Interpreting Your Breast Cancer Surgical Pathology Report

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The surgical pathology report is the record of the pathologist’s findings from examining the tissue that is removed during an operation. This surgical pathology report for a breast cancer surgery contains several parts:

  • Clinical Findings
  • Final Diagnosis
  • Breast Cancer Synoptic Report, which includes information about breast cancer tumor receptors and tumor stage (TNM stage)
  • Comments
  • Specimens
  • Gross
  • Frozen Section Diagnosis
  • Addendum

    
Clinical Findings
Clinical findings are a description of the patient’s history and physical that prompted the cancer surgery. For breast cancer surgery this includes:

  • which breast is involved
  • the location of the cancer in the breast    
  • previous treatment, such as whether the patient has received chemotherapy before surgery or if the patient has a recurrent breast cancer after previous remission

Final Diagnosis
The final diagnosis will give a summary of each specimen received. A typical breast cancer operation will involve several separate specimens,  including the lumpectomy or mastectomy specimen, each  sentinel lymph node, each extra margin, and axillary contents if an axillary lymph node dissection was performed. Each specimen is listed separately and a description of its findings stated. The type of cancer, the size of the cancer in that specimen and its margins are described. If no cancer is found in a particular specimen this will also be stated (for example one lymph node, negative for metastatic disease).

Breast Cancer Synoptic Report
This report gives a concise summary of the findings of all the specimens received from an operation.  It is the best place to look to find specifics about the pathologist’s findings.  It includes all the following details:

  • type of specimen and which side
  • lymph node sampling
  • type and grade of cancer
  • size of the cancer
  • margin status of the cancer (i.e., negative or positive margins and how close the cancer was to the edge of the tissue removed)
  • number of lymph nodes removed and whether they had cancer in them, and the amount of cancer in the lymph nodes if present
  • breast cancer tumor receptors and whether positive or negative, and their quantitative value
  • tumor stage (written as stage I, II, or III, but also as TNM, where T=tumor, N=lymph node status and M= metastasis)

Comments
This section contains any extra information that the pathologist wants to relay to the breast cancer treatment team, such as specific methods that were used to test the tissue and any protocols (processes) that were used for handling the tissue.

Specimens
This section individually lists each specimen received as well as descriptions provided by the surgeon to the pathologist about each specimen.

Gross
The gross description lists characteristics about each specimen, including the size, weight and visual appearance. It may also contain information about how the surgeon oriented the specimen for the pathologist. Correct orientation of breast cancer specimens is important because it will determine whether a specific edge of the cancer was removed in its entirety of if cancer may remain in the remaining breast. 

Frozen Section Diagnosis
This describes the findings of any frozen section results that the pathologist performed during the patient’s surgery. A frozen section refers to what happens when the surgeon sends a specimen (a piece of tissue) to the pathologist to perform a visual and/or microscopic evaluation while the patient is in the operating room. Frozen sections are used by the surgeon during surgery to help guide the procedure. Most frequently they help a surgeon know whether they should take extra tissue from a specific area in order to avoid leaving cancer behind.

Addendum
This is where information about additional testing will appear. These specialized tests are performed after the pathologist performs the standard, routine testing of the surgical specimens. Specialized testing includes testing the individual patient’s tissue for very specific proteins and genes, called genomic testing. Examples of genomic testing are MammaPrint and Oncotype DX Breast Cancer Assays. These genomic tests are ordered to help direct therapy, and are not routinely ordered on all breast cancer specimens. 

While the surgical pathology report from different institutions may vary in the order of these parts, the basic information is the same. You may ask your surgeon for a copy of your surgical pathology report to keep for your personal medical records. Your surgeon and medical providers can help answer your questions about the specifics of your pathology report and what it means for you and your cancer treatment.