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Excerpt
The essay by Dr. Foucar provided a scholarly and compelling response to the call by Dr. Medline for diagnostic “individuality.”1,2 Whereas Dr. Foucar's essay focused on diagnosis, Dr. Medline also called for more freedom to disregard “information...irrelevant to diagnosis; much of it pertains to prognosis and is wholly speculative.”2 Apparently, Dr. Medline believes that the only job of the pathologist is to render a diagnosis, and not to provide other information relevant to the management of the disease.
As surgical pathologists at a university-based NIH/NCI-designated Comprehensive Cancer Center, we must take exception with this point of view. Increasingly, much of what we do does not pertain to diagnosis, but rather to that which Dr. Medline perceives as “irrelevant”; that is, prognosis and staging. Indeed, during the past two decades, pathologists have been leaders in identifying those pathologic findings at the morphologic and molecular level that predict patient outcome. Without this information, as provided by surgical pathologists, patients cannot be managed in any rational or appropriate way. Prognostic and staging parameters, whether they be determined by classical means or by more modern technologies, are far from “peripheral matters that are of dubious value and soon will be outdated.”2 They are indeed among the most important work that we do, and of great value to the patient.
Finally, we can only hope that many of the methods that we use now, both for diagnosis and prognosis, will become outdated in the future. If they are not, this can only mean that we will have made no progress.
