Pathology reports: Frequently asked questions

In this section, our team of pathologists answers some of the most common questions about pathology and pathology reports. If you have additional questions, feel free to contact us.

What is a pathology report?

A pathology report is a medical document that explains what was found when a pathologist examined a tissue sample. It describes any tests performed and, when possible, provides a diagnosis to explain the changes in the tissue. A pathologist is a doctor who specializes in diagnosing diseases by studying tissues, cells, and fluids. They work closely with your healthcare team to guide your treatment.

Is a pathologist a medical doctor?

Yes, a pathologist is a fully trained medical doctor with additional expertise in pathology. After medical school, they complete several years of specialized residency training and may do extra training in specific areas like cancer diagnosis or blood disorders. Pathologists work behind the scenes to analyze your tissue and provide critical information to your doctor.

Can I get a copy of my pathology report?

Yes, you can request a copy of your pathology report. Many hospitals now provide access to reports through an online patient portal. If this option isn’t available, you can ask your doctor or the hospital where the sample was processed for a copy.

Are there different types of pathology reports?

Yes, there are different types of pathology reports depending on the type of tissue and procedure performed. Common types include:

• Surgical pathology reports: For biopsies, excisions, or resections.
• Cytopathology reports: For small samples, like those from a Pap test or fine needle aspiration.
• Hematopathology reports: For blood, bone marrow, or lymph node samples.
• Neuropathology reports: For brain, spinal cord, or nerve tissue.
• Autopsy or forensic pathology reports: For cases involving post-mortem examinations.

What information is included in a pathology report?

Pathology reports usually include:

• Your personal information (name, date of birth).
• The location where the tissue was taken (specimen source).
• A summary of the findings (diagnosis).
• A description of what the pathologist saw under the microscope (microscopic description).

If cancer is found, the report will include details like the type, size, and stage of the tumour.

How long does it take to get a pathology result?

Pathology results can take anywhere from one day to several weeks, depending on the type of sample and any additional tests needed. Small biopsies usually take 2–3 days, while larger samples may take a week or more. Extra tests like immunohistochemistry or molecular testing can add a few more days.

Can a pathology report be wrong?

While it is rare, errors can happen. Studies show that pathology reports are highly accurate, with an error rate of less than 2%. If you have concerns, a second opinion can provide reassurance.

What are special tests, and why were they done?

Special tests are additional analyses that pathologists perform to understand your tissue sample better. These tests help confirm a diagnosis, identify the type of disease, or guide treatment decisions. Common special tests include:

• Immunohistochemistry (IHC): Uses antibodies to detect specific cell proteins. This test is often used to confirm the type of tumour or identify markers that guide treatment.
• Special stains: Highlight specific tissue components, such as collagen, amyloid, and mucin, or micro-organisms, such as bacteria and fungi.
• Molecular tests: Tests such as next-generation sequencing (NGS) detect genetic alterations such as mutations or fusions, which may help identify targeted therapies.
• In situ hybridization (ISH): Identifies specific DNA or RNA sequences in the cells, often used for certain viruses or genetic changes.
• Fluorescence in situ hybridization (FISH): A type of ISH that uses fluorescent probes to detect chromosomal abnormalities such as fusions or rearrangements.
• Flow cytometry: Analyzes the physical and chemical properties of cells, often used for blood or bone marrow samples.
• Polymerase chain reaction (PCR): Amplifies specific DNA or RNA sequences to detect genetic mutations, infections, or other molecular changes.

Did the pathologist find cancer?

The diagnosis section of your pathology report will clearly state whether cancer was found in your tissue sample. To make this determination, the pathologist examines the tissue under a microscope and looks for features commonly seen in cancer, such as:

• Invasion: Cancer cells breaking through normal tissue boundaries, such as the basement membrane, and spreading into surrounding tissues.
• Perineural invasion: This term refers to cancer cells growing around or into nerves, which can sometimes lead to pain or other symptoms.
• Lymphovascular invasion: This term refers to cancer cells spreading into lymphatic vessels or blood vessels, which increases the risk of the cancer spreading to other parts of the body.
• Increased mitotic activity: A high number of mitotic figures (dividing cells), which is a sign of rapid tumour growth and often indicates a more aggressive cancer.

If no cancer is found, the pathologist may describe normal tissue or other changes that could explain your symptoms, such as inflammation or benign (non-cancerous) growths.

What does it mean if a pathology report says the tissue “may not be representative”?

This means the sample may not fully show what’s happening in the area being tested. For example, a small biopsy might miss important changes. In these cases, your doctor might recommend another biopsy or additional tests.

What does it mean if the pathology report says “suspicious”?

This means the tissue shows changes that could indicate a disease, such as cancer, but the findings are not definitive. More tests or a follow-up biopsy may be needed to confirm the diagnosis.

What does it mean if the pathology report says “cannot rule out”?

“Cannot rule out” means the pathologist cannot completely exclude a possible diagnosis based on the sample. This might happen if the sample is too small or doesn’t show enough information. Your doctor may recommend further testing.

What does it mean if the pathology report says “at least” in the diagnosis?

When the report says “at least,” it means the pathologist found a certain level of abnormality, but there could be more that was not visible in the sample. For instance, “at least high-grade dysplasia” suggests the sample shows significant changes, but there could be invasion (cancer spread) not seen in the biopsy.

How do I get a second opinion?

If you want a second opinion, let your doctor know. They can send your pathology slides and report to another pathologist for review. Second opinions are common and can help confirm your diagnosis or provide additional information.