The practice of pathology is continually changing driven by technological advances and clinical need. Usually these occur in a planned and gradual manner. However, once in a while there is a significant paradigm shift as “game-­‐changing” novel technologies emerge. When this occurs, as with the advent of immunohistochemistry in the 1980’s or expression profiling of tumours in the early 2000s, both the pathology and non-­‐pathology communities sing the death knell of conventional pathology. On each occasion, pathology has assessed the practical and clinical utility of the platforms and has adopted those that are fit for purpose leading to strengthening of pathology as a discipline and a clinical service. Recently, with the advent of affordable next generation sequencing for the molecular testing of cancers that has been largely driven by targeted therapies against specific tumour gene mutations, we are not only seeing a challenge to the service delivery model of pathology but the way we classify tumours. Is this a true revolution or continual evolution of pathology practice? These notions will be discussed in the light of the need for rapid tumour mutational analysis for personalised/precision medicine in oncology.