Xavier Matias-Guiu is the president-elect of the European Society of Pathology (ESP). A native of Spain, he has served as a professor of pathology at both the University of Barcelona and the University of Lleida, where he is currently chair of the Department of Pathology. Matias-Guiu is widely recognized for his contributions to gynecologic pathology and his involvement in clinical and pathological societies focused on gynecologic cancer and digital pathology. He is also actively engaged in various initiatives within the ESP.
Ivan Damjanov sat down with Matias-Guiu to learn more about his career in gynecologic pathology and historic contributions to societies across Europe.
Where did your interest in pathology come from?
I had a great interest in biology as a young child and, for many years, wanted to be a biologist. My father, a physician, wanted me to pursue medicine. He explained that the field has many specialties, allowing me to choose one that best suited my interests.
As I explored my options, I became fascinated with pathology, especially inspired by the Spanish neuroscientist and pathologist Santiago Ramón y Cajal. This interest led me to study medicine.
After my first year, I was drawn to pathology and volunteered as an intern in the Department of Pathology. Balancing classes with lab work, I fully immersed myself in the field. After graduation, I never considered another specialty – I knew I wanted to be a pathologist.
What is the history of pathology in Spain – is it a popular medical specialty?
Between 1970 and 1990, young Spanish pathologists began traveling abroad to train in top pathology departments in Europe and the US. When they returned, they transformed the field in Spain and became role models for aspiring pathologists. Today, more than 2500 pathologists are active members of the Spanish Society of Pathology.
Spain now has many highly skilled pathologists, some recognized among the world's best. Overall, pathology in Spain is well established, often meeting or exceeding WHO standards. Most major pathology departments also comply fully with the requirements of American pathology organizations such as CAP, ASCP, and USCAP.
Why did you decide to specialize in gynecologic pathology?
During my fourth year of residency, Jaime Prat joined Hospital Sant Pau in Barcelona as Chair of Pathology. After completing my residency, I chose to stay in his department, where I remained for 15 years. He was both my teacher and mentor, and I learned a great deal from him.
Working with Prat sparked my passion for gynecologic pathology, which became my main area of interest. Beyond medical knowledge, I also adopted many personal and professional values that shaped my career. He emphasized the importance of mastering diagnostics, dedicating time to teaching, and engaging in research. I have followed his guidance ever since and strive to pass on his lessons to my junior colleagues. I am deeply grateful for all he taught me.
What do you consider to be your major contributions to gynecologic pathology?
Together with Prat, and later with my own team, we have helped improve the understanding of gynecological tumors by combining morphological pathology with molecular analysis. This integrative approach has been valuable to our clinical colleagues, helping us develop new treatment strategies. So far, this method has been most effective in diagnosing and treating endometrial cancer.
Can you tell us more about your active role in the International Society of Gynecological Pathology (ISGYP) and the time you served as President?
Becoming President of ISGYP was a great honor, especially as it coincided with the start of the COVID-19 pandemic and continued into the post-pandemic period. I succeeded Esther Oliva, a fellow mentee of Prat. Together with ISGYP members, we launched numerous educational initiatives for gynecological pathologists worldwide.
During my tenure, we introduced a virtual annual meeting, which quickly became highly attended. We also expanded our courses beyond English, offering sessions in Spanish and Chinese. As a result, ISGYP membership doubled, with significant growth in countries outside the US and Europe.
You have a strong interest in molecular biology and are known for applying its techniques in both daily practice and research. Do you think molecular biology will transform the way diagnostic pathology is practiced today?
I began working in molecular pathology in 1992 when Prat sent me to the New England Medical Center in Boston to learn basic molecular biology techniques. Since then, the field has advanced rapidly, with new techniques emerging constantly.
Fortunately, our department has kept up with these developments, allowing us to use state-of-the-art equipment and perform advanced tests. Easy access to next-generation sequencing is already transforming tumor diagnosis and helping us identify predictive markers for targeted therapies.
You have participated in numerous clinical cancer guidelines and have been an active member of several pan-European clinical societies. Can you tell us more about these guidelines and what you learned from working in these polyvalent clinical teams?
This has been one of the most rewarding aspects of my scientific career. As a representative of ESP, I have collaborated with organizations like the European Society of Gynecological Oncology (ESGO) and the European Society for Radiotherapy and Oncology (ESTRO). Together, we developed the 2020 ESGO-ESTRO-ESP guidelines for managing endometrial carcinoma. These guidelines integrate pathology and molecular biology data, allowing for tumor risk stratification that directly impacts treatment decisions and patient care.
I also worked with the European Society of Medical Oncology (ESMO) to create guidelines for using molecular features, such as homologous recombination testing, in advanced ovarian cancer. This project has significantly influenced treatment strategies for these patients.
I am pleased to see modern pathology playing a key role in multidisciplinary efforts. For me, incorporating molecular pathology into patient management bridges the gap between research and clinical practice.
How far have you seen digital pathology progress in Spain, as well as across Europe, in recent years?
I believe digital pathology will soon transform how pathologists work. This technology is rapidly expanding, with more pathology departments in Spain and across Europe integrating it into daily practice.
Five years ago, we launched a digital pathology project called DIGIPATICS, funded by the European Union. It involved seven major pathology departments in Catalonia – all tertiary hospitals – where 160 pathologists transitioned entirely to digital pathology. Three years in, the results have been very promising, and we plan to publish our findings soon.
You’ve also shown interest in applying AI to pathology. Do you think AI and machine learning will change pathology as we know it?
As part of the DIGIPATICS project mentioned above, we are collaborating with an academic group in Barcelona (UPC) that has developed several algorithms for tumor biomarker quantification. Many AI-driven algorithms, from both academic centers and private companies, are now available for tasks such as biomarker quantification, histological grading, predicting molecular alterations, and even prognosis.
These algorithms need validation on a large number of cases, ideally through well-controlled prospective studies. While I don’t believe AI will replace experienced pathologists, it can help reduce inter-observer variation, which remains a key challenge in our field.
You have received many awards during your career. Is there one award in particular that means the most to you?
Last March, I received the Helga Salvesen Award from ESGO, which honors a clinician or researcher for significant contributions to translational research in gynecological oncology. The award commemorates a brilliant researcher who died prematurely a few years ago.
Receiving this recognition was a great honor, especially for personal reasons, as I had the privilege of collaborating with Salvesen on several international projects over the years.
You are also a well-known world-wide lecturer – do you enjoy this aspect of your career?
Of course! Traveling is fun, and meeting new colleagues is a great bonus. However, the most valuable part of lecturing on gynecological cancer is the interaction with attendees. Teaching is not a one-way experience – I have gained a lot from my audience, learning through their questions and feedback.
This September you’re due to serve as the next president of ESP. Do you have any plans for this period – how will you assure a bright future for the society?
ESP is a strong organization with over 5,000 members. I have been actively involved for the past 10 years, especially in the last two, working closely with the executive committee, including current president Peter Schirmacher, past president Aleš Ryška, and CEO Raed Al Dieri.
We are currently developing a strategic plan for the coming years, with a strong focus on molecular and digital pathology. Education remains a key priority, as we strive to help European pathologists enhance their practice, stay updated on new developments, and expand their knowledge. Additionally, collaborating with National Societies across Europe is an important part of our efforts.
Any advice for early-career pathologists?
I was very lucky to have an inspiring mentor early in my scientific career. I’d urge young pathologists to find a role model and mentor who can guide you. Strive for excellence in three key areas: daily diagnostic practice, teaching students, residents, and team members, and engaging in research.
Always make time for research, no matter where you work. Pathologists, by definition, are scientists, and this should be a hallmark of our specialty in every hospital. Staying involved in research keeps you open to innovations that can improve patient care.
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