NEW GEN DX TECHNOLOGIES –THE DIAGNOSTIC TRANSFORMATION -

The practice of medicine has been transformed by the diagnostics in the 20th century as imaging, blood tests, biopsies etc have offered physicians, greater insight into patient’s signs and symptoms. Today the new diagnostic tools and knowledge are taking pathologists into broader roles of research and correlating diagnosis for clinicians in much bigger way. Diagnostics are poised to help medical care toward the more predictive to preventive care to precision health care.

Diagnostics have been used to predict disease. But today through genetic testing, individuals can learn of their risk for certain genetically linked conditions, while they are still asymptomatic. With a diagnostic blood test, an individual can take informed decisions of taking prophylactic measures to reduce that risk. However, most disease are not the result of faulty genes. It is determined by social and environmental factors as well as the health choices that we make daily — what to eat, how to exercise etc. Rather than simply being a way to identify which patients have a specific disease, diagnostics are now used to support clinical development of drugs, predict disease before symptoms begin, forecast the progress of a disorder, and identify patients who are most likely to respond (or not respond) to specific treatments and much more. The future of diagnostics is to help us better understand what makes us healthy as well as unhealthy, and to empower us with knowledge about how our behaviours can mean the difference between wellness and disease.

There is rapid increase in automation - more things can be done with greater consistency, less time, and less cost. Today many new assays are focused on cancer diagnostic and prognostic markers and cure via targeted therapies. Advances in molecular taxonomy is an important adjunct to histologic diagnosis. Development of dedicated tissue banks, construction of tissue microarrays, standardization of processing protocols so that paraffinised tissue can be effectively used for immunohistochemical and molecular assays, research, all occurring within an established ethical framework that ensures moral standards, will be the future of diagnostic pathology.

We are in an era of Companion diagnosis, which is helping physicians to select the right drugs for the right patients. Companion diagnostics ensure that the patients get the most effective treatment for their specific type of disease, and reduce the number of ineffective or potentially harmful treatments they may receive

In histopathology much interpretive reporting will be done from flat screens rather than through microscope eyepieces. Molecular pathology has now developed alongside diagnostic macroscopy and microscopy and as an adjunct, rather than as a substitute.

Advances in genetics, information technology and digital imaging are transforming histopathology and many other pathology subspecialties including microbiology. Molecular diagnostic tools, genomics and proteomics will probably have the biggest impact because they will continue to redefine disease at the molecular level. Some of the challenges we face today in terms of difficult diagnosis will be eliminated i.e., uncertainty will be decreased, and accuracy will be increased. The further development of nanotechnologies will also drive change and expedite diagnostics.

Epigenetic markers are being developed as diagnostic tests for cancer, to assess the presence or absence of cancer, to distinguish between aggressive and non-aggressive cancers and forecast the risk of recurrence, and predict which treatments are most likely to be effective. Liquid biopsy, circulating tumour cells, ctDNA tests are being done using next generation sequencing. I think access to this cutting-edge technology can only be a good thing for oncologists and pathologists.

I am sure, molecular diagnosis incl RTPCR. Multiplexing, FISH, advanced flow cytometry, LCMS, sequencing, nanotechnology, biosensors, epigenomics, digital pathology, artificial intelligence supported by information technology will emerge as the future solution to precise healthcare. Highly complex testing and its applications conditions as acute bacterial and viral infectious ,will move these diagnostic offerings to general pathology labs across geographies. What better example can be then the COVID RT PCR testing labs, which started across India within no time. New therapies will change the profile of diseases. New laboratory-based approaches to these problems will continue to emerge.

These will be achieved by a variety of developments in test ordering, point of care testing, specimen transport, with enhanced laboratory information systems connecting with more developed electronic patient records, and new instrumentation providing better, faster tests. Increased focus on disease prevention and early diagnosis has led to basic Lab testing moving out from core Laboratory. More patient are doing selftesting with results uploaded via Internet to their health provider. Continuous monitoring devices incl wearable devices are now in the market and helping patients & clinicians to monitor signs and symptoms as real time basis. Getting diagnostic to patients in remote areas has been a challenge. Handheld devices /POCs are now ready solution. New type of samples like sweat, Saliva, Urine ,Oral cavity brushings, Faeces ,Menstrual Blood & pad etc are being considered as better source of diagnostic information .Self-sample collection and its transportation at ambient temperature is helping sample logistics .

Digital technology has fundamentally changed our thought process. We need to be more agile and act now. The diagnostics of the 21st century will help people partnering themselves in managing their own health. In nut shell, The evolution is leading to diagnostic revolution, which in turn is redefining precision medicine. The pathologist will continue as diagnostician and there will be a wider range of technologies, including artificial Intelligence, data analytics etc to support and to augment the diagnosis. However, a major challenge to the pathologist will be to master the new technologies and to incorporate them into the pathology diagnosis. Needless to say, new age pathologist has to become more of a clinical solution provider, in addition to diagnostician.

All new emerging technologies in diagnostics today have one thing have in common. They are innovative and exciting science and have the opportunity to make patients' lives better. Today, there is a great need for pathologists with passion and hunger for adopting new technology. This advancement should be harnessed to continually improve the diagnostic offerings.

Increased focus on disease prevention and early diagnosis has led to basic Lab testing moving out from core Laboratory