Understanding Your Pathology Report (2023)

What Does A Pathology Report Tell You?

Skin samples taken by a biopsy or surgical excision are typically sent to a pathology laboratory for microscopic examination and diagnosis. A pathology report is issued by a pathologist or dermatopathologist.

A pathologist is a physician who diagnoses disease through laboratory tests and direct evaluation of cells, tissues, and organs. A dermatopathologist specializes in skin pathology, a subspecialty of dermatology and pathology.

The pathology report states the diagnosis and further describes any defining characteristics of the melanoma, such as the type of melanoma, depth of invasion, presence or absence of ulceration, mitotic count, presence or absence of regression, presence or absence of satellite lesions, and presence or absence of blood vessel/lymphatic vessel/nerve invasion.

Additionally, the pathology report will indicate whether the excised lesion is a primary melanoma, in which case it would be described using the terms above, or a metastatic melanoma deposit. A metastatic melanoma deposit is one in which the melanoma started somewhere else on the skin and some of the melanoma cells broke off and spread within the skin tissue to the current biopsy/specimen site.

An Example of a Melanoma Pathology Report

The following information is from an actual melanoma pathology report. Not all pathology reports will have all of these details, but this sample report should help you decipher yours.

The report will begin by identifying you, your specimen, and your doctor (or the person who ordered the report):

(Video) Understanding Your Pathology Report: A Patient’s Story

PATIENT:

(your name)

DATE OF BIOPSY:

(date)

SUBMITTING SERVICE/PHYSICIAN:

(your physician’s name)

ACCESSION #:

(a number assigned to the biopsy specimen used to identify it in the pathology system)

SEX:

(your gender)

DOB:

(your birthday)

MRN:

(Video) Understanding Your Pathology Report

(medical record number)

There will be a diagnosis section, usually near the top of the report:

FINAL PATHOLOGY DIAGNOSIS: Right anterior distal thigh excisional biopsy; 1.5 x 1.7cm. MALIGNANT MELANOMA, NODULAR TYPE, BRESLOW THICKNESS AT LEAST 2.6MM, WITHOUT ULCERATION, BIOPSY EDGES ARE INVOLVED.

This section will typically state the type of excision and the location on the body of the biopsy, as well as the final pathologist opinion of the diagnosis of melanoma, and the type of melanoma. The Breslow thickness will be noted somewhere on the report—here or elsewhere, or both—because this measurement of the melanoma’s thickness is one of the most important details for diagnosis. Other important details about the melanoma, such as ulceration, may also be here.

CLINICAL HISTORY: Neoplasm of uncertain behavior; Melanoma vs. Nodular melanoma

The Clinical History is a description by your physician of the lesion that was biopsied. This description may include size, location, and/or what s/he is concerned about. In this case, it appears nodular melanoma was suspected.

MICROSCOPIC/DESCRIPTION: Microscopic examination has been performed and is consistent with the diagnosis. The tissue sample was received in the bottle labeled “right anterior distal thigh.” The tissue demonstrates a malignant melanocytic neoplasm. There are nests of atypical melanocytes filling the papillary and reticular dermis demonstrating a compact cohesive growth pattern with scattered mitoses, pleomorphic nuclei and prominent nucleoli with lack of maturation. There is no evidence of regression or pagetoid invasion noted. There is an intact epidermis with a junctional component identified. There is no ulceration, satellites, perineural or lymphovascular invasion identified in the tissues examined. As the lesion involves the deep margin, the lesion measures at least 2.6mm in depth and is at least Clarks’s level IV with the staging of at least pT3aNxMx. The lateral margin was additionally positive and involved with melanoma in situ. Correlation with larger excisional specimen is recommended due to the positive deep and lateral margins, as well as for further staging purposes. This case was reviewed by my colleague Dr._________ who concurs with the above interpretation.

These sections confirm the microscopic examination and the finding of melanoma. In many reports, this section can be quite detailed, with a very specific description of the appearance of the cells and characteristics of how the cells look under the microscope.

The rest of the report will describe the specifics about the melanoma in detail:

HISTOLOGIC TYPE: Nodular melanoma

Histologic type can be superficial spreading, nodular, lentigo maligna, acral lentiginous, desmoplastic, unclassified, etc. Histologic type is the type of melanoma you have. It’s important information because there are prognostic and treatment differences in different types of melanoma.

MAXIMUM TUMOR THICKNESS: At least 2.6mm

This thickness is also called Breslow Thickness or Breslow Depth. It describes in millimeters the thickest part of the melanoma. This measurement is very important for prognosis. A thinner tumor has a better prognosis.

ULCERATION: Not identified.

Ulceration is the breakdown or loss of the top layer of the skin (the epidermis). The pathologist/dermatopathologist determines the presence or absence of ulceration when s/he reviews the specimen under the microscope. Having ulceration is associated with a worse prognosis. Patients who report bleeding from their melanoma often have ulceration in the biopsy.

(Video) How to Understand Your Pathology Report

PERIPHERAL MARGIN: Involved by invasive melanoma; involved by melanoma in situ.

DEEP MARGIN: Involved by invasive melanoma.

Margins are the edge of a biopsy or surgical excision specimen. If melanoma extends to the edge of the sample (the margins), then it is presumed that the biopsy or excision did not remove the entire tumor. Deep margins are located at the base of the biopsy/specimen and lateral/peripheral margins are the side edges of the biopsy/specimen. If there is no tumor extending to the margins, the pathologist will describe how close the lesion came to the edge. (Example: tumor extends to within 2 mm of the margin). The thickness of the melanoma is used to guide the recommended margin of normal tissue the surgeon plans to remove at the time of surgery.

LYMPHOVASCULAR INVASION: Not identified.

Blood vessel/lymphatic or lymphovascular invasion means that melanoma cells have entered the blood vessels or lymphatic system. The presence of this finding is associated with a worse prognosis.

PERINEURAL INVASION: Not identified.

If identified, perineural invasion is evidence that melanoma cells are entering the local nerve fibers. The presence of this finding is associated with a worse prognosis.

TUMOR REGRESSION: Not identified.

Regression refers to an area of the tumor without active melanoma cell growth and is thought to be evidence that some of the melanoma was destroyed by one’s immune system. There are conflicting reports on whether this finding has useful prognostic significance.

AJCC STAGE/TNM: pT3a

The TNM System (Tumor-Node-Metastasis) is the most widely used way of determining cancer stages. This staging system, created by the American Joint Committee on Cancer (AJCC), provides important prognostic and survival information. The “T3a” describes this patient’s tumor depth and lack of ulceration. The “p” means that there is a pathology report to support the staging assigned. If there is an “x” noted in one or more of the categories, such as above in the Microscopic/Description section where the staging is noted as “pT3aNxMx” it means that there has been no assessment of that characteristic of the tumor.

COMMENT: There is local superficial erosion, consistent with trauma/irritation.

In the case of melanoma, pathologists will specifically comment on features that are relevant for prognosis and treatment. These are sometimes included in the description but also may be in list form.

(Video) How to Understand your Pathology Report

GROWTH PHASE: Vertical

Radial growth phase and/or vertical growth phase may be noted, describing whether the melanoma has begun an invasive pattern. If the melanoma has a Breslow depth, then it will have a vertical growth phase even if this is not separately reported.

MITOTIC RATE: 3/mm2

Mitosis is the process by which one mature cell divides into two identical cells. The pathologist counts the number of actively dividing cells (mitoses) that they see. This is seen in many cancers, including melanoma. Averaging this number gives the mitotic count, which is stated as the number of mitoses per square millimeter (mm). A higher mitotic count means more tumor cells are dividing at a given time and is associated with a worse prognosis.

GROSS: Received in formalin labeled with the patient’s name and the anatomic site are 2 superficial pieces of skin ranging in size from .8 cm by 0.3 cm by 0.1 to 1.4 cm by 1.0 cm by 0.3 cm. the specimens are sectioned and submitted entirely in 1 cassette. The measurements may not correspond to those in vivo as shrinkage from formalin fixation may occur.

Gross is a description of the actual size of the biopsied tissue and what it looked like to the naked eye. This section is used by the pathologist for identification of the tissue.

Other Details That May Be On Your Pathology Report Include The Following:

Clark Level/Level of Invasion/Anatomic Level:

Clark Level was replaced in the revised melanoma staging system in 2010 by more reliably predictive features (mitotic count and ulceration). It is now only used to stage thin melanomas (< 1mm).

Tumor Infiltrating Lymphocytes (TILs):

Lymphocytes are immune cells. Lymphocytes can be present in a melanoma and are described as “brisk,” “non-brisk,” “sparse,” and “absent.” A brisk immune response has been associated with a better prognosis. However, the true significance of this criterion is still controversial, and some pathologists do not report it.

Satellite Lesions:

Also called “local metastasis.” They are small nodules of melanoma located more than 0.05mm from the primary lesion but less than 2cm. They are described as being present or absent. Some satellite lesions (macroscopic) can be seen with the naked eye. Others, which are smaller (microscopic) can be found only by the pathologists. Both macroscopic and microscopic lesions are reported in the pathology report.

Recommendations:

(Video) How to Read a Pathology Report

Based on all the above information, the pathologist may make initial recommendations to the doctor, including whether another biopsy needs to be done to get additional tissue, or whether the doctor should perform an excision of the lesion to ensure complete removal.

FAQs

How do I read my cancer test results? ›

Sections of Your Report
  1. Grade 1 or well-differentiated: Cells appear normal and are not growing rapidly.
  2. Grade 2 or moderately-differentiated: Cells appear slightly different than normal.
  3. Grade 3 or poorly differentiated: Cells appear abnormal and tend to grow and spread more aggressively.
16 Feb 2022

Can a pathology report tell if cancer has spread? ›

The pathology report provides the definitive cancer diagnosis. It is also used for staging (describing the extent of cancer within the body, especially whether it has spread) and to help plan treatment. Common terms that may appear on a cancer pathology report include: invasive.

How often are pathology reports wrong? ›

Although tests aren't 100% accurate all the time, receiving a wrong answer from a cancer biopsy – called a false positive or a false negative – can be especially distressing. While data are limited, an incorrect biopsy result generally is thought to occur in 1 to 2% of surgical pathology cases.

What are good cancer marker numbers? ›

Normal range: < 2.5 ng/ml. Normal range may vary somewhat depending on the brand of assay used. Levels > 10 ng/ml suggest extensive disease and levels > 20 ng/ml suggest metastatic disease.

How does a pathologist determine if cancer is present? ›

During a biopsy, a doctor removes a small amount of tissue from the area of the body in question so it can be examined by a pathologist. For most types of cancer, a biopsy is the only way to make a definitive cancer diagnosis.

Can you tell cancer stage from biopsy? ›

The clinical stage is an estimate of the extent of the cancer based on results of physical exams, imaging tests (x-rays, CT scans, etc.), endoscopy exams, and any biopsies that are done before treatment starts. For some cancers, the results of other tests, such as blood tests, are also used in clinical staging.

Can they tell what stage cancer is in by biopsy? ›

Doctors use diagnostic tests like biopsies and imaging exams to determine a cancer's grade and its stage. While grading and staging help doctors and patients understand how serious a cancer is and form a treatment plan, they measure two different aspects of the disease.

Does cancer spread faster after biopsy? ›

A long-held belief by a number of patients and even some physicians has been that a biopsy can cause some cancer cells to spread. While there have been a few case reports that suggest this can happen — but very rarely — there is no need for patients to be concerned about biopsies, says Dr. Wallace.

What are red flags in reference to clinical assessment? ›

Essentially red flags are signs and symptoms found in the patient history and clinical examination that may tie a disorder to a serious pathology. [5] Hence, the evaluation of red flags is an integral part of primary care and can never be underestimated. The term “red flag” was originally associated with back pain.

What should I look for in a pathology report? ›

Components of a pathology report
  • Your name and your individual identifiers. ...
  • A case number. ...
  • The date and type of procedure by which the specimen was obtained (for instance, a blood sample, surgery, or biopsy)
  • Your medical history and current clinical diagnosis.
  • A general description of the specimen received in the lab.

What does my pathology report mean? ›

A pathology report is a medical document that gives information about a diagnosis, such as cancer. To test for the disease, a sample of your suspicious tissue is sent to a lab. A doctor called a pathologist studies it under a microscope. They may also do tests to get more information.

What is the most important part of a pathology report? ›

The most important part of the pathology report is the final diagnosis. This is the “bottom line” of the testing process, although this section may be at the bottom or the top of the page. The doctor relies on this final diagnosis to help decide on the best treatment options.

Can you get a second opinion on a pathology report? ›

Some people find that asking another doctor about their disease, before undergoing a procedure or treatment, can often help them deal with the uncertainty and stress. Professionals in many medical specialties offer second opinions, including in pathology.

Why would a pathologist get a second opinion? ›

Second opinions in pathology improve patient safety by reducing diagnostic errors, leading to more appropriate clinical treatment decisions.

What is a high cancer marker? ›

What are tumor markers? Tumor markers are substances found in higher-than-normal levels in the blood, urine, or tissues of some people with cancer. These substances, which are also called biomarkers, can be made by the tumor. They can also be made by healthy cells in response to the tumor.

What is high tumor marker count? ›

High tumor marker levels can be a sign of cancer. Along with other tests, tumor marker tests can help doctors diagnose specific types of cancer and plan treatment. Tumor marker tests are most commonly used to do the following: Learn if a person has cancer.

What are normal cancer levels? ›

CA-125 normal range

The range of 0 to 35 U/mL is considered within the normal guidelines. Levels over 35 U/mL may indicate the presence of cancer or other conditions. Not all patients with a high CA-125 result have cancer.

What is the best way to confirm a diagnosis of cancer? ›

In most cases, doctors need to do a biopsy to diagnose cancer. A biopsy is a procedure in which the doctor removes a sample of tissue. A pathologist looks at the tissue under a microscope and runs other tests to see if the tissue is cancer.

Do doctors tell you if they suspect cancer? ›

If you're deemed to be of sound mind, and you ask the question, then yes, they are legally obligated to disclose your medical data to you.

Does clear margins mean cancer free? ›

A clear, negative, or clean margin means there are no cancer cells at the outer edge of tissue that was removed. A positive margin means that cancer cells come right out to the edge of the removed tissue and have ink on them.

Which stage cancer is curable? ›

In situ means "in place." Stage 0 cancers are still located in the place they started. They have not spread to nearby tissues. This stage of cancer is often curable. Surgery can usually remove the entire tumor.

When is cancer considered terminal? ›

Cancer that cannot be cured and leads to death. Also called end-stage cancer.

Do oncologists lie about prognosis? ›

Many have fulminated against oncologists who lie to patients about their prognoses, but sometimes cancer doctors lie for or with patients to improve our chances of survival. Here's the back story in this case. The patient, a woman in her early 50s, was given a diagnosis of endometrial cancer.

When cancer spreads to lymph nodes what stage is it? ›

stage 3 – the cancer is larger and may have spread to the surrounding tissues and/or the lymph nodes (or "glands", part of the immune system)

At what stage of cancer is chemotherapy used? ›

For cancer that has spread

Your doctor might suggest chemotherapy if there is a chance that your cancer might spread in the future. Or if it has already spread. Sometimes cancer cells break away from a tumour. They may travel to other parts of the body through the bloodstream or lymphatic system.

Is stage or grade more important in cancer? ›

Doctors can't be certain exactly how the cells will behave. But the grade is a useful indicator. Doctors sometimes look at the cancer grade to help stage the cancer. The stage of a cancer describes how big the cancer is and whether it has spread or not.

Do you still have cancer if tumor is removed? ›

Surgeons do their best to remove all of the cancer during surgery. But it is always possible to leave behind a small group of cancer cells. Your surgeon may recommend more treatment if they feel that there is a risk that the cancer could come back. This is sometimes called adjuvant treatment.

Can cancer cells escape during a biopsy? ›

If the outer capsule is damaged during biopsy or an operation to remove it, cancer cells can “spill” from the tumor, allowing them to spread or regrow. These types of tumors should be removed and biopsied only by a highly skilled and experienced surgeon who specializes in these types of cancer.

How often do biopsies come back as cancer? ›

Suspicious mammographic findings may require a biopsy for diagnosis. More than 1 million women have breast biopsies each year in the United States. About 20 percent of these biopsies yield a diagnosis of breast cancer. Open surgical biopsy removes suspicious tissue through a surgical incision.

What is a red flag in pathology? ›

Red flags are specific attributes derived from a patient's medical history and the clinical exam that are usually linked with a high risk of having a serious disorder like an infection, cancer, or a fracture.

What is a yellow flag in a patient? ›

Introduction
FlagNature
YellowBeliefs, appraisals and judgements
Emotional Responses
Pain behaviour (including pain and coping strategies)
BluePerceptions about the relationship between work and health
3 more rows

What is a red flag diagnosis? ›

A red flag is defined as a constellation of symptoms, signs, clinical data or circumstances, conceptualized by an individual clinician, that should lead to heightened suspicion for a serious condition and trigger additional evaluation.

How do pathologists tell normal from abnormal cells? ›

After a pathologist or lab technician processes and stains the cytology samples, they examine the cells under a microscope, looking for abnormal cells. If they find abnormal cells, they mark them on the slides with a special pen. A pathologist then makes a diagnosis based on the cells and puts together a report.

How accurate are pathologist? ›

The reported frequency of anatomic pathologic errors ranges from 1% to 43% of all specimens, regardless of origin and disease, he said. The error rate for oncology is 1% to 5%.

What are the 4 aspects of pathology? ›

Pathology emphasized four aspects of the disease process. These are the cause (etiology), the mechanism of development (pathogenesis), the alterations of structure and forms (morphology) and functional alterations (pathophysiology).

What does Gross mean in a pathology report? ›

In medicine, a description of what tissue taken during a biopsy looks like without using a microscope. The gross description may include the size, shape, color, and weight of the tissue sample.

What does a negative pathology report mean? ›

The pathologist will look to see if there are cancer cells at or in the margin. Positive or involved margins means there are cancer cells at the margin. Negative, clean, or clear margins means there are no cancer cells at the margin.

What does final diagnosis mean? ›

A final diagnosis that is made after getting the results of tests, such as blood tests and biopsies, that are done to find out if a certain disease or condition is present.

How do you read biopsy results? ›

Sections of Your Report
  1. Grade 1 or well-differentiated: Cells appear normal and are not growing rapidly.
  2. Grade 2 or moderately-differentiated: Cells appear slightly different than normal.
  3. Grade 3 or poorly differentiated: Cells appear abnormal and tend to grow and spread more aggressively.
16 Feb 2022

What does a pathology test show? ›

A pathology test is a test that examines samples of your body's tissues, including your blood, urine, faeces (poo), samples obtained by biopsy. Doctors use this information for diagnosis and treatment of diseases and other conditions.

What is the difference between a biopsy and a pathology report? ›

For many health problems, a diagnosis is made by removing a piece of tissue for study in the pathology lab. The piece of tissue may be called the sample or specimen. The biopsy report describes what the pathologist finds out about the specimen.

How often do pathologists make mistakes? ›

Biopsy specimens are examined by pathologists, who look at the tissue sample under a microscope in order to determine if it is cancerous. It has been estimated that 1 in every 71 biopsies is misdiagnosed as cancerous when it was not, and 1 out of every 5 cancer cases was misclassified.

How often do patients get misdiagnosed? ›

According to a recent study, nearly 12 million outpatient U.S. people are misdiagnosed each year. This is 5% of adults or 1 in 20. According to the Society for the Improvement of Diagnosis in Medicine (SIDM), between 40,000 and 80,000 individuals die each year due to misdiagnoses.

What percentage of patients get a second opinion? ›

Systematic reviews of the literature have indicated that the quest for a second opinion in different patient populations varied widely between 7 and 36% [20] and between 1 and 88% [22].

Can a pathologist report be wrong? ›

Although tests aren't 100% accurate all the time, receiving a wrong answer from a cancer biopsy – called a false positive or a false negative – can be especially distressing. While data are limited, an incorrect biopsy result generally is thought to occur in 1 to 2% of surgical pathology cases.

Who pays for a second opinion? ›

Medicare covers second opinions if a doctor recommends that you have surgery or a major diagnostic or therapeutic procedure. Note: Medicare does not cover second opinions for excluded services, such as cosmetic surgery.

Can a pathology report be inconclusive? ›

Sometimes, the result of a biopsy will be inconclusive, meaning that the test has not produced a definitive result. This can happen for several reasons: There could have been a problem processing the sample, the sample didn't contain enough of the affected tissue or the sample size was not large enough.

What is normal range for cancer? ›

The normal range for CA 125 is 0 to 35 units/ml. While a CA 125 level over 35 may indicate cancer, it does not always mean the person has cancer.
...
CA 125 Levels Chart.
CA 125 Levels (units/mL)Potential Cancer
>35 (high)Possible cancer. More tests will be needed for a diagnosis.
1 more row
5 Mar 2021

What do cancer scores mean? ›

Cancer grades

grade 1 – cancer cells that resemble normal cells and aren't growing rapidly. grade 2 – cancer cells that don't look like normal cells and are growing faster than normal cells. grade 3 – cancer cells that look abnormal and may grow or spread more aggressively.

How do you interpret cancer staging? ›

The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues. The cancer has spread to distant parts of the body. The higher the number, the more advanced the cancer is. Letters and numbers are often used after the first number to describe the cancer in more detail.

What cancers have a low survival rate? ›

Cancer survival rates by cancer type

The cancers with the lowest five-year survival estimates are mesothelioma (7.2%), pancreatic cancer (7.3%) and brain cancer (12.8%). The highest five-year survival estimates are seen in patients with testicular cancer (97%), melanoma of skin (92.3%) and prostate cancer (88%).

What is low level cancer? ›

(TOO-mer grayd) A description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells.

What is considered high risk for cancer? ›

These include using tobacco and alcohol, being overweight, and getting multiple sunburns. Other risk factors cannot be avoided, such as getting older. Learn about the risk factors for certain types of cancer.

What are the three cancer tests you can get to detect cancer? ›

Taking a sample of the tissue called a biopsy. Medical imaging, such as X-ray, CT scan or MRI. Physical examination. Specialized tests such as a mammogram for breast cancer and a Pap smear for cervical cancer.

What is the average cancer survival rate? ›

The 5-year relative survival rate for all cancers combined that were diagnosed during 2009 through 2015 was 67% overall, 68% in whites, and 62% in Blacks. Cancer survival has improved since the mid-1970s for all of the most common cancers except cervical and endometrial cancers.

What is the highest cancer grade? ›

But most tumors are graded as X, 1, 2, 3, or 4.
  • Grade X: Grade cannot be assessed (undetermined grade)
  • Grade 1: Well differentiated (low grade)
  • Grade 2: Moderately differentiated (intermediate grade)
  • Grade 3: Poorly differentiated (high grade)
  • Grade 4: Undifferentiated (high grade)
1 Aug 2022

How fast can cancer metastasis? ›

Most malignant tumors that metastasize do so within five years after the primary tumor has been detected, so this raises the question of how one can explain “dormancy” among tumor cells for decades.

How long do you live when cancer spreads to lymph nodes? ›

A patient with widespread metastasis or with metastasis to the lymph nodes has a life expectancy of less than six weeks. A patient with metastasis to the brain has a more variable life expectancy (one to 16 months) depending on the number and location of lesions and the specifics of treatment.

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