The technical wording on a pathology report can be confusing. Because it is prepared for health care providers, a pathology report is written in medical language. However, understanding the basics parts of the report can help you be better informed about your diagnosis.
When reading your report, note that different pathology laboratories may use different terms to describe the same information. Your report may not have the exact wording found here. Also, some tests are only done when invasive cancer or certain types of cancer are found. If your tissue is found to be free of cancer or if your diagnosis is ductal carcinoma in situ, many of the sections described below will not appear on your report.
Diagnosis or Final diagnosis
This is the most important section of the report. It gives the pathologist's final diagnosis and may include information on features of the tumor such as size, type, grade, hormone receptor status and HER2/neu status. If lymph nodes were removed, the status of these lymph nodes will also be included. These characteristics may appear grouped together or as separate sections, depending on your pathology report.
Microscopic description
The microscopic description details what the pathologist saw and measured when he/she looked at the biopsy tissue under a microscope.
Tumor size
Tumor size is most often reported in centimeters (1 inch = 2.54 centimeters). The measurements are taken under the microscope and refer to the dimensions (length and width) of the area of the biopsy that contains cancer cells. This may be much smaller than the size of the biopsy sample (the measurement of entire sample is reported in the gross description). When the length and width of a sample are measured (for example, 1.5 x 1.9 centimeters) the longer of the two is reported as the tumor size. In general, the smaller the tumor, the better the prognosis. Find out more on tumor size.
Invasive vs. non-invasive
Invasive cancer (also called infiltrating cancer) means the cancer cells inside of a duct or lobule have broken out and have spread to nearby tissues. Ductal carcinoma in situ (DCIS) is non-invasive or stage 0, breast cancer.
Tumor grade
For invasive tumors, the pathologist notes the shape of the suspicious cells and assigns a histologic grade, using either a number system or words. Tumor grade relates to the structure of the cells and is different from tumor stage. In general, the more the abnormal 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.
Grade 1 = Well differentiated (cells look most similar to normal and are not growing rapidly
Grade 2 = Moderately differentiated (cells look somewhat different than normal
Grade 3 = Poorly differentiated (cells look irregular, and may grow and spread more aggressively than other grades
Nuclear grade
The nuclear grade describes how closely the nuclei of cancer cellsk like normal breast cells. In general, the higher the 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 histologic grading and prognosis.
Hormone receptor status
Hormone receptors are proteins that appear on the nucleus of some cancer cells. When hormones (estrogen and progesterone) attach to these receptors, they make the cancer cells grow. A tumor that is estrogen and/or progesterone receptor positive (ER+ and/or PR+) has many hormone receptors and a tumor that is estrogen and/or progesterone receptor negative (ER- and/or PR-) has few receptors. Both the American Society for Clinical Oncology and the National Comprehensive Cancer Network recommend hormone receptor testing for all tumors.
The hormone receptor status of your tumor helps guide your treatment plan. If your tumor is ER+ and/or PR+, treatments that cut off the supply of hormones, such as tamoxifen or aromatase inhibitors, may stop tumor growth. Tumors that are ER-/PR- should not be treated with hormone therapies.
Learn more about hormone receptor status and prognosis.
Learn more about hormone therapies .
HER2/neu status
HER2/neu (human epidermal growth factor receptor 2), also called ErbB2, is a protein that appears on the outside of some breast cancer cells. It is an important part of the cellular pathway for growth and survival. A tumor is HER2/neu-positive when there are many HER2/neu genes inside the cancer cells. This is also called HER2/neu over-expression. The high number of HER2/neu genes causes a large amount of HER2/neu proteins to appear on the surface of the cells.
HER2/neu-positive status is found in about 20 percent of all breast cancers [21]. These breast cancers tend to be more aggressive. HER2/neu status helps guide your treatment plan. HER2/neu-positive cancers can benefit from trastuzumab (Herceptin) therapy, which directly targets the HER2/neu receptor. This type of therapy is not recommended for cancers that are HER2-negative.
Both the American Society for Clinical Oncology and the National Comprehensive Cancer Network recommend HER2/neu testing for all tumors. HER2/neu status can be determined in two ways: 1) immunohistochemistry (IHC) testing which detects the amount of HER2/neu protein on the surface of the cancer calls and 2) fluorescence in situ hybridization (FISH) testing which detects the number of HER2/neu genes in the cancer cells. Most often, IHC is the first test and if the score is +2 (or borderline), the tumor is sent for FISH to confirm the status.
Results of an IHC test
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Score is 0 or +1
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The tumor is HER2/neu-negative.
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Score is +2
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The results are unclear and should be confirmed by FISH.
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Score is +3
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The tumor is HER2/neu-positive.
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Results of a FISH test
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Positive
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The tumor is HER2/neu-positive.
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Negative
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The tumor is HER2/neu-negative.
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Learn more about HER2/neu status and prognosis.
Learn more about treatment with trastuzumab (Herceptin).
Tumor margins
During surgical biopsies, an area of normal breast tissue (called a margin) around the suspicious cells is taken out to be sure that entire tumor was removed. The pathologist at the margins and decides whether or not they contain cancer cells.
Positive (also called "involved") margins
- The margins along the surgical edge of the biopsy contain cancer cells.
- More surgery may be needed to obtain clear margins. This should be discussed with your surgeon.
- Sometimes it is not possible to get a clear margin due to its location; for example, if it is at the chest wall.
Close margins
- The cancer cells approach but do not touch the edge.
- More surgery may be needed. This should be discussed with your surgeon.
Negative (also called "not involved", "clear" or "clean") margins
- The margins do not contain cancer cells.
- No more surgery is needed.
Vascular invasion (blood vessel invasion/angiolymphatic invasion/lymphovascular invasion)
Vascular invasion occurs when cancer cells enter blood vessels and/or lymph channels. This may suggest a more aggressive tumor.
Lymph node status
If lymph nodes were removed during the biopsy, the pathologist determines the lymph node status.
- Negative lymph node means there were no cancer cells in that lymph node.
- Positive lymph node status means that cancer cells were found in that lymph node.
In general, cancers with negative lymph nodes have a better prognosis than cancers with positive lymph nodes. Learn more about lymph node status and prognosis.
Other information on a pathology report
The following items are included on all pathology reports, but do not impact prognosis or treatment.
Patient information
This section of the report has basic information including your name, medical record number, date of birth, age and sex, the date of the biopsy and the 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 that you have the correct pathology report.
Specimen(s) received (specimen source/specimen submitted
This section records the location in the breast where the biopsy sample(s) was removed (may simply state left or right breast, or may give more detail). It also includes the date the pathologist received the tissue,
Procedure (description of procedure)
This is a description of the type of biopsy used to remove the tissue sample (e.g. needle biopsy or surgical biopsy for tumor tissue and sentinel node biopsy or axillary node biopsy for lymph nodes).
Clinical history (clinical information/clinical diagnosis/pre-operative diagnosis)
The clinical history describes the initial diagnosis before the biopsy and sometimes, a brief summary of your symptoms. If there was a previous biopsy, the pathologist often will review this tissue so that he/she can distinguish the recurrence of a prior tumor from a new tumor. The location of the tumor biopsy is also noted (e.g. left or right breast).
Gross description (macroscopic description)
One of the first things the pathologist does when he/she receives the biopsy tissue is to take basic 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 this case, 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.
Pathologist's signature
The pathologist who is responsible for the contents signs and dates the report.
Information sometimes seen on a pathology report
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 either they do not predict prognosis over and above standard measures or because they are not reliable measures for all tumors.
Immunohistochemistry (IHC) prognostic markers
Beyond HER2/neu status testing, IHC can detect other molecular markers that may give prognostic information.
Mitotic rate (proliferation rate)
The mitotic rate, or proliferation rate, represents the percentage of cancer cells that are actively dividing. In general, the higher the mitotic rate, the more aggressive the tumor tends to be. Despite mitotic rate being a possible good predictor of prognosis, it has some measurement issues. For this reason, medical oncologists do not often use it to make treatment plans. The Ki-67 antibody test is now the standard method for measuring mitotic rate.
DNA
For some tissue samples, the pathologist determines whether or not the cancer cells contain the normal amount of DNA (two copies of each chromosome, except for the Y chromosome). Diploid cells contain the normal amount of DNA and aneuploid cells contain an abnormal number of chromosomes. Aneuploid cancers may be more aggressive than diploid cancers. This test is rarely done in current clinical practice
Updated 10/27/09
Understanding your pathology report
