Johnson & Johnson has funded the development and publication of this article, including a consultancy fee for Eva Compérat. The views expressed in the article are those of the authors and publisher, and do not necessarily reflect the views of Johnson & Johnson. CP-601882 | September 2026.

As cancer care becomes more personalized and pathology more closely connected to treatment decision-making, questions around how these changes translate into routine practice are becoming increasingly important.

Eva Compérat, Professor of Pathology at the Medical University of Vienna and Hôpital Tenon, Sorbonne University, brings experience across different European healthcare systems and a perspective on the practical realities of delivering precision oncology. In this interview, she discusses how pathology is evolving, where gaps remain, and what needs to change to make more integrated care possible.

How is precision oncology changing the role of the pathologist?

The fundamentals of pathology remain essential, but our role is becoming much broader. Increasingly, we need to understand the molecular characteristics of the tumor alongside the histological diagnosis and, crucially, what those findings could mean for the patient’s treatment.

It is no longer enough simply to identify a lesion or molecular alteration. Pathologists need to understand the clinical implications of what we diagnose. This is why I encourage younger pathologists to attend multidisciplinary meetings and engage beyond pathology alone. We need to understand how the information we generate will be used in clinical practice.

At the same time, we have to recognize that practice varies considerably across Europe (1). I have worked in both France and Austria, and there are important differences in how molecular pathology is taught, organized, and delivered. Different regulations, reimbursement structures, and laboratory models all influence what can be implemented in routine care (2).

Which advances are having the greatest impact on pathology today?

Somatic testing of the tumor is extremely important because it gives us the molecular information needed to better understand an individual cancer (3). Alongside this, digital pathology, AI, and emerging approaches such as liquid biopsy are creating new possibilities.

But we need to be realistic about where different technologies are today. Liquid biopsy and circulating tumor DNA are promising, including for areas such as monitoring minimal residual disease, but further development and robust evidence will be needed before they become routine across all settings (4).

Digital pathology and AI are also likely to significantly change how we work. AI has particular potential in areas such as pattern recognition and data interpretation (5). As the volume of molecular and clinical information grows, it simply isn’t feasible for one person to manually interpret everything at scale.

However, implementation is a major part of the equation. Digital pathology requires substantial infrastructure (6). Even storing the volume of data generated by digital slides can be challenging. We also need bioinformatics expertise to interpret increasingly complex molecular data (2). The technology may be advancing quickly, but laboratories need the infrastructure and skills to use it effectively.

If the science is advancing, why are some patients still missing out on biomarker-informed care?

Access and implementation remain inconsistent, both between and within European countries (1).

There can be a considerable difference between being treated in a major university center and in a smaller or more remote setting (7). In a large center, clinicians are generally familiar with which tests are needed, where samples should be sent, and how results can inform treatment (8). In smaller or less specialized centers, the pathway may be less clear, particularly where access to molecular expertise is limited (8). Healthcare professionals may not know where testing is available, what material is required or how reimbursement works.

In some settings, this can mean patients are not tested or referred at all.

Turnaround time matters too. If molecular testing takes weeks or months, this can have significant implications in cancers where time is life and treatment decisions need to be made quickly (9). We therefore need to think beyond whether a test exists and consider whether the entire pathway enables reliable information to reach the clinical team in time to make a difference for the patient.

What needs to change to close these gaps?

Education is one of the most important areas. Expert centers already have considerable knowledge and infrastructure, but we also need to reach pathologists and clinicians working outside major centers, including those in smaller and private practices. They may encounter these testing pathways less frequently or lack immediate access to specialist colleagues.

We need to make the pathways easier to navigate and give healthcare professionals the confidence to know what testing is needed, how to access it, and where material should be sent when specialist analysis is required.

Greater standardization is also important. While standardized procedures already exist, there can still be variation in how testing is carried out between laboratories and countries, with some centers continuing to follow established local practices (2). This is particularly important for molecular testing, where consistent approaches, validated methods, and quality standards can help ensure that results are reliable and comparable. If two people in different parts of Europe undergo biomarker testing, we should be working towards the same standards of quality and consistency regardless of where they happen to be treated. Greater alignment across Europe could help reduce variation and support the integration of precision oncology into routine care.

And we cannot forget the workforce. Molecular pathology increasingly relies on specialist technical and bioinformatics expertise, but these skills are in high demand (2). Investment in people, education, and infrastructure needs to keep pace with investment in technology.

What does a more integrated role for pathology look like in practice?

It starts with something very basic: pathologists need clinical information about the patient. It is much easier to interpret a specimen when you understand the clinical history and the question the treating team is trying to answer. From there, I would like to see smoother, more coordinated pathways in which histology and molecular testing are integrated rather than treated as separate steps.

Ideally, this would mean a more streamlined workflow from biopsy to testing, with molecular testing initiated early when appropriate and when sufficient tissue is available. As our ability to work with smaller samples improves, there may be greater opportunities to integrate testing into the diagnostic process rather than waiting for a separate request later in the pathway.

This requires a multidisciplinary approach, with closer and more consistent interaction between pathologists, oncologists, urologists, and other specialties. Crucially, that exchange needs to work both ways. Pathologists need access to the relevant clinical context and a clear understanding of the questions the treating team is trying to answer, so that they can interpret findings in a way that is as clinically meaningful as possible.

Most importantly, pathologists should not sit outside the clinical conversation. They need to be actively included in multidisciplinary discussions and equipped with the clinical information that can help them contribute most effectively to treatment decision-making. We are part of the team, and the way we work together should reflect that.

What will define the next era of pathology?

Digital pathology, AI, and molecular diagnostics will continue to develop and, I believe, significantly change how we work over the next five to ten years. We will also identify molecular alterations that we do not fully understand today. In many respects, we are still at the beginning.

The real opportunity with AI may ultimately go beyond analyzing an individual image or result. If we can bring together histology, molecular findings, clinical information, treatment, and outcomes in high-quality datasets, we may be able to generate new insights that support clinical decision-making in ways that are not possible from any one source of information alone.

I believe the pathologist will play an even more central role in connecting these different sources of information and translating them into clinically meaningful insights.

Technology alone will not determine whether precision oncology succeeds. We need infrastructure, specialist skills, greater standardization, education, and stronger collaboration across the patient pathway to ensure the right information reaches the right team at the right time.

The science is moving quickly. Our priority now should be to build the pathways, capabilities, and collaborations that allow pathology to move with it, so that advances in precision oncology translate into meaningful benefits for more people.

More articles by Eva Compérat:

Pathology’s Precision Oncology Mandate

Bringing Precision Medicine to the Patients

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