kaler
Consultant Molecular Pathologist, Department of Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jpo.jpo_9_22
How to cite this article:
Kaler AK, Vishal Rao U S. The role of the pathologist in the next-generation era of molecular oncology. J Precis Oncol 2022;2:52-3 |
Since the advent of comprehensive genomic analysis in diagnostics, there has been an increase in demand for translation of molecular data into clinical practice. A pathologist is a clinician who not only provides a morphological diagnosis but may also forecast the behavior of a tumor under slide and offer tissue biomarkers that may assist guide treatment decisions, commonly known as “morphogenomics”.[1] In other words, next-generation pathologists (NGPs) bridge the gap between molecular pathogenesis of genomic biomarkers with cancer prognosis and prediction, also referred to as “precision medicine.” This target-based approach has revolutionized existing cancer therapeutic protocols and is rapidly becoming the “core dogma” of patient care to avoid the potential side effects of chemotherapy.[2]
Tumor tissue is heterogeneous, so there can be differences in pathogenic mutations at the primary and metastatic sites, as well as within the same tumor tissues, which has not been sampled.[1] To reduce sampling errors, NGP selects tissue or samples for genetic testing that appropriately represent the tumor or disease process. This has allowed modern technologies such as multiple parallel sequencing, single cell sequencing to operate seemlessly for somatic testing. It is critical to gain a better understanding of cancer pathways, truncating proteins, and transcription factors that contribute to oncogenesis.[2]
Over time, the patient may develop resistance to medication as a result of receptor change, or other mutations may impact the pathways. As a result, NGPs can detect such mutations and help with treatment decisions, such as whether to use an aggressive combination therapy to prevent new mutations from occurring, or which pathogenic mutations should be targeted first based on their impact on other pathways.[2] As a result, oncologists, surgeons, radiologists, and NGPs must all work together in a multidisciplinary team to treat patients.
Therefore, we must teach our junior staff, motivate them, and disseminate our molecular pathology information to postgraduate medical schools. Incorporating molecular profiling into the Pathology Laboratory has result in novel patient treatment workflows. It could include reflex tests, epidermal growth factor receptor, c-ros homolog (ROS), and anaplastic lymphoma kinase in lung cancers; BRAF in melanomas; MGMT/IDH1/1p19q codeletion in central nervous system tumors; c-KIT/PDGFRA in gastrointestinal stromal tumor; cMYC in lymphoma; ER/PR/Her2Neu/PIK3CA in breast cancers; and BRCA1/2 status in ovarian malignancies.[3]
The development of personalized medicine, which has since become the underpinning of clinical therapeutic decisions, put an end to pathologist's solitude. Hence, genomics and precision oncology only achieve their highest level of validation when they provoke a “twinkle” in patient's eyes.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Angerilli V, Galuppini F, Pagni F, Fusco N, Malapelle U, Fassan M. The role of the pathologist in the next-generation era of tumor molecular characterization. Diagnostics (Basel) 2021;11:339.  |
| 2. | Fassan M. Molecular diagnostics in pathology: Time for a next-generation pathologist? Arch Pathol Lab Med 2018;142:313-20. |
| 3. | Harris G, O'Toole S, George P, Browett P, Print C. Massive parallel sequencing of solid tumours – Challenges and opportunities for pathologists. Histopathology 2017;70:123-33. |
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