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Understanding Your Pathology Report: Breast Cancer

Carolyn Vachani, RN, MSN, AOCN

Abramson Cancer Center of the University of Pennsylvania


What is a pathology report?

A pathologist is a medical doctor who specializes in diagnosing diseases by examining tissue from the body. You will probably never meet the pathologist, but samples of your breast tissue and lymph nodes, removed during surgery or biopsy, will be sent to him or her for review. The pathologist prepares a summary report of his or her findings, which is called the pathology report.

What will you find on a pathology report?

The report is broken down into a few sections, including some information about the patient, such as the clinical diagnosis (suspected or known), procedure, a description of what the specimen looks like to the naked eye (called gross description), a description of what was seen under the microscope (microscopic description), and a pathologic diagnosis. In the case of a breast cancer, the pathologist will describe the type of cell the cancer comes from, the tumor size and grade, whether the cancer cells have entered the lymph channels or blood vessels, information about surgical resection margins, and hormone receptor and Her2 status. Breast cancer pathology reports are one of the more complex pathology reports and can seem quite overwhelming at first glance. To help you better understand your report, let's break down each section individually.

The Gross Description

This is generally not that important to you, the patient. It is a description of what the pathologist received and sees with the naked eye. In a biopsy, the specimen is likely a small, nondescript piece of tissue, in which case the pathologist may describe the color, shape, feeling and size of the tissue. After a breast cancer surgery, large pieces of tissue and lymph nodes may be submitted and described in the report. This description might report the presence of "inked" margins or sutures, which the surgeon adds so the pathologist can tell "which end is up" once the tissue is disconnected from the body. There may be mention of surgical clips or wires that were used by the surgeon to be sure that the suspicious area was removed. After a sentinel node biopsy, the gross description may say a lymph node is "hot", which refers to the radioactive tracer that is used by the surgeon to locate the sentinel node, or that it is "blue", due to the presence of dye that can also be used to locate the node. The pathologist often then describes how the tissue was divided up for further analysis.

This section has told us the size of the tissue submitted, but not the size of the actual cancer. The gross description isn't helpful in determining the stage of the cancer or treatment, which is what is important to you, so let's move on to the next section.

Microscopic Diagnosis

This section may be called microscopic diagnosis or description or just diagnosis. This is the meat of the report and contains the most useful information. Not every report goes through the microscopic diagnosis in the same order and some use different terms to describe the same thing. In this section we will discuss each part of the microscopic description in detail. Sometimes the tests are performed in different laboratories or take different lengths of time to complete, which can mean you may not get all the results at once. It is important to wait for all the results to best understand your situation.

Type of Breast Cancer

It seems simple: we are talking about breast cancer, so that's what type it is. But it is not so simple. Almost all breast cancers arise from glandular tissue, making them adenocarcinomas (cancer of the glandular tissue); they are further named by where they start in the breast and how they appear under the microscope. To better understand this section, you need to have some knowledge of normal breast tissue. Breast tissue is composed of lobules, which produce milk; and ducts, which carry the milk to the nipple. Breast cancer starts in a duct or a lobule and this, along with its appearance under the microscope, determine the type of breast cancer it is. The type can dictate some of the treatment choices, although many types are treated similarly.


Last Updated on Thursday, 21 January 2010 10:13