Molecular imaging and molecular diagnostics: two sides of the same coin?

Abstract

Back in the 1950s, it was a common concept to start further education in internal medicine with pathology [1]. The idea behind this was that a deeper knowledge of anatomy and pathohistomorphology of diseases would improve the accuracy of diagnosis and the success of treatment. It was during this period when internal medicine specialists started to utilize radioactive isotopes as tracers in biological assays, in vitro to enhance their understanding of molecular processes and in vivo to improve diagnostics -never losing sight of their ultimate goal of tailoring treatment to, and prolonging survival of, their patients. This period is today recognized as the birth of nuclear medicine.The main drivers of nuclear medicine at that time (and still today) were the diagnosis and treatment of thyroid diseases. Based on a strong interdisciplinary background and education, it was self-evident that nuclear medicine diagnostics included not only scintigraphic evaluation of iodine metabolism, but also analysis of cytological findings. In addition, radioimmunoassays were developed for the analysis and interpretation of thyroid hormone constellations in the blood, a comprehensive theranostic approach which finally led to precise treatment with thyroid hormones and radioiodine. Given this historical development and the partly overlapping techniques applied, it is surprising that the obvious synergisms among nuclear medicine, pathology and laboratory medicine, which in many countries today is fused with clinical chemistry, have not yet led to greater collaboration among these disciplines on a broader level.Today we are rapidly entering the age of personalized medicine, which means that molecular diagnostic techniques are increasingly used for the guidance of individualized therapy and the prediction of treatment response. As a consequence, the clinical field of pathology is today increasingly converting into a field of molecular pathology strategy. Driven by the recent evolution of technologies, including mass spectrometry and different B-omics^approaches, conventional pathology techniques such as immunohistochemistry are at present frequently accompanied by genetic, epigenetic and proteomic analyses which are available on-site in oncology centres and have become ever cheaper [2]. These technologies enable the identification of diagnostically and therapeutically relevant molecular targets and thus can be directly linked to modern biological treatments [3]. A review of the current literature verifies this concept in early clinical trials, in which a biomarker-driven rationale has been demonstrated to be superior to the conventional Bone treatment fits all^concept.However, while early clinical trials have proved the success of the new concepts, conflicting results and even failure of phase II and III clinical trials have been seen [4], and the overall likelihood of approval from phase I in oncological trials is still below 20% [5]. Today, the main limitation of these novel and more personalized concepts is widely recognized as the ch...

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