Reading Your Pathology Report - Histology, Margins and Grade

Kevin Knopf, MD Health Guide
  • A large part of the initial consultation with your oncologists (surgeon, radiation oncologist, and medical oncologist) is spent discussing your pathology report. We almost take good pathology for granted but it is unwise to do so; the Pathologist is a crucial member of your breast cancer team who usually goes unsung, and almost never gets their picture on the glossy brochure put out by the breast cancer centers that advertise in the local magazines.


    If you are obtaining a second opinion at a DIFFERENT institution from where you were diagnosed it is only logical that you get a second pathologic opinion - perhaps with the exception of the situation where the 2nd physician has full and complete trust in your pathologists' expertise. However, even markedly distinguished institutions typically review pathology a 2nd time (e.g. Hopkins will review Harvard's pathology). There are a handful of "superstar" pathologists where once in a while your pathology may be sent for an opinion; however given how common breast cancer is I have not seen this happen very often.

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    The accurate description and assessment of your particular pathology, however, governs everything that happens to you from the time of diagnosis on. They attend our breast tumor boards, where every patient presented has their pathology viewed.


    What are the major elements to be gleaned from your pathology report?


    1. The Diagnosis (and Subtype) of Cancer


    There are many benign entities of the breast that are not cancer, and still most of the biopsies of suspicious lesions on mammography will turn out not to be cancer. There are several other entities that we would consider "precancerous" including atypical ductal hyperplasia - distinguishing these from actual malignancy is key.


    The differentiation between carcinoma in situ (aka DCIS or LCIS) - which cannot metastasize and never requires chemotherapy - is another key differentiation feature.
    Among patients with true breast cancer there are two main types - Ductal and Lobular, and several subtypes which have implications in deciding treatment.


    2. The Margin Status


    The margins look for any cancer at the edge of the resection and are labeled geometrically to correspond to how the cancer was removed from the breast (usually by stitches). The margin status - whether or not there is residual cancer left behind - a key feature pertinent for a surgical cure. Positive margins do sometimes happen, and a re-operation is occasionally needed.


    3. The Grade of the Cancer


    Here we get only three grades - I, II and III (III being the most aggressive or "poorly differentiated"). The higher grade lesions are "more cancerous", have a more concerning prognosis, and are treated more aggressively after surgery (i.e. a patient with a grade III cancer is more often going to be considered for adjuvant chemotherapy).


    Next: Reading Your Pathology Report: Cancer Size, Lymph Node Involvement, ER and PR Status

Published On: December 09, 2008