Understanding Your Pathology Report

The better you understand your pathology report, the better prepared you’ll be to discuss your prognosis and treatment with your team of physicians. While pathology reports vary depending on the laboratory, they are generally divided into the following sections:

  • Gross Description
  • Final Diagnosis
  • Microscopic Description or Comment

Gross Description

This part of the report explains the type of biopsy specimen being reviewed, and the size and features of the specimen based on what is visible to the naked eye. Types of biopsies include:

Fine needle aspiration: Performed by different members of your medical team, a thin needle is inserted into the area of concern in your breast or one of your lymph nodes. Cells are aspirated out and spread onto a slide then stained for review by a cytopathologist.

Core needle biopsy: Unlike a fine needle aspiration that focuses on individual cells, a core needle biopsy takes multiple “cores” of tissue from your breast or lymph nodes, places them in a fixative and sends them to the pathology lab. Typically performed by a radiologist, this type of biopsy provides the pathologist with more information about the architecture of the area of concern.

Excisional biopsy/Lumpectomy/Partial mastectomy: Performed by your surgeon, this type of biopsy involves surgical removal of tissue. Though the terms are often used interchangeably, an “excisional biopsy” is usually performed in order to make a primary diagnosis, whereas a “lumpectomy” or “partial mastectomy” are used to confirm a diagnosis and define clear margins of tissue around the area of concern.

Mastectomy: A mastectomy is also performed by your surgeon and involves the removal of the entire breast. The breast is then placed in fixative and sent to the pathology lab. Getting a mastectomy does not imply the problem in your breast is more worrisome. There are a variety of reasons why a patient and surgeon choose mastectomy over lumpectomy/partial mastectomy.

Sentinel lymph node biopsy/axillary dissection: A sentinel lymph node biopsy is another procedure performed by your surgeon.  This procedure is a way to see if your cancer has spread to what is felt to be the “first” lymph node that a cancer would travel to from your breast.

Prior to your surgery, a dye or radiotracer (or both) is injected into your breast that will travel along your lymphatic system to your “sentinel node.”  Often, based upon established criteria in the surgical literature, there will be more than one node that is considered “sentinel.”  This is not abnormal.

If cancer is found in your sentinel node, often the remainder of the lymph nodes in your armpit (axillary lymph nodes) will be removed in what is called a “completion axillary dissection.” These lymph nodes are also sent to the histology lab to be processed as slides for the pathologist to review.

You may note that a “frozen section/intraoperative consultation” is listed in your pathology report for your sentinel node. This is because some surgeons will ask the pathologist to quickly “freeze” the lymph node to see if there is cancer in the node while the surgeon is still operating on you.  If the pathologist finds cancer, the surgeon can complete your axillary dissection at that point without requiring you to return for a second surgical procedure.

Frozen section/intraoperative consultation is not a requirement and in many cases your surgeon will not ask for this procedure for a variety of reasons.

Final Diagnosis

A critical part of your pathology report, the final diagnosis summarizes the findings your pathologist has noted on the tissue he/she has received. Your medical team will rely this information, so its accuracy is imperative. Depending on the specimen, the biopsy results, and whether or not your medical team feels the final pathology diagnosis matches their clinical or radiologic suspicions, you may need additional treatment.

If your pathologist makes a diagnosis of cancer, either carcinoma in situ or invasive carcinoma, then make sure that your pathology report includes the appropriate staging information (Understanding Your Breast Cancer Stage). Depending on that information, you may be referred for more surgery and/or to a medical oncologist and radiation oncologist to discuss further treatment.

Microscopic Description or Comment

This part of your report may or may not be present and this is not abnormal.  Depending on the diagnosis, many pathologists will issue a microscopic description. This explains all of the things he/she saw under the microscope that caused him/her to arrive at your diagnosis.

Sometimes, if there were extenuating circumstances regarding the biopsy or if your diagnosis is rare or required an additional pathologist’s review, a comment might be made explaining the circumstances under which the pathologist rendered his/her diagnosis.

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