Begin with the diagnosis and the specimen details
A histopathology report records the examination of submitted tissue. Before interpreting individual terms, check your name, the specimen site and the procedure described. Then review the diagnosis with your treating clinician.
Typical sections include a description of the tissue received, the microscopic findings and the diagnostic conclusion. Additional tests may be reported separately or in an addendum. The final interpretation combines the tissue findings with relevant clinical information. [1]
Understand the limits of the sample
Ask whether the procedure sampled part of the lesion or removed it in its entirety. This helps explain what the report can establish and what still requires clinical assessment.
A useful question is: “Does this result adequately explain what was seen during the examination and on imaging?” If the answer is uncertain, the treating clinician and pathologist may need to discuss the case.
Grade and stage describe different things
When cancer is diagnosed, grade refers to microscopic features of the tumour cells and tissue. Stage describes the extent of the cancer, including its size and spread. A biopsy report does not always provide everything needed to determine the complete stage. [2,3]
Avoid interpreting a word such as “well differentiated” as a complete statement about severity or treatment. Ask how the microscopic diagnosis fits with examination, imaging and other findings.
What margin information means
In an appropriate surgical specimen, the pathologist may assess whether tumour reaches the tissue edges. This is margin assessment. Its relevance depends on the procedure and the specimen; a small diagnostic biopsy should not be read as though it were necessarily a definitive cancer excision. [1,4]
Questions worth taking to the appointment
- What is the diagnosis in plain language?
- Is the result final, or are further tests pending?
- Does the tissue result fit the clinical findings?
- What is the next step, and how soon should it happen?
- Is specialist review or a second opinion appropriate?
Keep the complete report rather than only a cropped photograph of the diagnosis line. Comments and addenda can contain information relevant to the next decision.
The report becomes most useful when it is explained in the context of your case and followed by an agreed plan.
Sources
[1] National Cancer Institute. Surgical Pathology Reports. https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/pathology-reports-fact-sheet
[2] National Cancer Institute. Tumor Grade. https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/tumor-grade
[3] National Cancer Institute. Cancer Staging. https://www.cancer.gov/about-cancer/diagnosis-staging/staging
[4] National Cancer Institute, SEER Training Modules. Pathological Exams. https://training.seer.cancer.gov/staging/sources/pathologic.html