Your Pathology Report

Updated 
April 10, 2016

The pathology reportinfo-icon is one of the most important documents you will receive during your diagnosisinfo-icon. This report creates a profile of the cancer’s traits, including its size and location, and it describes features that provide clues to the aggressiveness of the tumorinfo-icon.

The pathology report helps your doctors predict your risk for recurrenceinfo-icon, the chance the cancer will return or spread. Your oncologistinfo-icon then uses this information to recommend treatments for you.

To create the pathology report for your biopsyinfo-icon, a pathologistinfo-icon, a doctor who diagnoses cancer by looking at cells and tissues under a microscope, looks at tissues collected during your initial procedure. The pathology report for your biopsy will provide most of the information for your treatment, but more details will be added once you have your definitive surgery. This surgeryinfo-icon, which may be a lumpectomyinfo-icon or mastectomyinfo-icon, should end with cancer-free margins: no cancer found along the edges of the tissueinfo-icon removed during surgery. The pathologist will also gather information from your lymph node biopsy, if you had one.

Sections of Your Pathology Report

You may get your complete report all at once or in parts. You may even get a few reports at a time. Most pathology reports are split into three sections:

  • Gross descriptioninfo-icon: This section describes the tissueinfo-icon the pathologistinfo-icon received as seen with the naked eye. It often includes information on how the tissue was oriented and prepared before its dissection and submission for processing.
  • Microscopicinfo-icon description/Synoptic Summary: This section goes into detail about the cancer itself and how it looked under the microscope. This section is very important in treatment planning. Among the details covered in this section of the report are:
    • the size of the cancer
    • the number of lymphinfo-icon nodes with cancer, if any
    • whether cancer was found in one area or several areas of your breast
    • whether the surgeoninfo-icon removed all the cancer, called the margininfo-icon status
    • how the cells look under a microscope, called the histologic gradeinfo-icon
    • the pathological staginginfo-icon
    • any predictive markerinfo-icon testing
    • how quickly the tumorinfo-icon is growing, called the mitotic rate/proliferative indexinfo-icon
  • Final Diagnosisinfo-icon/Impression - This section sums up all the information the doctors learned. 

Make sure to get your own copy of your final pathology reportinfo-icon from your surgeon’s office.

Pathological Diagnosis

Content coming soon!

Anatomic Site

The location of the tumorinfo-icon is known as the anatomic site. The word “anatomic” is a medical term that refers to a part of your body: in this case, the part of your body that contains the breast cancer.

Tumors can grow in any part of the breast. If a tumor appears in the breast ducts but is noninvasiveinfo-icon, meaning it has not grown beyond the ductinfo-icon and into nearby healthy breast tissues, it is called ductal carcinoma in situinfo-icon or DCISinfo-icon. Cancer cells that start in the ducts or in the lobules, structures that make and carry breast milk to the nipples, become invasive if they have spread outside the ducts or lobules into healthy breast tissues.

Breast cancer can spread to areas outside the breast, such as nearby structures called lymphinfo-icon nodes. Breast cancer can also metastasizeinfo-icon or spread to different anatomic sites, including organs and locations outside of the breast and nearby lymph nodes. These areas include the bones, liver, lungs or brain.

Size

The size of a tumorinfo-icon is important for you and your doctors to know as you plan your treatment. Generally, smaller tumors are associated with less intense treatment, better results and longer survival. Larger tumors are usually treated more aggressively and are associated with shorter survival and higher risk for recurrenceinfo-icon, the chance that the cancer will return or spread to other parts of the body.

This isn’t always the case, though. A small cancer can be very aggressiveinfo-icon and a large cancer can be very manageable. Your pathology reportinfo-icon will include other features of the cancer that will help determine the aggressiveness of your tumor  

Your doctors may be able to get a sense of how large the tumor is during a physical exam or by looking at images from a mammogram or ultrasound. But the only way to know the tumor’s exact size is to measure it after it has been removed during surgeryinfo-icon and examined by a pathologistinfo-icon, a doctor who diagnoses cancer by looking at cells and tissues with a microscope.

The pathologist measures the area that contains cancer cells in three dimensions. The largest dimension is considered the tumor size. For example, a tumor that is 3 centimeters by 2 centimeters by 2 centimeters will be called 3 centimeters in size. 

Histopathologic Grade

Content coming soon!

Ki-67 Proliferation Index

Content coming soon!

Lymphovascular Invasion

Content coming soon!

Hormone Receptor Status

After you were diagnosed with breast cancer, you should have had a number of tests to help your doctors learn more about the cancer and how to treat it.

One of those tests checked the cancer’s hormone receptorinfo-icon status. This test checks whether the cancer cells have receptors for the hormones estrogeninfo-icon and progesteroneinfo-icon. Receptors on the surface of breast cancer cells work like satellite dishes. They detect and bring in hormoneinfo-icon signals. These signals can direct cells to grow, multiply and repair damage. Learn more about how your doctor tests for hormone receptor status and how it might impact treatment. 

Surgical Margins

After you have lumpectomyinfo-icon or mastectomyinfo-icon, information about surgical margins will be added to your pathology reportinfo-icon. The surgical margininfo-icon is the edge of the tissueinfo-icon that was removed. In other words, it is the tissue that the surgeoninfo-icon cut across to remove tissue from your body. Your surgeon’s goal is to remove all of the cancer in your breast and achieve “clear,” or “negative” margins, meaning they find no cancer at the edge of the tissue they remove. Clear margins are associated with a lower risk of a local recurrence (cancer returning in the same breast). Research shows about 1 out of 4 women who have a lumpectomy go on to have a second breast surgeryinfo-icon because the margins weren’t clear after their first surgery.

If you have more than one tumorinfo-icon in the breast, it’s harder to achieve clear margins with a lumpectomy. In this situation, your surgeon may recommend mastectomy instead. Or, your oncologistinfo-icon may recommend neoadjuvant, or pre-surgery, treatment with chemotherapyinfo-icon or targeted therapyinfo-icon, depending on what type of breast cancer you have, to shrink the tumor and make lumpectomy more likely to succeed.

Lymph Node Status

To determine what stageinfo-icon of cancer you have, your surgeoninfo-icon will need to look at the lymphinfo-icon nodes under your arm, called axillary nodes, on the side of the body where the cancer was found. Lymph nodes help the body filter out waste, damaged cells and infectioninfo-icon. The axillary lymph nodes are the often the first place breast cancer cells travel to.

To see if cancer cells are in your lymph nodes, your surgeon will remove them during the breast surgeryinfo-icon you have to remove the tumorinfo-icon.

Knowing whether there are cancer cells in your lymph nodes will help you and your doctors learn the stage of the cancer and decide what treatments you need in addition to surgery.

Lymph nodeinfo-icon status is different from lymphovascular invasion (see section above). Lymphovascular invasion means the pathologistinfo-icon saw some cancer cells in the blood vessels or the lymph channels within your breast, rather than in the lymph nodes themselves.

You may have one of two types of surgery to remove the lymph nodes. You can read about these surgeries here.

Cancer Stage

The stageinfo-icon of a breast cancer describes the extent of the cancer in your body. Staginginfo-icon is usually based on

  • the size of the tumorinfo-icon
  • whether lymphinfo-icon nodes near the breast contain breast cancer
  • whether the breast cancer has spread from the breast to other parts of the body

In general, the higher the stage, the larger the amount of cancer in your body. Learn more about how cancer is staged and what it means for you.

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