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Associate Professor of Pathology, Nun Study Director, South Texas Alzheimer's Disease Research Center Neuropathology Core Leader, Bigg’s Institute Brain Bank Director, Baptist Health Foundation of San Antonio’s Endowed Chair, University of Texas Health Science Center San Antonio, USA

Biggest challenge in pathology? Standardizing digital pathology systems and ensuring interoperability between different platforms is a major challenge. Variations in image formats, scanning resolutions, and software capabilities can hinder seamless data sharing and collaboration across institutions. Digital pathology also generates vast amounts of data that require robust infrastructure for storage, management, and retrieval. Ensuring the security and privacy of patient data while maintaining accessibility for research and clinical purposes is a complex issue. Navigating the regulatory landscape for digital pathology and AI tools is difficult, as these technologies must meet stringent standards for clinical use. Ensuring compliance with regulations across different regions adds another layer of complexity. Practicing pathologists also need to be fully trained to effectively use new digital tools and AI systems.

Ensuring that AI models are accurate, reliable, and generalizable across different populations and pathology labs is another significant challenge that is involved. Extensive validation and continuous monitoring are required to maintain confidence in AI-assisted diagnostics. The use of AI in pathology raises additional ethical and legal questions, particularly regarding accountability for diagnostic errors and the potential for biases in AI algorithms. Addressing these concerns is critical for the widespread adoption of these technologies. Addressing these challenges requires a concerted effort from researchers, clinicians, technologists, and policymakers to ensure that digital pathology and AI can be effectively integrated into clinical practice, ultimately improving patient care and advancing the field of pathology.

Exciting developments and trends? One of the most exciting developments in pathology today is the advent and rapid advancement of digital spatial transcriptomics. This technology allows scientists and clinicians to analyze gene expression within the spatial context of tissue architecture, offering unprecedented insights into the molecular and cellular dynamics of tissues in health and disease. 

Missing from the diagnostic toolbox? One of the key elements missing from the diagnostic toolbox in pathology is the comprehensive integration of multi-omics data (genomics, transcriptomics, proteomics, and metabolomics) with traditional histopathological techniques. While extensive progress has been made in each area in the research space, combining them effectively in routine pathology diagnostics is still a challenge.

We need platforms that can seamlessly combine data from various omics technologies with histopathological imaging. This integration would help pathologists correlate molecular changes with morphological features, leading to more accurate diagnoses and personalized treatments. Consistent protocols and systems are crucial for generating, analyzing, and interpreting multi-omics data. Standardization would allow for better comparison and adoption of these data in clinical practice. Robust computational tools are needed to handle and analyze large-scale multi-omics and imaging data. These tools should provide insights that can be directly applied in clinical diagnostics. 

Multi-omics approaches need rigorous validation in clinical settings to prove their reliability and usefulness in routine diagnostics. This includes establishing clinical guidelines for using multi-omics data in diagnosis. Pathologists and lab personnel need additional training to interpret multi-omics data and integrate it with histopathology. This training is crucial for pathologists and laboratory medicine professionals to fully understand the biological significance of molecular changes and their impact on disease diagnosis and treatment.

The high cost of multi-omics technologies and the need for specialized equipment and expertise can be additional barriers. Therefore, developing cost-effective solutions and making these technologies accessible to more clinical labs is essential. Clear guidelines are also needed to govern the use of multi-omics data in the diagnostic space within clinical practice. This includes data privacy, patient consent, and the clinical implementation of new diagnostic technologies. In my opinion, addressing these gaps would significantly improve diagnostic capabilities in pathology, leading to more precise diagnoses, better patient outcomes, and advances in personalized medicine.