A pathology report is a medical document written by a pathologist. A pathologist is a doctor who diagnoses disease by:
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Explaining laboratory tests
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Evaluating cells, tissues, and organs
The report gives a diagnosis based on the pathologist’s examination of a sample of tissue taken from the patient’s tumor. This sample of tissue, called a specimen, is removed during a biopsy. Learn about the various types of biopsies.
By looking at and testing the tumor tissue, the pathologist is able to find out:
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If the tissue is noncancerous or cancerous. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A noncancerous, or benign tumor, means the tumor can grow but will not spread.
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Other specific details about the tumor’s features. This information helps your doctor figure out the best treatment options.
Your doctor will receive these test results as they become available. It may take a few days to a few weeks to receive the full report. The timing depends on the testing needed. You are allowed by law to receive a copy of your pathology report. But you should expect the report to contain highly technical medical terms. Ask your doctor to explain the results in the pathology report and what they mean.
Parts of a pathology report
Different pathologists use different words to describe the same things. But most pathology reports include the sections discussed below.
Patient, doctor, and specimen
This section lists the following items:
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Patient’s name, birth date, and other personal information
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An individual number assigned to the patient to help identify samples
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The pathologist’s and oncologist’s contact information, as well as the laboratory where the sample was tested
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Details about the specimen, including the type of biopsy or surgery and the type of tissue
Gross, or obvious, description
This section describes the tissue sample or tumor as seen with the naked eye. This includes the general color, weight, size, and consistency.
Microscopic description
This is the most technical section of the report. It describes what the cancer cells look like when viewed under a microscope. There are several factors noted in this section that affect diagnosis and treatment.
Whether the cancer is invasive. Tumors of many types may be noninvasive (in situ, which means “in place”) or invasive. Invasive tumors can spread to other parts of the body through a process called metastasis. Although noninvasive tumors do not spread, they may grow or develop into an invasive tumor in the future. For invasive tumors, it is important for the pathologist to note how much the tumor has grown into nearby healthy tissue.
Grade. Grade describes how the cancer cells look compared with healthy cells. In general, the pathologist is looking for differences in the size, shape, and staining features of the cells. A tumor with cells that look more like healthy cells is called “low grade” or “well differentiated.” A tumor with cells that look less like healthy cells is called “high grade,” “poorly differentiated,” or “undifferentiated.” In general, the lower the tumor’s grade, the better the prognosis. There are different methods used to assign a cancer grade for different types of cancers. Learn more about grading for specific cancer types.
How quickly cells are dividing, mitotic rate. The pathologist usually notes how many cells are dividing. This is called the mitotic rate. Tumors with fewer dividing cells are usually low grade.
Tumor margin. Another important factor is whether there are cancer cells at the margins, or edges, of the biopsy sample. A “positive” or “involved” margin means there are cancer cells in the margin. This means that it is likely that cancerous cells are still in the body.
Lymph nodes. The pathologist will also note whether the cancer has spread to nearby lymph nodes or other organs. Lymph nodes are tiny, bean-shaped organs that help fight disease. A lymph node is called “positive” when it contains cancer and “negative” when it does not. A tumor that has grown into blood or lymph vessels is more likely to have spread elsewhere. If the pathologist sees this, he or she will include it in the report.
Stage. Usually, the pathologist assigns a stage using the TNM system from the American Joint Committee on Cancer (AJCC). This system uses 3 factors:
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The size and location of the tumor (Tumor, T)
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Whether cancer cells have spread to the lymph nodes located near the tumor (Node, N)
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Whether the tumor has spread to other parts of the body (Metastasis, M).
Pathologic stage, along with the results of other diagnostic tests, helps determine the clinical stage of the cancer. This information guides a person’s treatment options. Learn more about the stages of cancer.
Results of other tests. The pathologist may perform special tests to identify specific genes, proteins, and other factors unique to the tumor. The results of these tests may be listed in a separate section or in a separate report. These additional tests are especially important for diagnosis because choosing the best treatment option may depend on these results.
Diagnosis
This section provides the “bottom line.” You may find this section at the beginning or the end of the report. If cancer has been diagnosed, the section may include the following:
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The type of cancer, such as carcinoma or sarcoma
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Tumor grade
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Lymph node status
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Margin status
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Stage
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Any other test results, such as whether the tumor has hormone receptors or other tumor markers
Synoptic report, or summary
When the tumor was removed, the pathologist will include a summary. This lists the most important results in a table. These are the items considered most important in determining a person’s treatment options and chance of recovery.
Comments section
Sometimes, a cancer may be difficult to diagnose or the development of the cancer is unclear. In these situations, the pathologist may use the comments section. Here, he or she can explain the issues and recommend other tests. This section may also include other information that can help the doctor plan treatment.
Sampling differences
Sometimes, the pathology report for a biopsy may be different from a later report for the entire tumor. This happens because the features of a tumor can sometimes vary in different areas. Your doctor will consider all of the reports to develop a treatment plan specific to you.
Questions to ask your health care team
To better understand what your pathology report means, consider asking your health care team the following questions:
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What type of cancer do I have and where did it start?
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How large is the tumor?
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Is the cancer invasive or noninvasive?
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How fast are the cancer cells growing?
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What is the grade of the cancer? What does this mean?
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Was the entire cancer removed? Are there signs of cancer cells at the edges of the sample?
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Are there cancer cells in the lymph vessels or blood vessels?
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What is the stage of the cancer? What does this mean?
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Does the pathology report specify the tumor characteristics clearly? Should we get another pathologist’s opinion?
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Do any tests need to be done again on another sample or in another laboratory?
Getting a second opinion
It may be helpful to talk with more than one doctor about your diagnosis and treatment plan. This is called a second opinion. It is important to get a copy of the pathology report and any other medical records.
If you choose to get a second opinion, you will want to share these with the second doctor. Some doctors work closely with their own pathologists and may want their own pathologist’s opinion too. Other tests can also be done on the biopsy sample if needed. The tissue sample is kept for a long time and is available upon request. Learn more about getting a second opinion.
Related Resources
Spotlight On: Pathologists
After a Biopsy: Making the Diagnosis
When the Doctor Says Cancer
More Information
College of American Pathologists: How to Read Your Pathology Report
National Cancer Institute: Pathology Reports
When your breast was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from a breast biopsy, such as a needle biopsy or an excision biopsy.
In a needle biopsy, a needle is used to remove a sample of an abnormal area. An excision biopsy removes the entire abnormal area, often with some of the surrounding normal tissue. An excision biopsy is much like a type of breast-conserving surgery called a lumpectomy.
What does hyperplasia mean?
The normal breast is made of ducts (tiny tubes) that end in a group of sacs called lobules. Hyperplasia is a term used when there is growth of cells within the ducts and/or lobules of the breast that is not cancerous. Normally, the ducts and lobules are lined by 2 layers of cells. Hyperplasia means that there are more cells than usual and they are no longer lined up in just the 2 layers. If the growth looks much like the normal pattern under the microscope, the hyperplasia may be called usual. Some growths look more abnormal, and may be called atypical hyperplasia (see below).
The two major patterns of hyperplasia in the breast are ductal hyperplasia and lobular hyperplasia. What makes the hyperplasia ductal or lobular is based more on what the cells look like under the microscope rather than whether the hyperplasia is occurring within the ducts or lobules.
What does it mean if my report mentions E-cadherin?
E-cadherin is a test that the pathologist might use to help determine if the hyperplasia is ductal or lobular. (The cells in atypical lobular hyperplasia (ALH) are usually negative for E-cadherin.) If your report does not mention E-cadherin, it means that this test was not needed to figure out which type of hyperplasia you have.
What does it mean if my report says atypical ductal hyperplasia (ADH)?
In ADH, the pattern of growth of cells is abnormal and has some (but not all) of the features of ductal carcinoma in-situ (which is a pre-cancer). This means that ADH is not yet a pre-cancer, although it is linked to an increased risk of getting breast cancer later on.
If ADH is found on needle biopsy, more tissue in that area usually needs to be removed to be sure that nothing more serious is also present in the breast. The tissue that is removed is looked at under the microscope, and if nothing more serious is found, no other treatment is needed. The patient is then followed up with breast exams and breast imaging tests like mammography.
If ADH is found on excision biopsy, no additional surgical treatment is needed, but your doctor may recommend taking medicine to help reduce your risk of breast cancer.
What is the significance of atypical lobular hyperplasia (ALH)?
ALH is also an abnormal growth of cells within lobules of the breast that is linked with an increased risk of breast cancer. If ALH is found on needle biopsy, it isn’t clear what is the best thing to do—some doctors think that more surgery should be done to make sure that there isn’t anything more serious nearby, while other doctors think that it is enough to follow the patient with physical exams and imaging tests (like mammograms). If ALH is found on an excision (lumpectomy), patients are most often followed-up without further treatment, but your doctor may recommend taking medicine to help reduce your risk of breast cancer.
What does it mean if my report mentions special tests such as high molecular weight cytokeratin (HMWCK), CK903, CK5/6, p63, muscle specific actin, smooth muscle myosin heavy chain, calponin, or keratin?
These are special tests that the pathologist sometimes uses to help make the correct diagnosis of a variety of breast lesions. Whether your report does or does not mention these tests has no bearing on the accuracy of your diagnosis.
What does it mean if my report also uses any of the following terms: usual ductal hyperplasia, adenosis, sclerosing adenosis, radial scar, complex sclerosing lesion, papillomatosis, papilloma, apocrine metaplasia, cysts, columnar cell change, collagenous spherulosis, duct ectasia, fibrocystic changes, flat epithelial atypia, or columnar alteration with prominent apical snouts and secretions (CAPSS)?
All of these are terms for benign (non-cancerous) changes that the pathologist might see under the microscope. They are not important when seen on a biopsy sample that contains ADH or ALH.
What does it mean if my report mentions microcalcifications or calcifications?
Microcalcifications or calcifications are calcium deposits that can be found in both non-cancerous and cancerous breast lesions. They can be seen both on mammograms and under the microscope. Because certain calcifications are found in areas containing cancer, their presence on a mammogram may lead to a biopsy of the area. Then, when the biopsy is done, the pathologist looks at the tissue removed to be sure that it contains calcifications. If the calcifications are there, the treating physician knows that the biopsy sampled the correct area (the abnormal area with calcifications that was seen on the mammogram).
