Friday, May 30, 2008

Understanding Your Pathology Report: A Short Primer

Your pathology report will include information your doctor will use to determine your treatment and to gauge your prognosis. If you had a biopsy before surgery, you will probably have two different reports—one from the biopsy and one from surgery. Make sure you get a copy of all your reports as they will help you understand your doctor’s recommendations. Lalit vora, MD, director of breast MRI at the City of Hope, even suggests women talk to the radiologist who did the original screening. “The radiologist should be part of your team,” he says. This can be easier said than done, however, as many radiologists prefer to work through the doctor, to reduce the risk of misunderstanding.

Your pathology test has seven sections: specimen, clinical history, clinical diagnosis, gross description, microscopic description, special tests or markers, and summary or final diagnosis.

SPECIMEN: Where the test was taken, such as left or right breast or lymph nodes. A biopsy report will not have data on lymph nodes.

CLINICAL HISTORY: A cryptic statement about your history related to this and any previous cancers. On a biopsy report, this will explain why the test was done, with a notation such a “density” or “palpable lump.” On a surgical report, it will refer to why the surgery was done, often with a simple reference to “left breast cancer.” It may also explain your surgery—“mastectomy” or “partial mastectomy,” for example.

CLINICAL DIAGNOSIS: Your specific type of cancer, such as infiltrating ductal carcinoma (a cancer that has broken through the wall of the milk duct) or ductal carcinoma in situ (the cancer remains contained in the duct).

GROSS DESCRIPTION: The size of the tumor and, for a surgical report, the size and status of the surgical margins and lymph node involvement. This includes:

•Tumor size: Tumors are measured by centimeters (cm). One cm is .394 of an inch. The smaller the better, with under 2 cm usually considered “early stage beast cancer.” 

• Lymph node involvement: The number of lymph nodes tested, and those that tested positive for cancer. A positive lymph node is one to which cancer has spread. A negative node means cancer has not spread.

• Surgical margins: This measures the amount of tissue the surgeon removed around the tumor. Ideally, this should be between 1cm and 10 cm. Clear margins mean that the cancer has not spread to the surrounding tissue.

Microscopic Description: How the cells looked under the microscope. This is most likely where you receptor status is indicated.

• Receptor status: Pathologists measure this using a system that stains the tumor after a biopsy. Different labs present results differently. Some will quantify the result; others will simply note that the cancer is positive or negative. Quantification is ideal, because the more hormones present in the cell, the less aggressive the cancer and the more likely it is to react to hormone treatment.

Some labs use a 3-point system, with a score a “0” meaning none of the cells in the biopsy sample contained receptors, and a “3” meaning most cells contained receptors. A “2” is usually considered weakly positive. Other labs may simply indicate a percentage, with 0 percent meaning no hormones were present and 100 percent meaning all cells in the sample had receptors. In this case, anything under 50 percent is usually weakly positive.

SPECIAL TESTS OF MARKERS: Two common means of assessing how rapidly the tumor is likely to grow are the Bloom-Richardson Scale and the Nottingham Histologic Score. Both readings will likely be high with HR- cancer.

• A Bloom-Richardson high grade means a fast-growing tumor; Low grade means slow-growing. The pathologist might also use the term “poorly-differentiated,” which is another way of saying aggressive.

• The Nottingham Histologic Score rates the tumor numerically based on its “mitotic” count, or how rapidly it appears to be dividing and growing. A Grade I tumor has between 1-5 points and is slow-growing. A Grade II has between 6 and 7 points and is growing at a medium pace. A Grade III is over 8 points and is rapidly growing.

SUMMARY OR FINAL DIAGNOSIS: An overview of the important aspects of your tumor.

WHAT THIS ALL MEANS: The best prognosis comes with smaller tumors that have not spread, with a low Bloom-Richardson rating or Nottingham Histologic Score. Even small HR- tumors, though, are considered aggressive.

Read more about testing and treatment for TNBC in my book, Surviving Triple-Negative Breast Cancer.

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