Bridging the Translational Gap Between Molecular Classification and Clinical Implementation in Gastrointestinal Tumors

The incorporation of molecular pathology into GI oncology at a lightning pace has brought about a change in tumor classification from being largely morphology-driven to becoming a histomolecular approach that is used in precision oncology. Improvements in next-generation sequencing, predictive biomarkers, and comprehensive genomic profiling have brought about improvements in diagnostic precision, prognostic stratification, and biomarker-driven therapy decision-making. However, the implementation of these molecular techniques has been highly inconsistent across healthcare systems, owing to differences in technology infrastructure, proficiency, cost, and access to advanced diagnostic technology. The growing inconsistency in the implementation of these techniques brings about a gap in the provision of precision oncology despite the rising complexities in the histomolecular classification by the WHO. In this perspective, we analyze the challenges faced in the adoption of molecular diagnostics in gastrointestinal pathology and come up with a practical three-tier molecular implementation plan. It enables incremental incorporation of molecular diagnostics conforming to WHO guidelines, ensuring standardization and clinically relevant decision-making in varied healthcare settings. We also cover the growing significance of digital pathology, artificial intelligence, liquid biopsy, and multi-omics in facilitating the translation of scientific advances in molecular medicine into everyday clinical practice. The implementation gap will be crucial to bridge to ensure that future advancements in molecular medicine find practical application in precision oncology.