Pathology bridges clinical practice with basic science and research, seeking diagnostic answers at the cellular level. With the recent transition to digital pathology, its applications have expanded significantly. Radiology, on the other hand, focuses on identifying tumors – benign or malignant – by using imaging to assess their location and behavior. Diagnosticians often emphasize the importance of correlating pathology and radiology findings for the most complete disease overview in oncology.
In many ways, both specialties are trying to answer the same fundamental question: What is the tumor? Radiology reveals how a lesion behaves, while pathology examines the cellular architecture to determine whether the process is malignant or benign. As a bone pathologist with long-standing clinical experience, and author of two books on radiologic–pathologic correlation of bone tumors, I firmly believe it is impossible to diagnose a neoplasm accurately without strong collaboration between the two disciplines.
I frequently receive only small tissue samples that contain fragments of reactive bone but no clearly suspicious tissue. By combining these limited findings with radiologic impressions from my radiology colleagues, I can often identify a tumor that the biopsy missed – preventing what would otherwise be a missed diagnosis.
In my lectures, I often present two instructive cases of dedifferentiated chondrosarcoma, a biphasic tumor composed of a low-grade cartilaginous component and a high-grade sarcoma. In the first case, the biopsy contained only the cartilaginous portion. Without radiologic correlation, the diagnosis might have been limited to enchondroma or low-grade chondrosarcoma, completely missing the high-grade sarcoma – the more aggressive component with a higher risk of metastasis.
In the second case, I received only the high-grade sarcomatous element. It could easily have been misdiagnosed as an undifferentiated pleomorphic sarcoma of bone if I had not correlated with imaging that clearly demonstrated a well-delineated cartilaginous component consistent with dedifferentiated chondrosarcoma. These examples underscore how essential radiologic–pathologic correlation truly is.
Despite this need, collaboration is not always seamless. In private practice, for example, we often receive tissue samples without detailed clinical or radiologic reports. Although both disciplines operate within the same healthcare system, they typically use separate reporting structures that are not directly linked. Accessing each other’s data usually requires navigating patient identifiers rather than working from an integrated platform.
Both radiology and pathology are indispensable for establishing a diagnosis, determining prognosis, and guiding patient management. Though diagnostically intertwined, they remain operationally distant. This raises a provocative question: should the two subspecialties merge?
While this idea is certainly up for discussion, I would be inclined to suggest a less drastic alternative. Perhaps we should aim, instead, to integrate our findings into a single, unified report that enhances diagnostic accuracy and improves clinical decision-making.
The growing use of digital pathology may play a pivotal role in this integration, enabling the visualization of radiologic and pathologic data on a single platform. Artificial intelligence, applied under the careful supervision of both pathologists and radiologists, could help coordinate this information fusion.
Radiologists and pathologists do not necessarily need to sit in the same room or combine specialties. What we need is a shared reporting system that consolidates our diagnostic insights. Working as a team – remaining distinct yet connected – offers the best path to delivering accurate diagnoses and ensuring optimal patient care.
Newsletters
Receive the latest pathologist news, personalities, education, and career development – weekly to your inbox.
