What does the pathology report mean?
A pathology report is a medical document of his/her findings summarized by a pathologist. A pathologist is a doctor who is specialized in examination of body cells and tissues and aid in the diagnosis of a disease. Pathology reports are written in technical medical language.
Samples of breast tissue and lymph nodes removed during the biopsy will be sent to a pathologist for examination. This process may take several days or more.
What information does a pathology report include?
A pathology report may include some details about the patient, clinical diagnosis, the procedure, macroscopic description (description of how the specimen appear to the naked eye), microscopic description (description of the how the tissue looks under the microscope), and a pathologic diagnosis.
The structure of your pathology report is as follows:
Breast cancer pathology report is one of the most complex pathology reports.
The normal breast tissue is composed of lobules, that produce milk and ducts (passage) which carry the milk to the nipple. Breast cancer starts in a lobule or a duct; depending upon the type of breast cancer, the treatment plan is framed. The cancer can be non-invasive (does not spread beyond the lobule/duct) or invasive (spreads beyond the lobule/duct) in nature.
Other Rare Subtypes:
Histological grade is reported by means of “Bloom Richardson Scale” or “Nottingham Score”. It is a combination of nuclear grade, mitotic rate, and tubule formation, which are characteristics of the tumor cells seen under a microscope that reflect/predict its aggressiveness. Rate of recurrence is high among the high grade tumors when compared to low grade tumors.
formation (better), a score of 3 is used when less than 10% of cells are in tubule formation (worse), a score of 2 is in between 10 and 75%
The three scores are then combined for a total score between 3 (1+1+1) and 9 (3+3+3). This score interprets a histological grade. The following is a presentation of histological grade:
The size of the tumor is measured in centimeters and the location depends on the quadrant in which it is found: assume the breast is divided into 4 quadrants – upper inner quadrant (UIQ), upper outer quadrant (UOQ), lower outer quadrant (LOQ), and lower inner quadrant (LIQ).
Multi-centric means there is more than one area of breast cancer in different quadrants of the breast. Multi-focal means more than one area has been noticed but only in one quadrant of the breast.
Margins are the edges of the excised surgical specimen that gives an indication of how close the cancer comes to the edge. A “clean” or “clear” margin is defined as no tumor cells within 1-2 millimeters of the edge of the specimen. If the tumor cells are closer than this to the margin, additional surgery may be needed.
The pathologist examines the tumor and surrounding tissue to detect any tumor cells has invaded them.
The lymph system is a network of lymph nodes, lymph ducts, and lymph vessels. The lymph nodes contain cells that act as a filter to clear bacteria and dead tissues from the body. Lymph is a fluid that flows between cells in the body and functions to clear the foreign debris.
Cancer cells enter the lymphatic system and spread to other parts of the body. During breast cancer surgery, lymph nodes are removed and checked for the presence of cancer cells.
Hormone receptor status is a main factor in planning breast cancer treatment. Some breast cancer cells grow with the help of estrogen and/or progesterone. These cancer cells have hormone receptors on them and when the hormone attaches to the receptor, it allows the cell to grow and multiply.
A pathologist determines the hormone receptor status by testing the tumor tissue removed during a biopsy.
Hormone therapy helps to slow or stop the growth of breast cancer cells by lowering the level of estrogen in the body or by blocking estrogen from attaching to the receptors.
The HER2 is a gene that stimulates production of HER2 proteins (receptors) found on the surface of breast cells that help control the cells to grow and divide. In about 25% of breast cancers, there are too many copies of the gene or the protein is over expressed on the cell surface, causing the cancer to grow faster and be more destructive. Breast tumors are routinely tested to see if they have too many copies of the gene or over express the protein.
Following are the tests for HER2:
HER2 positive tumors may be treated with medication called Herceptin. Herceptin attaches itself to the HER2 receptors on the breast cells and blocks them from receiving growth signals. Thus, it helps to slow or even stop the growth of breast cancer cells.
Talk to your breast care team if you have concerns regarding your pathology report.