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Understanding and Dissecting Your Breast Cancer Pathology Report

By Rosalyn Carson-DeWitt, MD

Updated February 09, 2009

(LifeWire) - Technical medical jargon can be particularly frustrating and anxiety-provoking when you're trying to understand something as important as your own pathology report. At a time like that, you want things to be crystal clear, yet the terminology used might muddy your understanding. Here's a guide to help you make sense of your pathology report.

Why Is the Pathology Report Important?

The pathology report is a detailed description of your cancer at the time of surgery. It provides information about where the tumor was located, how big it was, what kinds of cells it contained, and whether it has spread. These key pieces of information are crucial for the next step--planning your treatment.

Remember that you have the right--in fact, the obligation to yourself--to understand the report as fully as possible. If necessary, make an appointment with your doctor for the sole purpose of reviewing the report and getting all of your questions answered.

What Should I Look at First?

Check the demographics information. This is the section that gives your name, address, patient number, surgeon's name, date of the procedure, etc. Make sure that you are actually looking at your own report, and that a mix-up did not take place.

What Is the Clinical Description?

This part of the report describes a little bit about you and why you are having a biopsy. It may also contain a provisional or clinical diagnosis; this is the working diagnosis that your doctor suspects, and which the pathology report is asked to prove or disprove.

What Is the Specimen Description?

This describes the location on your body from which the biopsy was taken. It may also describe the procedure used to obtain the specimen, and what kind of preservative the biopsy was put into for transport to the pathology lab.

What Is the "Gross" Description?

"Gross" is one of those medical terms that is often misunderstood. In this case, it doesn't mean that anyone's disgusted by what they see. "Gross" means obvious; it's a description of what could be seen without the use of any special devices, procedures, dyes, etc. The gross description of the tumor may include its color, size, weight, consistency, the number of lymph nodes present, etc.

What Is the Microscopic Description?

This gets into more of the nitty-gritty characteristics of the cancer. The tumor is often frozen or stiffened with wax, and then sliced very thinly. The pathologist mounts the slices onto slides and applies dye to the slices to highlight details of the cancer cells. The pathologist views the slices under a high-powered microscope, and describes the images:

  • Tumor histology: The type of cell is identified and the way the cells are arranged are described here.
  • Tumor grade: This classifies the cancer cells by their degree of abnormality. Cancer cells, after all, are variants of normal cells. If the cancer cells are closer to normal in appearance, they are referred to as "well-differentiated." Less normal cells are referred to as "poorly-differentiated." Grade is usually also indicated by a number--cancer cells with higher numbers are poorly differentiated and more aggressive in nature. The tumor grade helps predict how quickly the tumor will grow and how likely it is to spread.
  • Tumor size, invasiveness, spread: The tumor is carefully measured, and tests are done to see whether it is well-contained within a defined area (called "in-situ"), or whether it has begun to spread to neighboring tissues (called "invasive"). The report will provide a description of what other tissues have been invaded, such as blood vessels, lymph nodes, or other nearby tissue. More invasive cancers have the potential to spread outside of their original location to other parts of the body (called metastasis)--additional tests (such as CT or MRI scans) may be required to see whether there is any evidence of distant spread.
  • Tumor margins: Most biopsies attempt to remove the tumor along with a margin of completely normal tissue that surrounds the tumor. The pathology report should comment on whether the tumor margins are clear (no cancer cells) or positive (cancer cells present). Close margins mean that the tumor cells are very tight up against the normal cells, which may mean that further surgery will be required to insure clear margins. This is important to know, because it suggests whether or not cancer cells may have been inadvertently left behind.
  • Lymph node status: Breast biopsies usually include removal of one or more lymph nodes. These will be examined in a way similar to the breast tissue itself for the presence of cancer cells. This may be expressed simply as "positive" (cancer found in the node) or "negative" (no cancer found) or as a number. For example, if ten lymph nodes were removed, and the number given is 6/10, then cancer was identified in six of the ten lymph nodes.
  • Other tests may also be performed to reveal more information about the biochemical attributes, hormone receptor status, or genetic characteristics of the cancer cells.

What if I Just Want to Cut to the Chase?

The bottom-line information is contained in the summary or final diagnosis section. Combining information from all of the other sections of the pathology report, this section will tell you whether you have cancer, and will provide a synopsis of the most important information regarding tumor location, size, cell type, grade, spread, margins, and markers.

Sources:

"How to Read a Pathology Report." Patient Care. Department of Pathology, New York University Medical Center. 14 Aug. 2008.

"Pathology Reports: Questions and Answers." Cancer.gov. National Cancer Institute, U.S. National Institutes of Health. 14 Aug. 2008.

"Understanding a Pathology Report." Cancer.net. American Society of Clinical Oncology. 14 Aug. 2008.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Rosalyn Carson-DeWitt, MD, works as a medical writer, editor, and consultant in Durham, NC. She served as editor-in-chief for two multivolume MacMillan encyclopedias: The Encyclopedia of Drugs, Alcohol, and Addictive Behavior and Drugs, Alcohol and Tobacco: Learning About Addictive Behavior. She worked on the 18th edition of the Merck Manual of Diagnosis and Therapy and has written thousands of print and online articles for health care providers and consumers.
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