What practicing pathologists and oncologists should know about the new computational pathology-based companion diagnostic tools

Research output: Contribution to journalReview articleContributedpeer-review

Contributors

  • Diana Montezuma - , IMP Diagnostics, Portuguese Oncology Institute of Porto (IPO Porto), European Society of Digital and Integrative Pathology (ESDIP) (Author)
  • Sara P. Oliveira - , Netherlands Cancer Institute, European Society of Digital and Integrative Pathology (ESDIP) (Author)
  • Inti Zlobec - , University of Bern, European Society of Digital and Integrative Pathology (ESDIP) (Author)
  • Nadieh Khalili - , Radboud University Nijmegen, European Society of Digital and Integrative Pathology (ESDIP) (Author)
  • Jordi Temprana-Salvador - , European Society of Digital and Integrative Pathology (ESDIP), Vall d'Hebron University Hospital (Author)
  • Sabine Leh - , Haukeland universitets­sjukehus, University of Bergen, European Society of Digital and Integrative Pathology (ESDIP) (Author)
  • David Ameisen - , ImginIT, European Society of Digital and Integrative Pathology (ESDIP) (Author)
  • Mircea Sebastian Șerbănescu - , Craiova University of Medicine and Pharmacy, European Society of Digital and Integrative Pathology (ESDIP) (Author)
  • Arsela Prelaj - , IRCCS Fondazione Istituto Nazionale per lo studio e la cura dei tumori - Milano, Polytechnic University of Milan, European Interdisciplinary Society for AI in Cancer Research (ESAC) (Author)
  • Jakob Nikolas Kather - , Else Kröner Fresenius Center for Digital Health, Department of Internal Medicine I, University of Leeds, European Interdisciplinary Society for AI in Cancer Research (ESAC), National Center for Tumor Diseases (NCT) Heidelberg (Author)
  • Norman Zerbe - , RWTH Aachen University, Charité – Universitätsmedizin Berlin, European Society of Digital and Integrative Pathology (ESDIP) (Author)
  • Vincenzo L'Imperio - , University of Milan - Bicocca, Fondazione IRCCS San Gerardo dei Tintori, European Society of Digital and Integrative Pathology (ESDIP) (Author)

Abstract

The integration of artificial intelligence into pathology is transforming the assessment of histological and immunohistochemical (IHC) slides, offering opportunities to reduce variability and streamline diagnostics. In practical terms, most available tools and research models emulate the diagnostic capabilities of pathologists by detecting, grading, and classifying tumours and other diseases. More recent applications have moved beyond mimicry, aiming to predict established biomarkers, such as microsatellite instability or IHC-based markers, and to tackle even more ambitious tasks, such as directly predicting patient prognosis from H&E whole slide images. Remarkably, novel computational tools are now being designed as companion diagnostic assays, linking the automated evaluation of specific IHC biomarkers to the prediction of response to specific drugs, potentially marking a new chapter in the evolution of digital and computational pathology. The TROPION-PanTumor01 trial recently demonstrated the superiority of a supervised machine learning model (termed the quantitative continuous score [QCS] by the vendor) in assessing TROP2 IHC compared with human scoring, promising better stratification of patients with non-small cell lung cancer for treatment with datopotamab deruxtecan. The same approach has shown promise in refining HER2 (human epidermal growth factor receptor 2) and PD-L1 (programmed death-ligand 1) evaluations, revealing patient subgroups that may benefit from targeted therapies. Moreover, other similar approaches are progressively reaching the market, posing significant opportunities and challenges for clinicians involved in the care of patients with cancer. This Perspective is promoted by the European Society of Digital and Integrative Pathology (ESDIP, founded in 2016, and having long-standing experience in computational pathology, esdipath.org) and the European Interdisciplinary Society of Artificial Intelligence for Cancer Research (ESAC, a recently established initiative, founded in 2024, esac-network.eu), both bringing together clinicians, engineers and other professionals dedicated to the development and clinical translation of computational approaches aimed at improving patient care. It aims to provide an informed overview of novel computational pathology companion diagnostic tools, with a particular focus on the background that practicing pathologists and oncologists need to have with these tools, when transitioning from research to clinical practice, irrespective of their prior familiarity with computational approaches.

Details

Original languageEnglish
Pages (from-to)143-148
Number of pages6
JournalJournal of pathology
Volume269
Issue number2
Early online date25 Feb 2026
Publication statusPublished - Jun 2026
Peer-reviewedYes

External IDs

ORCID /0000-0002-3730-5348/work/212492320
PubMed 41736658

Keywords

Sustainable Development Goals

ASJC Scopus subject areas

Keywords

  • computational pathology, digital pathology, NMR, precision medicine, predictive oncology, QCS, TROP2