This month we ask: Is pathology ready for molecular pathology?
Brendan O'Sullivan
Cellular Pathology - Operations Manager in Molecular Pathology
University Hospitals Birmingham NHS Foundation Trust
If not, many of those working in UK healthcare laboratories may begin to wonder exactly what we’ve been doing for the past decade.
We should acknowledge the implicit confusion over the term “molecular pathology”. Do we consider it to mean (as I believe) any analysis in which specific, detectable molecular alterations, be they to nucleic acid sequences or protein expression profiles, give us proven diagnostic, prognostic, or predictive information about a pathological process? If so, have labs not provided this information daily for many years? Or do we mean instead the coming genomics “revolution”?
In this case, no, we are not. Until we genuinely understand how routine application of genomic analysis will genuinely benefit patients, we cannot prepare in full. The ambitious 100,000 Genome Project may bring this understanding but we should not lose sight of where current developments in molecular pathology are revolutionising healthcare.
In the past year, patients have benefitted most from the application of new technologies to existing precision testing, or traditional technologies to new precision therapies.
If we labour under the impression that molecular pathology concerns only what is yet to come, we devalue the great work already performed as routine. We are in need of continued evolution in pathology, not revolution.
We have to remember that molecular pathology is an adjunct to clinical pathology
Matthew Griffiths
Senior Lecturer in Cellular Pathology
Nottingham Trent University
My initial thought is that pathology is ready for anything – I think that we are as prepared as we can be. There is some work still to do, but this is something that has been in development for a number of years.
Everywhere, from cutting-edge to routine laboratories, everyone knows about molecular pathology, even if this is at a fairly basic level.
The more specialist elements will be developing over time. For example, PD-L1 is going to be a fairly routine test over the next few years. Some people will not have heard of it yet, but with the IBMS we have got some great support. Even if there are individuals who are not ready, the profession as a whole is.
I am expecting to see gradual change – this will be something that gathers momentum over a period of time.
As things gradually start to fall into place and the training all begins to align, we will start to move forward and we can have molecular pathology as a discipline that lies under our umbrella.
This also represents an opportunity for the profession, however, there will inevitably be a lag phase.
Initially, this is likely to mean more work. However, ultimately, the changes will lead to earlier diagnostics and improved screening programmes.
So, in the long term we are looking at better technology, that will lead to time savings, even if that will take a while to come about.
Gary Reynolds
Cellular and Molecular Pathology Lead
Institute of Immunology and Immunotherapy, University of Birmingham
After many years we are moving in the right direction at a greater pace than ever before, in part, due to clinical demand. As long as we have the right numbers and academic level of staff (who know the basics of cellular and molecular pathology), we can take full advantage. The political will and financial support is here so molecular pathology will be “embedded” in pathology.
