W idespread utilization of computed tomography and magnetic resonance imaging, along with a wide range of clinical laboratory tests, have increased the diagnostic acumen of clinicians and fostered the impression that histopathologic examination of biopsies and performance of necropsies are superfluous and not cost-effective. There is, in fact, legislation that now allows surgeons to discard certain types of specimens without consulting the pathologist. If this trend continues, pathology will eventually become a medical specialty of historical interest alone.
At the moment, however, oncologists and radiotherapists still look to pathologists for assistance in tumor diagnosis. Indeed, they cannot proceed with plans for therapy without a tissue diagnosis, nor are they able to discuss prognosis with the patient or the patient's family. Equally important are test protocols involving the efficacy of new drugs or treatment regimens for certain tumors. Under the circumstances, the decision of the pathologist is pivotal to the patient, the clinician, and the investigator. Needless to say, it is of crucial importance that the pathologic diagnosis be accurate. The problem is to identify the ultimate arbiter of truth in these matters. Certainly, neither medicine in general nor diagnostic pathology in particular are exact sciences, and practitioners vary in their ability, experience, and expertise. Diseases of the nervous system often challenge the diagnostic skills of even the most erudite and experienced general pathologists, many of whom are relieved to turn to colleagues who devote themselves to diagnosing disturbances in the structures and functions of the brain, the spinal cord, and the nerves and muscles.
One of the most troublesome areas is that of tumor diagnosis, See referenced original article on pages 796an issue that Bruner et al. 1 address in an article in this issue. As 803, this issue. neuropathologists on the staff of the M. D. Anderson Cancer Center in Houston, Texas, they see a large number of brain and spinal cord Supported by Mental Retardation Core Grant IP tumors removed from patients who are referred to that hospital for 30HD26979:07 from the National Institute of Child and Human Development.