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.
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.
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
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
meansmore 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.
For more information, please call The Connie Dwyer Breast Center at (973) 877-5189.