In literature and popular culture, pathologists are often portrayed as physicians who perform autopsies and make postmortem diagnoses — professionals working quietly behind the scenes in laboratories or hospital basements. This image, however, reflects an outdated understanding of pathology and overlooks its increasingly central role in modern medicine.
Today, pathology is about far more than naming a disease. It involves understanding disease biology, determining how a disease is likely to behave, identifying therapeutic vulnerabilities, and providing information that can directly influence treatment and patient outcomes. In many ways, pathology has become one of medicine’s decision engines.
Histopathology remains the foundation of diagnosis, but contemporary pathology extends well beyond what can be seen under the microscope. Morphologic findings are increasingly integrated with molecular alterations, radiologic findings, clinical information, and artificial intelligence. Together, these sources of information can transform the pathology report from a static diagnostic document into a dynamic tool that contributes to prognosis, treatment selection, and ongoing patient management.
Despite this evolution, the pathologist’s contribution often remains invisible to patients. When a diagnosis is correct, it is frequently accepted as an established fact, without recognition of the expertise and multidisciplinary collaboration required to reach it. When uncertainty or disagreement arises, however, the pathologist suddenly becomes visible. This paradox reflects the outdated perception of pathology as a service performed for medicine rather than an integral component of patient care.
I believe the role of the pathologist should be more visible and more closely integrated into the clinical team. Treatment decisions ultimately remain the responsibility of the treating physician, but pathologists should be recognized as active participants throughout the patient’s therapeutic journey. Pathology does not simply provide an answer at a single point in time. It generates information that can influence care from the initial diagnosis through treatment selection, monitoring, and follow-up.
I had the opportunity to experience the value of this approach firsthand. Together with an orthopedic surgeon, I explained a patient’s diagnosis using digital pathology. By displaying the digital slides, I was able to show the patient the microscopic findings directly, while the surgeon explained how those findings influenced the treatment plan. The patient was no longer simply receiving information from physicians; they could see the evidence supporting the diagnosis and understand how that evidence connected to the recommended treatment.
The response was extremely positive. The patient appreciated the transparency and felt more engaged in the decision-making process. For me, this experience demonstrated an important principle about the future of pathology: patients should not have to experience pathology as something that happens somewhere else, beyond their understanding or participation. When appropriate, pathology can become a visible and understandable part of the patient’s medical journey.
This concept is already emerging in innovative models of patient-centered pathology. Some medical centers in the United States have begun developing pathology clinics that bring pathologists directly into patient interactions. Rather than treating the laboratory as a separate environment where specimens disappear and reports eventually emerge, these models recognize pathologists as physicians who can communicate diagnostic findings, educate patients, answer questions, and participate more visibly in their care.
Technology can also play an important role in bringing pathology to the patient. Digital pathology can turn an otherwise invisible laboratory process into something that patients and clinicians can see, discuss, and understand. It can also strengthen trust. When the pathologist and treating physician communicate with a patient together, the patient can see that diagnosis and treatment are not isolated decisions made by separate specialists. Instead, they are interconnected parts of a team-based process focused on the same goal: providing the best possible care.
Digital pathology has also transformed communication among specialists. Digital slides can be shared remotely, reviewed with subspecialty experts, and incorporated into multidisciplinary tumor boards without the physical transfer of glass slides. This capability is particularly valuable for rare and complex tumors, where access to specialized expertise can directly affect diagnostic accuracy and treatment planning.
Molecular diagnostics has expanded the role of pathology even further. In modern oncology, identifying the tumor type is often only the beginning. Molecular alterations can provide critical information about tumor biology, prognosis, and potential therapeutic targets. If histopathology tells us what a tumor looks like, molecular diagnostics increasingly helps us understand why it behaves the way it does.
Molecular testing can identify alterations that guide targeted therapies, allowing clinicians to move away from a one-size-fits-all approach. The goal is to match treatment as closely as possible to the biology of an individual patient’s disease. In doing so, we may increase the likelihood of therapeutic benefit while avoiding treatments that are unlikely to be effective.
Medicine is now entering an era in which the challenge is no longer simply a lack of information. In many cases, we have more information than ever before. The challenge is how to integrate it effectively.
Artificial intelligence represents an important opportunity in this regard. Modern cancer care generates enormous amounts of information, including histopathological images, molecular profiles, radiologic studies, clinical histories, laboratory results, and treatment outcomes. AI can assist in analyzing digital pathology images, recognizing patterns, automating repetitive tasks, and potentially improving diagnostic consistency. However, its greatest potential may extend beyond image analysis.
Imagine a system capable of integrating a patient’s pathology, molecular profile, radiologic findings, clinical history, and previous treatment responses — and helping a multidisciplinary team recognize relationships or patterns that might otherwise be difficult to identify. Such technology could support more informed decisions regarding diagnosis, prognosis, treatment selection, and follow-up. In the future, it may even help us better predict tumor behavior and response to specific therapies.
The future of pathology, therefore, may be less about pathologists versus AI and more about pathologists empowered by AI. Technology can help us analyze more information, but it is the pathologist who must place that information into biological and clinical context.
My own experience in musculoskeletal oncology has reinforced the importance of this collaborative approach. Working closely with radiologists, orthopedic oncologic surgeons, and other members of the multidisciplinary team has significantly improved my understanding of individual patients and their diagnostic challenges – ultimately making me a better pathologist. Such interactions have reinforced an important lesson: the most accurate diagnosis is rarely produced by one specialty working in isolation. It emerges from the integration of different perspectives.
The role of pathology is continuing to expand. We help establish diagnoses, characterize disease biology, identify therapeutic targets, contribute to multidisciplinary treatment decisions, and increasingly help predict treatment response and disease behavior. Digital pathology can make our work visible. Molecular diagnostics can reveal the biology hidden within a tumor. Artificial intelligence can help integrate increasingly complex information. Multidisciplinary collaboration can transform these individual pieces of information into meaningful clinical decisions.
But perhaps the most important transformation is cultural: recognizing the pathologist as a physician who is an integral member of the patient’s care team.
A patient does not need only a diagnosis. A patient needs to understand what that diagnosis means, why it matters, what can be done about it, and which treatment may be most appropriate. Pathology should therefore no longer be viewed as medicine practiced behind the scenes.
The pathologist is not merely reporting what a disease is; we are a central clinical decision engine, helping determine what it means, how it may behave, and, increasingly, how it should be treated.
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