Spathology: The Birth of Spatial Pathology as a Discipline

Pathology has always been a spatial science: for more than 150 years, diagnosis has rested on reading the architecture of cells and tissues. Three technological streams are now converging on this founding principle. Spatially resolved omics can measure thousands of transcripts and over a hundred proteins in intact, formalin-fixed paraffin-embedded (FFPE) tissue; multiplexed imaging quantifies tissue microenvironments cell by cell; and computational pathology has progressed from slide digitization to foundation models that can predict molecular features from morphology. The clinical evidence for spatial readouts is real but heterogeneous: a few assays have reached guideline mention or prospective use, while most findings remain retrospective, platform-dependent, and unevenly validated. Yet the field remains fragmented across "spatial biology", "digital pathology", and "computational pathology", without a unified framework for standards, training, and diagnostics. Here we propose, for discussion rather than as a settled matter, that this convergence be treated as a coherent branch of pathology, "spatial pathology", which we define as the use of spatially resolved measurements of tissue to derive diagnostic, prognostic, and predictive information. We set out which problems existing structures do not yet address, acknowledge the counterarguments, and outline a consensus-building agenda. We also suggest "spathology" as an optional shorthand, and we disclose openly that all authors are co-founders of a company, SPATHO AB, whose name derives from the same contraction.