by Jason Wasserman MD PhD FRCPC
November 2, 2022
A pathology report is a medical document describing the examination of tissue by a pathologist. A pathologist is a specialist medical doctor who works closely with the other doctors in your healthcare team.
Yes, you can get a copy of your pathology report. Most hospitals now provide patients access to their pathology reports and other medical records through an online patient portal. If the hospital or laboratory that prepared your pathology report does not have an online patient portal, you can always request to receive a copy of your report from the hospital, laboratory, or your doctor.
Yes, there is more than one type of pathology report and the type of pathology report prepared depends on the type of tissue sent for examination and the way the tissue was removed. Common types of pathology reports include surgical pathology, hematopathology, neuropathology, cytopathology, autopsy pathology, and forensic pathology. A surgical pathology report is used for most types of tissues including small biopsies, larger excisions and resections, and whole organ examinations. A hematopathology report is used to describe the examination of blood, bone marrow, and lymph nodes. A neuropathology report is used to describe the examination of tissue from the nervous system including the brain and spinal cord. In many hospitals, a neuropathology report is also used to describe the examination of muscle samples. A cytopathology report is used to describe the examination of very small tissue samples removed during either a fine-needle aspiration or a pap smear. Finally, autopsy and forensic pathology reports are used to describe the post-mortem examination of a body after a person has died. Whether an autopsy or forensic pathology report is prepared depends on the medical and legal circumstances surrounding the death.
All pathology reports include sections for patient information, specimen source, clinical history, and diagnosis. Surgical pathology reports (those that describe the examination of larger tissue samples such as biopsies, excisions, and resections) will typically also include sections for microscopic and gross descriptions and comments by the pathologist. Cancer reports may also include a section called the synoptic report which includes important information such as the type of cancer, tumour size, margin status, and pathologic stage. Some reports will also include a section called the intraoperative consultation or frozen section if a pathologist examined tissue at the time of the surgical procedure.
It can take anywhere from 1 day to several weeks to get a pathology result and the amount of time depends on many factors including the type of tissue, the size of the tissue sample, and the need to perform additional tests. Before any type of tissue can be examined by a pathologist, it first needs to be placed on a glass slide and stained so that it will be visible under the microscope. For small tissue samples such as those removed in a fine-needle aspiration or biopsy procedure, this can be completed within 1 to 2 days. For larger tissues, a visual or gross examination must first be performed to select areas of tissue to examine more closely under the microscope. This process can take an additional 3 to 4 days. Once the pathologist receives the glass slides, the microscope examination can usually be completed in 1 day. However, pathologists often order additional tests such as immunohistochemistry and special stains which need to be examined before completing the case. These additional tests can take 1 to 5 days to complete.
Pathologists use various terms to say that a tissue sample is essentially normal. These terms include ‘no significant pathologic abnormalities’, ‘no diagnostic abnormalities’, ‘unremarkable’, ‘no microscopic abnormalities’, and ‘normal’.
Pathologists use the word ‘negative’ to mean that something was not seen in the tissue sample. For example, a biopsy report that says ‘negative for malignancy’ means that no cancer cells were seen after the tissue sample was examined under the microscope. Pathologists also use the word negative to describe a variety of different pathological features including margins, lymphovascular invasion, and perineural invasion. The opposite of negative is ‘positive’ which means that something was seen in the tissue sample.
Benign can sometimes mean normal but not always. Pathologists often use the word benign to say that something is not cancer. However, many things that are non-cancerous are still not normal. For example, a non-cancerous tumour is benign but it is still an abnormal growth of cells. Importantly, in some areas of the body such as the brain, even benign tumours can cause significant harm as they grow and damage surrounding tissue.
Although it is rare, a pathology report like any other type of medical test can be wrong. However, studies have shown that the error rate in pathology is very low (less than 2%) so most reports will be correct.
No. Dysplasia does not mean cancer. Dysplasia is a term pathologists use to describe a group of cells showing an abnormal pattern of maturation. While dysplasia does not mean cancer, in many parts of the body it is considered a precancerous condition because it can lead to the development of cancer over time. Pathologists often divide dysplasia into two categories, low-grade and high-grade, with high grade being associated with a greater risk of developing cancer.
No. Cytologic atypia does not mean cancer. Cytologic atypia is a term pathologists use to describe cells that look abnormal when examined under a microscope. Cytologic atypia can be seen in cancerous tumours and a variety of non-cancerous conditions such as an infection, inflammation, or after radiation treatment. Pathologists use information such as the medical history of the patient and additional test results to determine the cause of the cytologic atypia.
No. Atypia does not mean cancer. Atypia is a term pathologists use to describe cells that look abnormal when examined under a microscope. Atypia can be seen in cancerous tumours and a variety of non-cancerous conditions such as an infection, inflammation, or after radiation treatment. Pathologists use information such as the medical history of the patient and additional test results to determine the cause of the atypia.
Yes. Atypical cells can be benign (non-cancerous). Atypical is a word pathologists use to describe cells that look abnormal when examined under a microscope. Atypical cells can be seen in cancerous tumours and a variety of non-cancerous conditions such as an infection, inflammation, or after radiation treatment.
No. Atypia is not the same as dysplasia. Atypia is a term pathologists use to describe any cells that look abnormal when examined under a microscope. In contrast, dysplasia is used to describe a group of cells showing an abnormal pattern of maturation. While areas of dysplasia typically show atypia, not all atypia is associated with dysplasia. In addition, in many parts of the body dysplasia is considered a precancerous condition because it can lead to the development of cancer over time. In contrast, atypia can be seen cancerous tumours and in a variety of non-cancerous conditions.
Metaplasia is not a type of cancer but some types of metaplasia can increase the risk of developing cancer over time. For example, Barrett’s esophagus is associated with an increased risk of developing a type of esophagus cancer called adenocarcinoma.
Incompletely excised means that only part of the tumour was removed from the body. Pathologists describe a tumour as being incompletely excised when tumour cells are seen at the edge of the tissue. In pathology, the cut edge of the tissue is also called the margin. It is normal for a tumour to be incompletely excised after a small procedure such as a biopsy because these procedures are usually not performed to remove the entire tumour. However, larger procedures such as excisions and resections are usually performed to remove the entire tumour. If a tumour is incompletely excised, your doctor may recommend another procedure to remove the rest of the tumour.
A positive margin means that tumour cells were seen at the cut edge of the tissue sample. A positive margin is important because it suggests that tumour cells may have been left in your body during the surgical procedure performed to remove the tumour.
A negative margin means that no tumour cells were seen at the cut edge of the tissue sample. A negative margin is important because it means that no tumour cells were left in that area of your body when the surgical procedure was performed to remove the tumour.
Yes. A pathologist is a medical doctor with additional subspecialty training in the area of pathology. Types of pathologists include anatomical pathologists, hematopathologists, neuropathologists, and forensic pathologists. To become a pathologist a person must complete medical school followed by residency training. Most pathologists also complete an additional 1 to 2 years of fellowship training after residency.