Pathology reports are prepared for health care providers. So, they are written in medical language. This can make some of the wording confusing. However, understanding the basic parts of the report can help you be better informed about your diagnosis.
Different pathology labs may use different terms to describe the same information. So, your report may not have the exact wording found here.
Needle biopsy reports may contain less information than surgical biopsy reports.
Also, some tests are only done when invasive breast cancer or certain types of breast cancer are found. If your tissue is found to be free of cancer or if your diagnosis is ductal carcinoma in situ (DCIS), many of the sections described below will not be on your report.
This is the most important section of the report. It gives the pathologist's final diagnosis and may include information on the tumor such as size, type, grade, hormone receptor status and HER2 status.
If lymph nodes were removed, the status of these lymph nodes will also be included.
This information may appear grouped together or as separate sections, depending on your pathology report.
The microscopic description details what the pathologist saw and measured when he or she looked at the biopsy tissue under a microscope.
Tumor size is most often reported in centimeters or millimeters (1 inch = 2.54 centimeters = 25.4 millimeters). The best way to measure tumor size is under a microscope (especially for small tumors).
The longest length of the tumor in the specimen (the tissue removed during surgery) is reported as the tumor size.
The tumor size may be much smaller than the size of the tissue sample (the measurement of entire sample is reported in the gross description).
In general, the smaller the tumor, the better the prognosis tends to be.
Learn more about tumor size.
Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer (stage 0). The cancer cells are contained within the milk ducts (“in situ” means "in place") and have not spread to nearby breast tissue.
Invasive breast cancer has spread from the original site (the milk ducts or lobules) into the nearby breast tissue, and possibly to the lymph nodes and/or other parts of the body.
For invasive breast cancers, the pathologist notes the shape of the cancer cells and assigns a histologic grade, using either a number system or words. Tumor grade describes the structure of the cells and is different from tumor stage.
In general, the more the cancer cells look like normal breast cells, the lower the grade and the better the prognosis.
The most common grading system in current clinical practice is the Nottingham system:
The nuclear grade describes how closely the nuclei of cancer cells look like the nuclei of normal breast cells.
In general, the higher the nuclear grade, the more abnormal the nuclei are and the more aggressive the tumor cells tend to be.
The nuclear grade is a part of overall tumor grade.
Learn more about tumor grade and prognosis.
Hormone receptors are proteins found inside some cancer cells. When hormones (estrogen and progesterone) attach to these receptors, they make the cancer cells grow.
The hormone receptor status of your tumor helps guide your treatment plan.
If the tumor is ER-positive and/or PR-positive, your treatment will include hormone therapy (such as tamoxifen or aromatase inhibitors). Hormone therapy prevents the cancer cells from getting the hormones they need to grow and may stop tumor growth.
Tumors that are ER-negative and PR-negative are not treated with hormone therapy.
The American Society for Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recommend hormone receptor testing for all tumors.
Learn more about hormone receptor status and prognosis.
Learn more about hormone therapy.
HER2 (human epidermal growth factor receptor 2) is a protein that appears on the surface of some breast cancer cells. It is also called HER2/neu and ErbB2. This protein is an important part of the pathway for cell growth and survival.
About 20 percent of breast cancers are HER2-positive [29-30].
HER2 status helps guide your treatment plan. HER2-positive cancers can benefit from trastuzumab (Herceptin) therapy, which directly targets the HER2 receptor. This type of therapy is not used to treat HER2-negative cancers.
ASCO and NCCN recommend HER2 testing for all tumors. The two common ways to determine HER2 status are:
Most often, IHC is the first test and if the score is +2 (or borderline), the tumor is sent for FISH testing to confirm the status.
Results of an IHC test
Score is 0 or +1
Tumor is HER2-negative
Score is +2
Results are unclear and should be confirmed by FISH
Score is +3
Tumor is HER2-positive
Results of a FISH test
The tumor is HER2-positive
The tumor is HER2-negative
Learn more about HER2 status and prognosis.
Learn more about treatment with trastuzumab (Herceptin).
During a surgical biopsy, a rim of normal breast tissue (called a margin) surrounding the suspicious area is removed. If the biopsy shows cancer, the margins help show whether or not all of the tumor was removed.
The pathologist looks at the margins under a microscope and determines whether or not they contain cancer cells.
Negative (also called “clean,” “not involved” or “clear”) margins
Positive (also called "involved") margins
Vascular invasion occurs when cancer cells enter blood vessels or lymph channels. This may suggest a more aggressive tumor.
If lymph nodes in the underarm area (axillary nodes) were removed during surgery, the pathologist looks at them under a microscope and determines whether or not they contain cancer.
In general, lymph node-negative breast cancers have a better prognosis than lymph node-positive breast cancers.
Learn more about lymph node status and prognosis.
Learn more about lymph node assessment.
The following items are included in all pathology reports, but do not impact prognosis or treatment.
This section of the report has basic information including your name, medical record number, date of birth, age and sex, date of the biopsy and name of the health care provider who ordered the report (most often your surgeon).
It is a good idea to check all this information to make sure you have the correct pathology report.
This section records the location in the breast where the biopsy sample(s) was removed. It may simply state left or right breast, or may give more detail. It also includes the date the pathologist received the tissue.
This is a description of the type of biopsies used to remove the tissue sample and lymph nodes (if lymph nodes were removed).
Learn more about biopsies.
Learn more about sentinel node biopsy and axillary dissection.
The clinical history describes the initial diagnosis before the biopsy and sometimes, a brief summary of your symptoms. The location of the tumor biopsy is also noted (for example, left or right breast).
If there was a prior biopsy, the pathologist often will review this tissue so he or she can distinguish the recurrence of a past tumor from a new breast cancer.
One of the first things the pathologist does when he or she receives the biopsy tissue is to take measurements and record a description of the tissue as it appears to the naked eye (without a microscope). This gross description may include the size, weight, color, texture or other features of the tissue and any other visual notes.
If there are multiple samples, there is often a separate gross description section for each sample. In these cases, the pathologist assigns a reference number or letter to each tissue sample to avoid confusion.
The gross description also includes information on how the sample was handled once it reached the pathologist.
The pathologist who is responsible for the contents signs and dates the report (most often, electronically).
The following items do not impact prognosis or treatment and may not appear on your report.
Some of these tests are only done for certain diagnoses. Others are not routinely done because they do not predict prognosis over and above standard measures or because they are not reliable measures for all tumors.
Beyond HER2 status testing, IHC can detect other molecular markers that may give information on prognosis.
The proliferation rate is the percentage of cancer cells that are actively dividing. In general, the higher the proliferation rate, the more aggressive the tumor tends to be.
Proliferation rate could be a good predictor of prognosis. However, there are issues related to its measurement, so it is not widely used by health care providers to make treatment decisions.
The Ki-67 test is a common way to measure proliferation rate. MIB1 is the antibody most often used to label the Ki-67 antigen. You may see these terms on your pathology report. A higher value shows a higher proliferation rate.
Learn more about understanding your pathology report.
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