A pathology report can be updated after it is first released. New information may be added in an addendum, or the report may be changed in an amended report, sometimes called a corrected or revised report. Most updates are a normal part of how pathology works, because some tests take longer than others. A small number correct a mistake or reflect a new review of the slides.
This article explains why pathology reports change, the difference between an addendum and an amended report, and why reports are amended. It also explains what to do if you see a changed report in your patient portal.
A pathology report changes after it is released because the work on a sample does not always finish at the same time. The main diagnosis is often ready before every test is complete. Releasing it first means your care team can start planning without waiting for the slowest result.
When the remaining results arrive, they are added to the report. Less often, something in the report itself needs to change. A pathologist may notice an error, a doctor may raise a question, or another pathologist may review the slides. In each case, the report is updated to stay complete and correct.
The label on a pathology report tells you whether it is complete and whether it has changed since it was first released. The label usually appears near the top of the report or beside the updated section, and the examples below show how these updates often look:
ADDENDUM (NOVEMBER 4):
BREAST BIOMARKER REPORTING TEMPLATE.
ESTROGEN RECEPTOR: POSITIVE (95%, STRONG).
The original diagnosis is unchanged.
AMENDED REPORT (NOVEMBER 6):
Reason for amendment: Specimen laterality corrected from RIGHT to LEFT.
The diagnosis is unchanged. Dr. Lee was notified on November 6.
Each label tells you something different about the state of the report:
A report can have more than one addendum or amendment, and they are usually listed in date order, so the most recent update is easy to find. Our section-by-section guide to the pathology report shows where these labels appear on a typical report.
An addendum adds new information to a pathology report without changing anything the report already said. It is the most common kind of update, and in many cases your report will say in advance that one is coming. A line such as “HER2 has been ordered and will be reported as an addendum” means exactly that.
Addenda are often used for results that take longer than the main diagnosis:
An addendum does not mean the original report was wrong. If an addendum is pending, our article on pending or additional testing explains what to expect while you wait.
Biomarker results in an addendum?
Our Biomarkers and Genetic Tests section explains results that often arrive in an addendum, such as estrogen receptor, HER2, and mismatch repair. Each article describes every result you might see and how it is used.
An amended report changes information in a pathology report that has already been released. Laboratories may call it an amended, corrected, or revised report, and these terms mean the same thing. The change may affect the diagnosis or another part of the report, such as a measurement or the side of the body.
An amended report should explain what was changed and why. Under the College of American Pathologists (CAP) checklist for anatomic pathology, the amended report includes the reason for the change and who made it. When the change significantly affects your care, the laboratory must promptly notify your doctor.
Most amended reports do not change the diagnosis. When one does, your doctor will explain what the new diagnosis means and whether your care plan needs to change.
Pathology reports are amended for four main kinds of reasons. Researchers who study laboratory quality group the reasons this way, and the categories help explain how serious a change is.
The pathologist, another pathologist, or your doctor may find errors. A doctor may call when a result does not fit the clinical picture. Case reviews at tumor board meetings also catch errors.
Amended pathology reports are uncommon. In a College of American Pathologists study of more than 360,000 cases from many laboratories, about 5 in every 1,000 reports were corrected after release. A single-hospital study found a similar rate of about 3 to 5 amended reports per 1,000 cases.
Most of these changes were minor, and in the multi-laboratory study, more than half were report errors, such as missing information or typing errors. Changes in interpretation made up about 15% of corrections, which works out to fewer than 1 in every 1,000 reports.
When your slides are sent to another pathologist for a second opinion, that pathologist usually writes their own report. It is a separate document from the original report, often from a different hospital, and it may be called a consultation report. Our article on what a pathologist does explains how second opinions fit into pathology practice.
Second opinions usually agree with the original diagnosis. In a study of more than 9,000 cases reviewed at a large cancer center in the United States, about 2% of surgical cases had a major difference. A major difference could affect care. About 12% had minor differences, such as a detail that would not change treatment.
If the second opinion differs from the original report, your doctor will discuss which diagnosis guides your care and what that means for your treatment plan.
Patient portals often show a pathology report as soon as it is released. You may therefore see an addendum or amended report before your doctor has discussed it with you. Some portals show the updated report in place of the original. Others show each version as a separate entry.
Check the date and label of each version. The most recent version is the current one, and an amended report usually states what changed. If you see a change in the diagnosis that no one has discussed with you, contact the doctor who ordered the test. Our article on getting your results explains who to contact.
If your pathology report has an addendum or an amendment, the first step is to find out what changed. An addendum usually adds a result you were already expecting. An amended report should say what was changed and why.
Your doctor is the best person to explain whether the change matters for your care. Many changes are minor and do not affect treatment. If a change affects your diagnosis, your care team will explain the next steps. If an earlier sample could not provide an answer, our article on non-diagnostic samples explains why.