Beyond the snapshot: optimizing prognostication and prediction by moving from fixed to functional multidimensional cancer pathology

Abstract

The role of pathology in patient management has evolved over time from the retrospective review of cells, tissue, and disease ('what happened') to a prospective outlook ('what will happen'). Examination of a static, two-dimensional hematoxylin and eosin (H&E)-stained tissue slide has traditionally been the pathologist's primary task, but novel ancillary techniques enabled by technological breakthroughs have supported pathologists in their increasing ability to predict disease status and behaviour. Nevertheless, the informational limits of 2D, fixed tissue are now being reached and technological innovation is urgently needed to ensure that our understanding of disease entities continues to support improved individualized treatment options. Here we review pioneering work currently underway in the field of cancer pathology that has the potential to capture information beyond the current basic snapshot. A selection of exciting new technologies is discussed that promise to facilitate integration of the functional and multidimensional (space and time) information needed to optimize the prognostic and predictive value of cancer pathology. Learning how to analyse, interpret, and apply the wealth of data acquired by these new approaches will challenge the knowledge and skills of the pathology community.

Recent Advances in Pathology: the 2022 Annual Review Issue of The Journal of Pathology

“…The next review, from Kramer et al in Leiden, Amsterdam, and Utrecht (The Netherlands), discusses the massive advances in the medical speciality of pathology since its first description in the 15th century to the current day, emphasising the previous restrictions to the use of 2D sections and arguing that 3D analyses including spatial genomics technologies and functional pathology approaches are becoming possible with multimodal data integration and computational pathology [3]. Although discussed mainly in the context of cancer, these rapidly advancing technologies have exciting possibilities across all human diseases.…”