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Professor and Chair, Department of Pathology and Laboratory Medicine, University of Florida College of Medicine, Jacksonville, USA; Medical Director, UF Health Jacksonville Breast Center; Medical Director, UF Health Jacksonville Laboratories; Interim Director of UF Health Jacksonville Cancer Program

Biggest challenge in pathology? One of the most important challenges in the practice of pathology is the limited understanding of the public about the role that pathologists play in their care and outcome. To some extent, the significance of the role of pathologists has remained under-recognized among the medical community as well. I have been firmly committed to teaching and training many young pathologists, taking a very patient-centered approach to changing the role of pathologists from morphologists and passive interpreters of the lab results to active partners in clinical care, and to reducing the gap between pathology and other disciplines. Pathologists have to also take a more active role in educating the patients individually and to use other measures to increase health literacy among the public. This still remains the biggest challenge the pathology field is facing. 

Exciting developments and trends? The advent of digital and computational pathology has brought significant advancements in the field, offering new possibilities for enhancing diagnostic accuracy and improving patient care. In addition, using digital and computational pathology may increase standardization and quality assurance, especially in areas with high interobserver variability. The continuous progress in the appropriate use of AI will ultimately provide a unique diagnostic adjunct in pathology. 

Controversial opinion? Pathologists are expected to establish a diagnosis, classify a neoplasm, differentiate between a primary versus a metastatic tumor, predict response to therapy, provide prognosis, and compose a comprehensive pathology report. Advances in science and technology, molecular characterization of tumors, and participation of pathologists in the process of the delivery of integrated care have provided significant change in the role of pathologists. As members of a multidisciplinary team, pathologists have become responsible for providing the most up-to-date morphological and biological information that is required for immediate therapy and long-term follow-up management of their patients. However, currently, many pathologists are not seen as an integral part of the system. Pathologists need to act as patient advocates and talk about issues that matter to the patients and their families. 

We must stop underestimating the power of the casual use of the term “cancer” in pathologic entities that may not be biologically malignant. Currently, the diagnostic challenges associated with entities, such as distinction between atypical ductal hyperplasia and low-grade ductal carcinoma in situ, continues to result in overdiagnosis and overtreatment of our patients. Similarly, low grade prostate cancer and intraepithelial prostatic hyperplasia are entities that will benefit from a more conservative approach. We must change the terminology and the pattern of practice by eliminating the unnecessary use of the term “cancer”. Pathologic diagnosis and patient’s follow-up therapy must be based on personal risk factors, the extent and the biology of the disease rather than an opinion.