What can a pathology report tell you?

If you’ve ever noticed a pathology report pop up in MyChart after a biopsy or a surgical procedure, you might have some questions.  

What types of information can your pathology report provide when it comes to a cancer diagnosis or its treatment? What is the ultimate goal of a pathology report? And, are there any phrases you should know to help you interpret it?  

Pathologists take multiple steps in analyzing tissue samples. Learn about them below to find answers to these questions and more. 

Step 1: Identifying a cell’s source

The first thing pathologists do with a tissue sample is determine where the cells came from. Our bodies are made up of cells. But there are several different types. Here are three that you might see mentioned, and what they can tell you about their origins. 

• Epithelial cells make up our organ tissues, including the liver, kidneys and skin.   
• Mesenchymal cells are found in support structures, such as fat and blood vessels. 
• Hematopoietic cells are found in blood components, including circulating blood and bone marrow. 

All pathologists are tissue specialists, by definition. So, they can identify cells from any part of the body. But surgical pathologists specialize in the evaluation of tissues taken from biopsies and surgical resections. Cytopathologists, meanwhile, specialize in the analysis of cells taken from curettage (scraping cells from a surface) and fine needle aspiration biopsies. Hematopathologists specialize in the analysis of blood cells, bone marrow, and lymphatic tissue. 

Step 2: Describing a cell’s appearance

The next thing pathologists do is categorize tissue by the way its cells look under a microscope. Here are some terms you might see, and what they mean. 

• Benign: Normal tissue. It might look a little unusual, but it’s still following the rules at a cellular level. 
• Atypical: This is sometimes called the “wastebasket” category because it’s a catch-all for “I don’t know what to tell you.” The cells don’t look normal, but we also don’t have enough information to determine why. So, additional testing is needed. 
• Indeterminate: There’s a chance that this tissue could be reacting to something else, such as an infection, but again, it’s not clear. This term is slightly more ominous than “atypical.” 
• Suspicious: The odds are high for cancer here, but based on the amount of tissue present or the way it looks, we cannot make a diagnosis with 100% confidence. Doctors will almost invariably treat this as a confirmation of cancer, though, and proceed accordingly. 
• Malignant: This is cancerous. No question. 

Step 3: Assigning abnormal cells a ‘grade’

Once we’ve confirmed that a tissue sample contains cancer, we indicate how aggressive it is by assigning it a grade. Generally speaking: 

• low grade: good  
• intermediate grade: not so good 
• high grade: bad  

High grade is considered worse than low grade because it means the cells look very abnormal and are growing rapidly. Low grade is considered better because the tumor tissue is growing slowly and still trying very hard to be normal. 

Step 4: Identifying biomarkers

We sometimes look for biomarkers because these can help physicians provide eligible patients with individualized — or targeted — therapies. This is particularly true for patients who have been diagnosed with breast cancer or lung cancer. But biomarkers are also present in several other types of tumors. 

Once we’ve identified any biomarkers present, doctors can then decide the proper sequencing of treatment, whether it starts with surgery, chemotherapy, immunotherapy, radiation therapy, targeted therapy or some other option.  

If a treatment is described as neoadjuvant therapy, that means it should be given before surgery, while adjuvant therapy means a treatment should be given after surgery.  

Explaining abnormalities helps us understand the big picture 

In the end, a pathologist’s report should adequately explain any imaging abnormalities noticed by a radiologist or physician.  

Your doctor may already have some ideas about what’s going on, based on your scans and blood work. But once the pathology report comes back, hopefully, they can put everything together, see the big picture clearly, and decide on the best treatment for you. 

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