A pathology report is a document that contains the diagnosis determined by examining cells and tissues under a microscope. As a patient reading a pathology report for the first time, it can be confusing, and I would like to clarify the following,
- A pathology report on a biopsy or a specimen does not mean that the diagnosis is cancer.
- Do not confuse prognostic report sometimes referred to as recurrence score or genomic profile with genetic testing.
- Genetic testing is done on a minority of patient in whom the physician is suspecting a hereditary form of cancer.
A biopsy of a suspicious breast lesion seen in a mammogram does not equate with the diagnosis of cancer. In this day and age, most if not all initial breast biopsies are image guided by either ultrasound, x-ray, or sometimes even MRI such initial biopsies are either done by the interventional radiologist or the breast surgeon. In most cases, the initial biopsies will establish the diagnosis, and guide subsequent therapy. Also, the breast cancer profile (Estrogen-receptor, Progesterone-receptor, and HER2) can be done on the initial biopsy and yield valuable information which allows your physician team to tailor the treatment decision to your individual case.
Your oncologist may order additional advanced tests on your tumor. Such test is intended to establish the specific prognosis of your particular tumor. Such tests are referred to as the genomic profile or genomic assay of your tumor (not be confused with genetic testing which is done by drawing your blood sample). There is more than one prognostic test available for example Oncotype DX, MammaPrint, and Mammostrat and many others.
Such prognostic test will help your oncologist to make a decision on whether additional chemotherapy is of benefit to your particular case. It usually takes up to two weeks to get your tumor genomic profile test results back.
Please be aware that the application of genomic profiles in treatment decision making continue to be an evolving field and that none of the above assays are perfect, some patients may do well without chemotherapy while there test score indicate high risk of recurrence, some patients may develop breast cancer recurrence while there test indicate good low risk of recurrence. Such assays must be considered as aids for decision making. For fillable pdf form please click on the link for plain pdf form please click on the link .
Most common words used in a pathology report is listed below. The terms below pertains to the most commonly reported types of breast pathology. For an extended list please visit my glossary page by clicking on the link or for rare forms of breast pathology please visit the NCI Dictionary by clicking this link…..
Gross description, Initial description of all human specimens provided to the pathologist, the description is provided without the aid of the microscope
Microscopic description, Refer to microscopic examination of the most important parts of the specimen provided.
Special tests aka breast cancer profile, This usually refer to other parameters such as Estrogen Receptor, Progesterone Receptor, and HER2.
Final diagnosis, This is the concluding paragraph that summarizes the most important finding in a pathology report.
Benign, Not cancerous. Benign tumors can grow locally but can not destroy nearby tissues and spread to other parts of the body.
Malignant, Cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body.
Non-invasive. Describes specific histology such DCIS which is not capable of distant spread.
Invasive, Describes cancerous histology which does have the potential of distant spread.
DCIS, ductal carcinoma in situ, cancer arising from the duct, and not capable of spreading.
LCIS, lobular carcinoma in situ, cancer arising from the lobule, and not capable of spreading.
IDC, invasive (capable of spreading) ductal cancer
ILC, invasive (capable of spreading) lobular cancer
Grade 1, histologic grading of cancer of least deviation from normal cells.
Grade 2, histologic grading of cancer of intermediate deviation from normal cells.
Grade 3, histologic grading of cancer of highest deviation from normal cells.
Margins, the layer of healthy tissues not affected by cancer.
Estrogen receptor, Estrogen receptors (ERs) are a group of proteins found inside and on cells. They are receptors that are activated by the hormone estrogen (17β-estradiol).
Progesterone receptor, a protein found inside cells. It is activated by the steroid hormone progesterone.
Allred score, a scoring procedure to determine estrogen receptor positivity
HER2, Amplification or over-expression of this oncogene has been shown to play an important role in the development and progression of certain aggressive types of breast cancer. In recent years the protein has become an important biomarker and target of therapy for approximately 30% of breast cancer patients
IHC, immunohistochemistry, a method of histologic examination of tissue utilizing specific immune antibodies. When utilized to detect HER2, the result will come out as,
- +1, meaning it is negative for HER2
- +2, meaning it is borderline for HER2, and other tests need to be done.
- +3, meaning it is positive for HER2
FISH, Fluorescence in situ hybridization (FISH) is a kind of cytogenetic technique which uses fluorescent probes binding parts of the chromosome to show a high degree of sequence complementarity.
Ki-67, a protein, measures the aggressiveness of breast cancer.
S-phase fraction, A measure of the percentage of cells in a tumor that is in the phase of the cell cycle during which DNA is synthesized. The S-phase fraction may be used with the proliferative index to give a complete understanding of how fast a tumor is growing.
Lymphovascular invasion, tumor cells in the breast cancer tissue is advancing and seen in lymph vessels and blood vessels
Lymph node involvement, breast cancer cells seen in the lymph nodes.
Lymph node micro-invasive disease, breast cancer cells seen in the lymph nodes, but at a very small area.
BRCA1 and BRCA2, these are rare abnormal genes underlying hereditary breast-ovarian cancer syndrome, other genes that occur with lesser frequency include ATM, BRIP1, CHEK2, PALB2, PTEN, TP53. Please note that genetic testing for such gene is not the pathology report, genetic testing is not routinely done on each patient, and it is discussed under genetic screening here and for more details here.
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