In the field of health, resistance to change is useless; technological advances cannot be ignored . It has occurred from the discovery of penicillin and vaccines to the introduction of antiretroviral drugs, through the appearance of minimally invasive surgery, endoscopy, and chemotherapy or radiology treatments.
In the beginning, none of these innovations allowed to anticipate in all their magnitude the transcendental changes that would derive from their application, and, likewise, all required significant modifications in the way of working.
The transformations that will shape the next generation of hospitals have been analyzed in the report The Changing Role of the Hospital in European Health Systems , published by the European Observatory of Health Policies and Systems of the WHO. Its authors – specialists and hospital managers – coincide in claiming a leadership position for a figure, unknown to the general public, who has gained great relevance during the COVID-19 crisis : pathologists.
And what exactly does your job consist of? One part focuses on the analysis of tissue fragments –biopsies– or cells –cytological samples– from patients affected by diseases of all kinds; and the other, in the autopsies . Thanks to these specialists, for example, we have been able to understand the clinical manifestations of COVID-19 and establish the routes of possible treatments.
Speaking in very general terms, if medicine were a tree, pathological anatomy would be the trunk that would unite all its branches : psychiatry, dermatology, pulmonology, traumatology, surgery … Although essential for all ailments, it turns out key in the approach to cancer . “Technically, a patient does not suffer from this disease until it is diagnosed by a pathologist under the microscope”, highlights Xavier Matias-Guiu, president of the Spanish Society of Pathological Anatomy (SEAP).
As important as the diagnosis is to establish what variety of tumor the affected person has developed . Among the hundreds that exist, the pathologist classifies it and gives it a name and surname; that is, it determines its location and the alterations that may condition the way of dealing with it, which allows choosing the best individualized treatment . As a consequence, Matias-Guiu exemplifies, “two patients with breast cancer will have a different prognosis and treatment, which will depend on the type of tumor detected under the microscope.”
These keys make up the challenges of an unknown specialty not only for the general public, but also for medical students themselves. This hinders the generational change that pathological anatomy is currently facing, which also coincides with access to new technologies. If we return to the subject of COVID-19 –and other possible emerging infectious diseases–, it is important that Spain align itself with neighboring European countries and invest in autopsy rooms with the necessary biosafety conditions to carry out the studies.
The case of cancer continues to be exemplary to face the times that come. Because the microscope is no longer enough: in the era of genomics and precision medicine, cancer tissue must be analyzed at the molecular level . The incorporation of state-of-the-art genetic sequencing technologies makes it possible to study the genes that are altered in tumors. But the most important thing, recalls the president of the SEAP, is that both the microscope image and the molecular modifications are jointly interpreted in the so-called integrated diagnosis, since the same alteration can have a different meaning depending on the type of cell that the Present.
The challenge of new technologies
Precision medicine, the heterogeneity of tumors or the development of immunotherapy are just three of the challenges that open up so that pathology services can continue to improve the precision of diagnoses and the effectiveness and monitoring of treatments. This will imply going hand in hand with new technologies, the adoption of which always takes longer than its development.
Today we discuss the potential of wearables or wearables – devices with integrated sensors to monitor physiological parameters – or of the next generation of biosensors, with miniaturized components, to store information that improves diagnostic capabilities.
While these examples remain in the realm of utopia, the future of pathological anatomy revolves around two interconnected tools: one is the one already mentioned in the general text , next-generation genetic sequencing ; the other, digital pathology . Both are integrated into what is known as computational pathology .
Through the annotation of images and artificial intelligence techniques, such as machine learning or deep learning, the digital examination of tissues has allowed the creation of interpretation algorithms that make the interpretation of pathologists less subjective. In them, the molecular information obtained by sequencing can be integrated and high precision integrated morphological-molecular reports can be generated. In a large number of cases, the application of computational pathology will generate massive data that will serve to better understand the lesions. A truly exciting future that is just around the corner.
By Carlos B. Rodríguez.
