Pathologists Can Play Key Role in the Era of Personalized Oncology

December 2011, Vol 2, No 7

Grapevine, TX—The role of pathologists in gathering and interpreting oncologic information has never been as complex as it is today, but neither has it been as clinically impactful, suggested presenters at the 2011 College of American Pathologists meeting.

“The genetic and molecular information we’re collecting does have real clinical impact,” Neal Lindeman, MD, Assistant Professor of Pathology, Harvard Medical School, Boston, told Value-Based Cancer Care. “It’s part of modern personalized treatment, it is getting bigger, and it needs to be included as part of the standard treatment or diagnostic approach.”

Dr Lindeman discussed acute myeloid leukemia (AML) at the meeting. “Pathologists are no longer just looking down a microscope for morphological information,” he said. They are also integrating the patient’s history with genetic and molecular diagnostic information to determine each tumor’s specific diagnostic and prognostic categories and which treatment, including molecular targets, the clinicians should focus on.

Megan Lim, MD, PhD, Director of Hematopathology, University of Michigan Medical School, Ann Arbor, agreed it is important for pathologists to embrace the rapidly growing array of molecular and genetic tests.

“Oncologists send material to the pathologist, they send material to the molecular lab, and they want someone to put that information together for them and let them know what’s pertinent and what the ways are to proceed with the best management of the patient,” Dr Lim said. “Right now the oncologists are doing it, but they do appreciatewhen pathologists integrate the information for them.”  

Dr Lindeman and his team discussed the 4 categories of the World Health Organization classification system for AML, including:

  • AML with characteristic genetic abnormalities, which now comprises just under 50% of AML cases
  • AML with multilineage dysplasia
  • AML and myelodysplastic syndromes, therapy-related
  • AML not otherwise categorized, which used to comprise just under 50% of cases but now comprises about 25% of them.

Using a case-based approach, they noted that the category of each tumor is determined and can be used to deduce information for a correct diagnosis, prognosis, targeted treatment, and disease monitoring.

This is particularly important for postremission treatment options, because molecular and cytogenetic characteristics have as much or more importance at this stage than in initial treatment.

“New genetic tools are leading to new genetic discoveries in hematopoietic tumors as well as solid neoplasms, and it’s changing every month,” said Dr Lim. “So the molecular-pathology laboratory workload has been one of the fastest-growing areas in pathology, and that will continue for the foreseeable future. Both pathologists and the oncologists they work with can benefit from harnessing these developments to provide as clinically relevant information as possible.”

Related Articles