Breastline | Understanding your Pathology Report

Understanding your Pathology Report

A biopsy of a breast lump is sent to a pathology laboratory where a pathologist (a physician who specializes in diagnosing disease from tissue specimens) analyzes the tissue and prepares a pathology report. This analysis reveals whether the tissue is benign (noncancerous) or malignant (cancerous) and helps your surgeon determine if you need additional surgery. If a malignancy is diagnosed, the pathology report provides your doctor with the information needed to develop a treatment plan based on the findings.

Because of the importance of the pathology analysis, many controls and guidelines are in place to promote accuracy. When the physician removes the biopsy specimen, it is placed in a container with your name, hospital number, date, and a number for the biopsy before being sent to the laboratory with specific details from your physician about the specimen. In the lab, the pathologist performs a gross exam, which includes a visual and descriptive report on weight, dimensions, contour, shape, texture, and any other visual findings. The next step is the cutting or sectioning of the lump that will be viewed under the microscope. Two types of procedures may be used according to the surgeon's orders, a frozen section or a permanent section.

A frozen section is a type of biopsy that is sometimes used for a quick analysis of the tissue. This procedure involves taking samples from the tumor and applying a chemical to instantly harden or "fix" the biopsy. The pathologist can review this tissue, and in a few minutes, offer an opinion as to whether it is benign or malignant. Frozen section analysis is usually as accurate as a permanent section, but the pathologist only views a small portion of the tumor. The problem occurs when there are no cancer cells present; the diagnosis is not a definite until all the tissues are carefully observed. Thus, the results of the permanent section are more comprehensive.

A permanent section is prepared by placing the remaining specimen in a chemical (formalin) that fixes the tissue, similar to boiling an egg. When the permanent section is firm, in approximately 24 hours, the tissue is cut into small sheets (thinner than tissue paper), and mounted on glass slides. The pathologist then reads the slides under the microscope and issues a report on what is seen. The slides are carefully stored so they may be reviewed in the future if necessary. A permanent section gives the most comprehensive answer because it studies all the tissues removed from the biopsy.

What Does the Pathologist Look For?

Cancer occurs when cells undergo change. Many different types of cells are located in the breasts, creating a potential for one of approximately 15 different malignancies to occur. These different types of cancer have their own characteristics and are often treated quite differently. In reviewing the tissue, the pathologist prepares a pathology report to give information on different aspects of the tumor which may include:

Tumor size - measures size of tumor; largest dimension is reported in centimeters or millimeters (10 millimeters equal one centimeter. One centimeter equals 3/8 inch. One inch equals approximately 2.5 centimeters.)
Margins - refers to the area of tissue surrounding a tumor, if the entire tumor was removed, and how it relates to the tumor. If the surrounding tissue has no evidence of cancer, the report will state the information with terms such as "clear," "clean," or "uninvolved"; if cancer was found, the terms used may be "involved," "residual cancer" or "indeterminate" (The pathologists were unable to make a definite statement).

Type of Cancer:

In situ cancers - Normal ducts and lobules are lined with one or two layers of cells that are in an orderly pattern; when the cancer develops and grows and does not break through the walls, but remains in the duct or lobule where it began, it is considered an in situ cancer (good prognosis).
Invasive cancers - The cancer's have broken through the wall of the duct or lobule and have begun to grow into the surrounding tissue.

Normal Cells
In Situ Cancer Cells
Invasive Cancer Cells
Node Status

If surgery included lymph node removal, the report will include how many were removed, a description of the area from which they came, and how many tested positive for cancer cells.

Questions to ask about your pathology report:

What is the name of the type of cancer I have?
Was my tumor in situ (inside ducts) or infiltrating (grown through the walls)?
What size was my tumor? (The size is in centimeters or millimetersC10 millimeters equal one centimeter, one centimeter equals 3/8 inch, one inch equals approximately 2.5 centimeters.)
Was the cancer found anywhere else in my breast tissue? (The term multicentric
means more than one place.)
How many lymph nodes were removed? How many levels of lymph nodes did you
sample or remove? (You have three levels of nodes.)
Were any nodes positive with cancer cells?
Was my tumor estrogen or progesterone receptor positive?
Was my cancer diploid (like the original cell) or aneuploid?
What was my S-phase or mitotic index? (How fast cancer was growing)
Is there anything else that I need to know about my cancer?

After the Pathology Report:

As a patient, you do not have any control over what your pathology report contains. However, you can become an active participant with your physicians in joining forces to defeat the disease. Remember:

Breast cancer is a treatable disease. It certainly is not an illness you would choose but it is an illness with many proven treatments.
Acquire an understanding of the treatment options. This will allow you to communicate with your health-care team and become an active participant in decisions. Understanding will alleviate many irrational fears and restore a sense of control to your life.
Employ the best of all medicines: your attitude. The most productive approach that you can bring, and one which the physician cannot provide, is a positive, cooperative attitude. Determination, combined with optimism, creates a healing environment that only you can provide.




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