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Pathology Reports: Questions and Answers
- What is a pathology report?
A pathology report is a document that contains the diagnosis determined
by examining cells and tissues under a microscope. The report may also contain
information about the size, shape, and appearance of a specimen as it looks
to the naked eye. This information is known as the gross description.
A pathologist
is a doctor who does this examination and writes the pathology report. Pathology
reports play an important role in cancer diagnosis and staging
(describing the extent of cancer within the body, especially whether it
has spread), which helps determine treatment options.
- How is tissue obtained for examination by
the pathologist?
In most cases, a doctor needs to do a biopsy or surgery to remove cells
or tissues for examination under a microscope.
Some common ways a biopsy can be done are as follows:
- A needle is used to withdraw tissue or fluid.
- An endoscope
(a thin, lighted tube) is used to look at areas inside the body and remove
cells or tissues.
- Surgery is used to remove part of the tumor
or the entire tumor. If the entire tumor is removed, typically some normal
tissue around the tumor is also removed.
Tissue removed during a biopsy is sent to a pathology laboratory, where
it is sliced into thin sections for viewing under a microscope. This is
known as histologic (tissue) examination and is usually the best way to
tell if cancer is present. The pathologist may also examine cytologic
(cell) material. Cytologic material is present in urine,
cerebrospinal
fluid (the fluid around the brain and spinal
cord), sputum
(mucus
from the lungs),
peritoneal
(abdominal
cavity) fluid, pleural
(chest cavity) fluid, cervical/vaginal
smears, and in fluid removed during a biopsy.
- How is tissue processed after a biopsy or surgery?
What is a frozen section?
The tissue removed during a biopsy or surgery must be cut into thin sections,
placed on slides, and stained with dyes before it can be examined under
a microscope. Two methods are used to make the tissue firm enough to cut
into thin sections: frozen sections and paraffin-embedded (permanent) sections.
All tissue samples are prepared as permanent sections, but sometimes frozen
sections are also prepared.
Permanent sections are prepared by placing the tissue in fixative (usually
formalin) to preserve the tissue, processing it through additional solutions,
and then placing it in paraffin wax. After the wax has hardened, the tissue
is cut into very thin slices, which are placed on slides and stained. The
process normally takes several days. A permanent section provides the best
quality for examination by the pathologist and produces more accurate results
than a frozen section (1).
Frozen sections are prepared by freezing and slicing the tissue sample.
They can be done in about 15 to 20 minutes while the patient is in the operating
room (1). Frozen sections are done when an immediate answer is needed;
for example, to determine whether the tissue is cancerous so as to guide
the surgeon
during the course of an operation.
- How long after the tissue sample is taken
will the pathology report be ready?
The pathologist sends a pathology report to the doctor within 10 days after
the biopsy or surgery is performed. Pathology reports are written in technical
medical language. Patients may want to ask their doctors to give them a
copy of the pathology report and to explain the report to them. Patients
also may wish to keep a copy of their pathology report in their own records
(1).
- What information does a pathology report usually
include?
The pathology report may include the following information (1):
- Patient information: Name, birth date, biopsy date.
- Gross description: Color, weight, and size of tissue as seen by the
naked eye.
- Microscopic
description: How the sample looks under the microscope and how it compares
with normal cells.
- Diagnosis: Type of tumor/cancer and grade
(how abnormal
the cells look under the microscope and how quickly the tumor is likely
to grow and spread).
- Tumor size: Measured in centimeters.
- Tumor margins:
There are three possible findings when the biopsy sample is the entire
tumor:
- Positive margins mean that cancer cells are found at the edge of
the material removed.
- Negative, not involved, clear, or free margins mean that no cancer
cells are found at the outer edge.
- Close margins are neither negative nor positive.
- Other information: Usually notes about samples that have been sent for
other tests or a second opinion.
- Pathologist's signature and name and address of the laboratory.
- What might the pathology report say about the physical
and chemical characteristics of the tissue?
After identifying the tissue as cancerous, the pathologist may perform
additional tests to get more information about the tumor that cannot be
determined by looking at the tissue with routine stains, such as hematoxylin
and eosin (also known as H&E), under a microscope (2). The pathology report will include the results of these tests.
For example, the pathology report may include information obtained from
immunochemical stains (IHC). IHC uses antibodies
to identify specific antigens
on the surface of cancer cells. IHC can often be used to:
- Determine where the cancer started.
- Distinguish among different cancer types: for example, carcinoma,
melanoma,
and lymphoma.
- Help diagnose and classify leukemias
and lymphomas (3).
The pathology report may also include the results of flow
cytometry. Flow cytometry is a method of measuring properties of cells
in a sample, including the number of cells, percentage of live cells, cell
size and shape, and presence of tumor
markers on the cell surface. (Tumor markers are substances produced
by tumor cells or by other cells in the body in response to cancer or certain
noncancerous conditions.) Flow cytometry can be used in the diagnosis, classification,
and management of cancers such as acute
leukemia, chronic
lymphoproliferative
disorders, and non-Hodgkin
lymphoma (2).
Finally, the pathology report may include the results of molecular diagnostic
and cytogenetic
studies. Such studies investigate the presence or absence of malignant
cells, and genetic
or molecular abnormalities in specimens.
- What information about the genetics of the cells
might be included in the pathology report?
Cytogenetics uses tissue culture and specialized techniques to provide
genetic information about cells, particularly genetic alterations. Some
genetic alterations are markers
or indicators of a specific cancer. For example, the Philadelphia
chromosome is associated with chronic
myelogenous leukemia (CML). Some alterations can provide information
about prognosis,
which helps the doctor make treatment recommendations (3). Some tests that might be performed on a tissue sample include:
- Fluorescence in situ hybridization (FISH) determines
the positions of particular genes.
It can be used to identify chromosomal abnormalities and to map genes.
- Polymerase
chain reaction (PCR) is a method of making many copies of
particular DNA
sequences of relevance to the diagnosis.
- Real-time PCR or quantitative PCR is a method of measuring
how many copies of a particular DNA sequence are present.
- Reverse-transcriptase polymerase chain reaction (RT-PCR)
is a method of making many copies of a specific RNA
sequence.
- Southern blot hybridization detects specific DNA fragments.
- Western blot hybridization identifies and analyzes
proteins
or peptides.
- Can individuals get a second opinion about
their pathology results?
Although most cancers can be easily diagnosed, sometimes patients or their
doctors may want to get a second opinion about the pathology results (1). Patients interested in getting a second opinion should talk
with their doctor. They will need to obtain the slides and/or paraffin block
from the pathologist who examined the sample or from the hospital where
the biopsy or surgery was done.
Some cancer centers and other facilities, such as the Armed Forces Institute
of Pathology (AFIP), provide second opinions on pathology specimens. Patients
should contact the facility in advance to determine if this service is available,
the cost, and shipping instructions. Contact information for National Cancer
Institute (NCI)-designated cancer centers can be found in the NCI-Designated
Cancer Centers database available at http://www.cancer.gov/cancertopics/factsheet/NCI/cancer-centers
on the Internet. Additional information about the AFIP is available on their
Web site at http://www.afip.org/ on the
Internet.
- What research is being done to improve the
diagnosis of cancer?
NCI, a component of the National
Institutes of Health, is sponsoring clinical trials that are designed
to improve the accuracy and specificity of cancer diagnoses. Before any
new method can be recommended for general use, doctors conduct clinical
trials to find out whether it is safe and effective.
People interested in taking part in a clinical trial should talk with their
doctor. Information about clinical trials is available from the NCI's Cancer
Information Service (CIS) (see below) at 1-800-4-CANCER and in the NCI
fact sheet Clinical Trials: Questions and Answers, which is available
at http://www.cancer.gov/cancertopics/factsheet/Information/clinical-trials
on the Internet. This fact sheet includes information about types of clinical
trials, who sponsors them, how they are conducted, how participants are
protected, and who pays for the patient care costs associated with a clinical
trial. Further information about clinical trials is available at http://www.cancer.gov/clinicaltrials
on the NCI's Web site. The Web site offers detailed information about specific
ongoing studies by linking to PDQ®,
the NCI's comprehensive cancer information database. The CIS also provides
information from PDQ.
Selected References
- Morra M, Potts E. Choices. 4th ed. New York:
HarperResource, 2003.
- Borowitz M, Westra W, Cooley LD, et al. Pathology and
laboratory medicine. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB,
McKenna WG, editors. Clinical Oncology. 3rd ed. London: Churchill
Livingstone, 2004.
- Connolly JL, Schnitt SJ, Wang HH, et al. Principles
of cancer pathology. In: Bast RC Jr., Kufe DW, Pollock RE, et al., editors.
Cancer Medicine. 6th ed. Hamilton, Ontario, Canada: BC Decker Inc.,
2003.
# # #
Related NCI materials and Web pages:
For more help, contact:
- NCI's Cancer Information Service
Telephone
(toll-free): 1-800-4-CANCER (1-800-422-6237) TTY (toll-free):
1-800-332-8615 LiveHelp® online chat: https://cissecure.nci.nih.gov/livehelp/welcome.asp
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