Understanding Your Pathology Report

The simple versionExplain▾

A pathology report (sometimes called a surgical pathology report) is a medical report that describes the characteristics of a tissue specimen taken from a patient. The report is written by a pathologist, a doctor who has special training in identifying diseases by studying cells and tissues under a microscope.

A pathology report includes identifying information (such as the patient's name, birthdate, and biopsy date) and details about where in the body the specimen is from and how it was obtained. It typically includes a gross description (a visual description of the specimen as seen by the naked eye), a microscopic description, and a final diagnosis. It may also include a section for comments by the pathologist.

The pathology report provides the definitive cancer diagnosis. It is also used for staging (describing the extent of cancer in the body, especially whether it has spread) and to help plan treatment.

Your pathology report is the document that confirms a cancer diagnosis and describes exactly what was found.

How tissue is obtainedExplain▾

The pathologist examines cells or tissues obtained during a biopsy or surgery, or from bodily fluids. A biopsy specimen can be obtained in several ways, such as by:

• taking a tissue sample from the surface of the skin
• using a needle inserted through the skin to withdraw tissue or fluid
• inserting a thin, lighted tube called an endoscope through the mouth, anus, urethra, or a small incision to look inside the body and remove a sample

If surgery is used to remove part or all of a tumor, some or all of the removed tumor will be examined. When the entire tumor is removed, the surgeon typically tries to remove some normal tissue around it (the margin) so the pathologist can check that it doesn't contain tumor cells. For some cancers, especially breast cancer and melanoma, the surgeon may also remove nearby lymph nodes (the sentinel lymph nodes) so the pathologist can see if they contain cancer cells.

A pathologist may also examine cells in bodily fluids, such as urine, cerebrospinal fluid, sputum, and others.

How the tissue is examinedExplain▾

Tissue or cell specimens must be cut into very thin slices, called sections, so the pathologist can look at them under a microscope. The specimen must first be processed to make it solid.

The most common approach is to chemically "fix" the specimen, usually with a chemical called formalin. This stabilizes the cells. The tissue is then embedded into a permanent paraffin wax block, sliced into very thin sections, placed onto slides, and stained with dyes to help show parts of the cell and structures in the tissue. This is known as histologic (tissue) examination. Preparing these fixed sections normally takes several days, and the pathologist typically sends the report within 10 days after the biopsy or surgery.

Frozen sectioning is another approach, used when an immediate answer is needed—for example, during surgery to give the surgeon a rapid diagnosis while the patient is in the operating room. A frozen section can be examined in about 15 to 20 minutes. However, fixed (permanent) sections preserve more detail and are more commonly used to make a diagnosis.

The gross descriptionExplain▾

The gross description includes the color, weight, and size of a tissue sample as seen by the naked eye. It may also include the shape of the sample and any visible abnormalities. It indicates the body site the tissue was taken from, how many samples were taken, and whether and how many lymph nodes were removed.

The microscopic descriptionExplain▾

The microscopic description covers the appearance of the cells after they have been stained (often with hematoxylin and eosin, or H&E) and viewed under the microscope. It may include the type and number of cells seen, how abnormal the cells look (the tumor grade), and notable cell features.

This section also indicates whether abnormal cells are found in the margins or in lymph nodes:

• Margins are described as negative (or "clean") when no cancer cells are found at the edge of the removed tissue, suggesting all the cancer has been removed. A margin is positive (or "involved") when cancer cells are found at the edge, suggesting some cancer has not been removed.
• Lymph nodes are called positive if they have cancer cells and negative if they do not.

The microscopic description may also include results of additional tests, such as tests that measure properties of the cells or that look for genetic or molecular abnormalities.

The diagnosisExplain▾

The diagnosis section is the pathologist's summary of all the findings from the visual and microscopic examination, combined with relevant clinical information. It is here that the cancer type is identified, including the tumor grade, lymph node status, margin status, and stage.

Molecular and biomarker resultsExplain▾

Certain molecular tests, sometimes called biomarker tests, are done as part of the initial pathology analysis for all cases of a given cancer type. For example, a report for suspected breast cancer will include results of testing for estrogen and progesterone receptors and the protein HER2/neu. These results help identify the best treatments for an individual patient.

A liquid biopsy—testing a sample of blood or other fluid for pieces of tumor DNA—is another way molecular characteristics may be analyzed. Some of these results may appear in separate reports linked to the pathology report.

Getting your report and a second opinionExplain▾

The doctor in charge of your treatment will tell you about the findings in the pathology report and can help you understand what it means for your situation. You can also ask to discuss your report with the pathologist. Be aware that report results often appear in the patient portal at the same time the doctor receives them, so you may see your report before your doctor has reviewed it.

Although the diagnosis of most cancers is straightforward, you or your doctor may want a second opinion from another pathologist. To do this, you will need to obtain the slides and/or paraffin block from the pathologist or hospital that examined the sample. Many institutions, including NCI-designated cancer centers, provide second opinions; contact the facility in advance about availability, cost, and shipping.

Your doctor is your guide to the report — and getting a second opinion is always an option if you want one.