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The most common diagnosis and accurate methods of diagnosing
cancer include microscopic examination of either tissue
or cells. Cells examined are usually obtained from fluid
around the suspected site of cancer. Tissues examined
are usually removed from the primary or metastatic site
of a cancer.
There are many kinds of biopsies to remove tissue for
a cancer diagnosis. An aspiration biopsy is obtained
by using a needle to suction fluid, cells, or tissue
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into a syringe. A bone marrow biopsy is the removal of bone
marrow from one of the body's larger hollow bones such as the
femur or pelvic bone.
Excisional biopsies
attempt to remove the entire tumor. Incisional
biopsies remove only a portion of the tissue. Often,
the biopsy specimens are quickly frozen, thinly sliced, and
examined to determine the presence of absence of cancer cells
(frozen sections). Permanent sections are then made, and the
diagnosis from the permanent sections should take precedence
over frozen section reports.
Surgical resections involve removing more tissue from the
body, including margins of normal tissue and/or regional lymph
nodes. The pathologist can often determine staging by examining
the primary tumor, surrounding tissues, and regional nodes
when there is a "total" resection of the tumor. The information
from a total resection takes precedence over biopsy reports
and operative notes.
Quite often, there are several tissues samples, biopsies,
or surgical resections for one cancer. When staging a cancer,
it is important to review all pathological reports for the
clinical diagnosis, gross description of the specimen and
postoperative diagnosis.
The gross description of the specimen should include the
total size of the tumor. Both the gross and the microscopic
descriptions should state whether the surgical margins are
involved by tumor. The pathology report should contain information
about the primary site and the spread of the disease in surrounding
tissues. It is important to note all areas, organs, or structures
involved with tumor.
The pathology report contains the histologic type of cancer
and the grade of the tumor (how closely the cancer cells resemble
normal tissue). Grade is normally expressed as Grade I through
III or as well differentiated, moderately differentiate, and
poorly differentiated, respectively. Tumors can also be described
as anaplastic or undifferentiated (Grade IV).
The final diagnosis of the histological type takes precedence
over preliminary reports and frozen sections. The microscopic
description takes precedence over the gross description. Occasionally,
pathological specimens are sent to other centers for consultation,
and the final pathology report may not be signed until all
consultations have been returned.
The most important information in a pathology report includes
source of the specimen, primary site, tumor size, histologic
type of cancer, grade of tumor, and the extent of the disease
within the organ of origin and beyond. The type, size, location
and number of lymph nodes removed, and number of nodes containing
tumor should be noted. This information is often required
for accurate staging.
Pieces of chips of tumor should not be added together to
determine tumor size. If the patient has received preoperative
radiation therapy, the size of the tumor should be recorded
as found in radiology reports prior to radiation therapy.
Multifocal and multicentric are synonymous terms. The size
of the largest of the multifocal tumors should be used for
staging.
Autopsy reports are a type of pathology report that contains
detailed information about organs and structures of the body.
An autopsy is considered to be an ultimate pathology report.
In summary, pathology reports, or reports of tissue, contain
information about biopsies, frozen sections, tissue aspiration
or biopsy of bone marrow, surgical specimens and autopsies.
Cytology reports describe the microscopic examination of
cells in body fluids such a sputum, bronchial washings and
brushings, pleural fluid, peritoneal fluid, spinal fluid,
aspirations from bone marrow, and cervical smears. The Papanicolaou
(Pap) smear, used for detection of abnormal cervical cells,
is probably the most widely known cytology specimen. Cells
can also be obtained by fine-needle aspiration to diagnose
cancers of the liver, pancreas, breast, and lung. The most
common ways of obtaining cells include brushing the lining
of an organ, puncturing the cavity and removing fluid, scraping
the lining, or using a swab to obtain secretions.
Thoracentesis
is a puncturing of the thoracic, or chest cavity for the removal
of fluid. Paracentesis is the puncture of the abdominal cavity
for removal of fluid.
There may be multiple cytology reports. It is important to
note the source of the specimen, the histologic description,
and pertinent findings, along with interpretations.
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