There are some sayings circulating in the world that emphasize the importance of pathology, such as: “Pathology is the foundation of medicine,” “Pathology is the gold standard,” “Pathologists are the doctors’ doctors,” “In principle, physicians should not prescribe anti-tumor drugs for treatment before the pathological diagnosis results are issued,” and so on.
Why is this? Why is pathology so important?
There are many methods for diagnosing diseases, such as: clinical diagnosis, laboratory diagnosis, ultrasound diagnosis, imaging diagnosis, molecular diagnosis, etc. Why is pathological diagnosis alone endowed with so many important “accolades”? What exactly makes pathology so crucial? Only by clarifying this issue can pathologists avoid losing their direction and know where to focus their efforts.
The fundamental reason why pathological diagnosis is so important lies in the fact that it is currently the “most reliable diagnosis” among all diagnostic methods, the “diagnosis with the highest reproducibility,” and therefore, the “most scientific diagnosis.”
Why does pathological diagnosis have the “highest reproducibility”? The fundamental reason lies in “tissue and cell morphology,” in being able to “see,” and in being able to “localize.” Moreover, it has “verifiability” (the same pathological slide can be verified by multiple people, i.e., verified under the same conditions), rather than being a one-time test result.
Therefore, being able to “see” under the microscope is the core element of pathological diagnosis and the “bottom line of pathology.”
This “bottom line of pathology” that can be seen includes: HE morphology, histochemistry (special stains), immunohistochemistry, in situ hybridization (and other derived indirect in situ techniques, such as microdissection technology + molecular technology), and the information obtained from these techniques.
The “bottom line of pathology” is the core technology and information that pathological diagnosis can rely on, the indispensable technology and information in pathological diagnosis, the irreplaceable bottom line that other “non-localizing” technologies and information cannot replace; it is the basic guarantee for the important “accolades” of pathological diagnosis.
The “bottom line of pathology” is precisely the key area or content that young pathologists must strengthen their cultivation in, and it is also the focus of teaching for senior pathologists.
On the premise of adhering to the “bottom line of pathology,” pathologists should also keep pace with the times, draw on the strengths of others, and absorb technologies and information that are “invisible” under the microscope or “non-localizing,” such as molecular technologies (PCR, NGS, etc.), laboratory information, clinical information, etc., to enrich and enhance the information for pathological diagnosis and strengthen comprehensive judgment capabilities.
Only with such understanding and practice can pathology develop healthily.
Author of this article:Professor Zhou Xiaoge
