What Is a Pathology Report?
A pathology report gives you and your doctor the results of an examination of a tissue or fluid sample. It helps your doctor diagnose breast cancer and decide which treatment options will work best for you.
It comes after a biopsy – a procedure to remove a sample of tissue from an area in your breast where your doctor thinks there may be a problem. That sample goes to a lab where a doctor called a pathologist takes a close look at it and runs tests. The pathologist specializes in diagnosing diseases, including cancer.
Some of the report will be in technical language you may not understand unless you’ve had medical training. Your doctor will summarize the results for you and can explain any parts you don’t understand.
You might automatically get a copy of the report. If not, ask your doctor how to get one. It’s important to keep this information for your records so you can read it over again if you don’t remember all the details. You can also show it to another pathologist or cancer specialist if you want a second opinion.
How Long Does a Pathology Report Take?
It can take several days to prepare the tissue sample so it can be examined and several more to run tests on it. Your doctor may have the results in about 10 days, but it could take more or less time depending on the lab and what kind of tests were done.
In certain cases, it’s possible for a pathologist to do a report on the spot while you’re still in surgery. This gives the surgeon information about the extent of the cancer so they can remove all of it at once and keep you from having to have another procedure.
As part of a breast cancer diagnosis, you may receive more than one pathology report. Samples get tested in different ways, and those results may come back as separate reports. If you had a biopsy that only took a small tissue sample, you’ll get another report after the whole tumor is removed.
Parts of a Pathology Report
Pathology reports will look different depending on the labs that prepared them. Reports can be organized in different ways and use different terms.
They will also have different information depending on what kind of surgery you had. If you had a needle biopsy that only removed fluid or a small amount of tissue, your report will have less information than if you had an entire tumor or lymph nodes removed.
In general, a pathology report will contain many of these elements:
Basic information
This is information about you, your procedure, and your pathologist, such as:
- Your name, birthday, and social security number or medical ID
- Case or sample number
- Type of biopsy procedure
- Type of sample, such as breast tissue or lymph nodes
- Date of the biopsy
- Name and signature of the pathologist
- Name and address of the lab
The report may also have information about your medical history and the reason you had the biopsy.
Description
The pathologist describes how the tissue sample looks in two ways:
Gross description. This is what the pathologist sees using just their eyes. It includes things like the color, size, and texture of the sample. This section may also detail where the sample came from – which breast, which area in the breast, and whether it includes lymph nodes.
Microscopic description. This is what the sample looks like under a microscope. The tissue is cut into very thin slices and mounted on slides, so the pathologist can see individual cells. This description includes things like the shape of the cells, how they’re arranged, and the number of abnormal cells in the sample. It’s usually written in very technical language.
Diagnosis
In this section, the pathologist reports whether the tissue is cancerous or not. This may be at the top of the document or farther down. If they find cancer, they’ll include detailed information about it, such as:
Cancer type. The diagnosis reports the type of cancer the pathologist found. With early breast cancer, the most common type is carcinoma, specifically adenocarcinoma – a kind of cancer that starts in glandular tissue.
The name will include a term that refers to which cells are involved. This is usually the cells that line the sacs (lobules) and tubes (ducts) that produce milk. If the cancer is in the milk sacs, the report will say “lobular.” If it’s in the tubes, the report will say “ductal.”
The pathologist might list a breast cancer subtype. There are several of these, which have to do with the shape that the cancer cells form as they grow. There are also some less common types of breast cancer that could be in your diagnosis, like Paget disease.
The report also indicates whether the cancer is still only in the area where it started (in situ) or whether it’s grown into surrounding breast tissue (invasive or infiltrating).
Cancer size. If you had surgery that removed the whole tumor rather than a smaller sample, the pathology report will include the size of the tumor at its widest point. This will be listed in millimeters or centimeters.
Cancer grade. The grade is a number that tells you how quickly the cancer is likely to grow and spread. It’s based on things like how much the cancer cells look like healthy cells, how they’re arranged, and how many are dividing at a particular time. In general, the higher the breast cancer grade, the more aggressive the cancer.
Margins. If they remove the whole tumor, the surgeon will also remove some of the surrounding healthy tissue. That’s to be sure no cancer cells are left behind. The pathologist checks how close cancer cells come to the edges of the sample, called the margins.
If they touch one of the edges, that’s reported as a positive or involved margin, and it means there may still be cancer cells in your breast. If the margin is negative – also called clean, clear, or not involved – you can be reasonably sure all of the cancer was removed.
Hormone receptor status. Breast cancer cells are usually tested for certain proteins that help doctors understand how they grow. One type is a hormone receptor. If cancer cells have these, that means they use either estrogen, progesterone, or both as fuel.
HER2 status. Another protein the pathologist tests for is human epidermal growth factor receptor 2, shortened to HER2. If cancer cells have a lot of this protein, that means they’re more likely to grow and spread quickly.
Lymphovascular invasion. The pathologist will report whether they find cancer cells inside either blood vessels or vessels that transport an immune system fluid called lymph. Having lymphovascular invasion means it’s more likely the cancer has spread to other parts of your body.
Lymph node involvement. Sometimes the lymph nodes in your armpit are tested at the same time as breast tissue. That’s because when breast cancer spreads, those lymph nodes are often the first place it goes. If your biopsy included lymph nodes, the pathology report will show how many were tested, how many contained cancer cells, and how many cells were in each node.
Genetic characteristics. Sometimes the pathologist runs tests to analyze the genes inside the cancer cells. They look to see if certain genes are more active than normal, or whether any genes have mutations (changes). This can help your doctor predict how likely the cancer is to come back after surgery or other treatment.
Stage. Doctors use stages to describe how serious the cancer is. One way to stage breast cancer is the TNM system, based on things like the size of the tumor (T), whether it has spread to nearby lymph nodes (N), and whether it has metastasized, or spread to other parts of your body (M).
Not all pathology reports will include a breast cancer stage. It depends on what kind of biopsy you had. For example, if you had surgery to remove the whole tumor, the pathologist may include staging information about the tumor size. If your biopsy only removed a smaller piece of tissue, the pathologist won’t know this.
If the report does include staging information, you’ll see a series of letters and numbers starting with a lowercase “p,” which indicates pathological stage.
Other information
Your report may include other information or notes. It may answer specific questions your doctor has asked, or include recommendations for more testing. Some reports will have a summary section.
How Doctors Use Your Pathology Report
The information in your pathology report helps your doctor predict how the cancer is likely to behave, and which treatment may work best for you.
Staging
Your doctor uses the pathology report, along with results from imaging and other tests, to assign an overall breast cancer stage. This will be a number, in Roman numerals, from 0 to IV. Stages 0 to II, along with some stage III cancers, are considered early breast cancer. Your treatment options are largely based on the stage of the cancer.
Treatment
If your biopsy took a small tissue sample and the pathologist found cancer, you’ll likely have surgery to remove the rest of the tumor, and possibly the entire breast and nearby lymph nodes. You may also need another procedure if the pathologist found cancer cells or precancerous cells at the tumor margins.
Different drug treatments work better on different types of breast cancer. Some treatments are only approved for people whose cancer cells have certain characteristics, like hormone receptors or gene mutations. Your pathology report has the information that shows which drugs are appropriate for your treatment.
Monitoring
You might have treatment to try to shrink a tumor before surgery to make it easier to remove. In that case, the pathology report will show how effective that was. A pathology report on blood or other samples taken during treatment can show whether chemotherapy or other drug therapy is working.
Takeaways
A pathology report is an important part of the process of diagnosing breast cancer. A doctor called a pathologist examines a tissue sample taken during a biopsy and says whether or not it’s cancerous. The report also gives you and your doctor detailed information about the cancer that you’ll use to choose the best treatment. Be sure you understand what’s in this report and keep a copy so you can be part of these decisions.
Show Sources
Photo Credit: Dmytro Zinkevych/Shutterstock
SOURCES:
National Cancer Institute: “Pathology Reports,” “Breast Health: Follow-up after an Abnormal Mammogram,” “Tumor Grade,” “Cancer Staging,” “Early-Stage Breast Cancer.”
American Cancer Society: “What Information Is Included in a Pathology Report?” “Your Breast Pathology Report: Breast Cancer,” “Breast Cancer Stages.”
Johns Hopkins Medicine: “The Pathology Report,” “Biopsy Report,” “Biopsy.”
Breastcancer.org: “Understanding Your Pathology Report,” “Breast Cancer Stages,” “Breast Biopsy,” “Screening and Testing.”
Susan G. Komen: “What is a Pathology Report?” “Contents of a Pathology Report.”
OncoLink: “Understanding Your Pathology Report: Breast Cancer.”
