Pathology departments are under significant pressure to meet the demands of a precise medicine environment where general phenotypic attributes are no longer sufficient for accurately defining disease risk, clinical progression and therapeutic options.   The classical approach to solid tumor diagnostics combined with immunohistochemical analysis remains the foundation of anatomic pathology; however, recent developments in genomic medicine have altered the paradigm, specifically for lung cancer, colon cancer and melanoma, where DNA mutation detection with next gen sequencing is now part of the pathologist’s tool-box.   Although critical for therapeutic selection, there is considerable evidence that DNA analysis is only one part of the ‘precise equation’ as evidenced by the recent success of check-point inhibitors and the importance of in situ immune composition.  Furthermore, the field of systems or precise pathology which encompasses digital image analysis and quantitative protein detection integrated with deep learning processes is poised to have a tremendous impact on the practice of pathology in the future.   In addition to tissue based analytics the continued advances in the liquid biopsy space including circulating tumor cells, cell-tumor DNA and exosomes combined with serum proteomics will undoubtedly bring another level of complexity to the patient assessment process.     With the ever-changing and competitive healthcare atmosphere, novel technologies and data management – bioinformatics will continue to be at the forefront of clinical medicine.
 
Learning Objectives:

1. Define in your own words what is meant by:  Precise Medicine.
2. Provide a sentence on your understanding of systems –precise pathology and how this will change the practice of pathology.
3. What is meant by the terms ‘morphometry’ and how will it be used in precise pathology?
4. What is meant by the term ‘liquid biopsy’?  Please provide a few examples of how this approach will add information to tissue diagnostics and how it will be used clinically?