The Rise of AI-Assisted Diagnosis: Will Pathologists Be Partners or Bystanders?

Over 150 years, pathology has transformed remarkably, from the humble beginnings of microscopic tissue examination to today's revolutionary advancements in digital pathology and artificial intelligence (AI) applications. This review briefly retraces the evolution of microscopes and highlights breakthroughs in complementary tools and techniques that laid the foundation for modern surgical pathology, recently expanded into a new dimension with digital pathology. Digital pathology marked a pivotal turning point by addressing the longstanding limitations of conventional microscopy, paving the way for AI integration. AI now revolutionizes pathology workflows, offering unprecedented opportunities for automated diagnostics, enhanced precision, accelerated research, and advanced medical education. Despite widespread consensus on AI as complementary to pathologists, rare studies critically explore the feasibility of a fully autonomous, pathologist-independent diagnostic workflow. Given the rapid advancement of AI, it is timely to examine whether mature AI systems might realistically achieve diagnostic autonomy. Thus, this review uniquely addresses this gap by evaluating the feasibility, limitations, and implications of a disruptive, pathologist-free diagnostic model. This exploration raises critical questions about the evolving role of pathologists in an era increasingly defined by automation. Can pathologists adapt to emerging trends, maintain their central role in patient care, and leverage AI effectively, or will their traditional roles inevitably diminish? Could the continued advancement of AI eventually prompt a return of pathologists to their initial mid-19th century role as scientist scholars, removed from frontline diagnostics? Ultimately, we assess whether AI can independently sustain diagnostic accuracy and decision making without pathologist oversight.