Your pathology report: what to look for and what to ask your doctor
The pathologist's role
In our newsletter "The Doctor's Doctor", we introduced the people behind the diagnosis. Here, we turn to the answer they provide: your pathology report.
When tissue is removed during a biopsy or procedure, it is sent to a laboratory, where a pathologist examines it. A pathologist is a physician who specializes in studying tissue and cells under a microscope. They look closely at the sample and reach a diagnosis: a medical conclusion about what the tissue shows. That diagnosis is expert interpretation, not a printout of raw numbers.
The pathologist's report goes to your treating doctor, the physician managing your care. Your treating doctor connects the diagnosis to the rest of your picture, such as your history, symptoms and imaging, and explains what it means for you.
What you'll find in a typical report
Names and order vary by laboratory, type of sample and country, but many reports include:
- Patient and specimen information: your identifying details, the date, the body site, and how the sample was obtained.
- Gross description: what the specimen looks like to the naked eye, such as size, color, shape and number of pieces.
- Microscopic description: how the cells and tissue look under the microscope after staining.
- Diagnosis: the pathologist's summary of the findings, combined with relevant clinical information.
- Comments: extra context, unusual features, tests that are recommended, or tests still in progress.
Some reports also include a short clinical history. Not every report has every section. If a word is unfamiliar, write it down and ask about it.
If your report concerns cancer: reports about cancer can include extra details, such as grade, margins and sometimes stage. Grade describes how normal or abnormal the cells look under a microscope. Stage describes how large a cancer is and whether it has spread, and it can depend on information beyond the biopsy itself. They are different things, and your doctor weighs them together with other factors. Please don't try to work out an outlook from these words alone.
Why some results are not ready yet
Our article "Behind every tissue diagnosis: the specimen and its story" follows the people and handoffs that bring tissue to the microscope. That journey helps explain why a report is not instant.
Some reports say that results are still pending. That can happen for several reasons.
Getting tissue ready takes time. It is preserved, processed, embedded in wax, cut into very thin slices and stained. Preparing these sections normally takes several days.
After that, the pathologist may want to look at more sections, or may order special stains or advanced tests. Some of these tests are sent to a specialized outside laboratory. For hard or unusual cases, the pathologist may ask an expert colleague for a second opinion. Sometimes the delay is simply administrative, such as the time it takes to enter a report into the system.
How long this takes varies, from a few days to a few weeks depending on the tests. Your clinic can tell you what to expect for your sample.
Extra processing, additional tests or an expert review can take time. The wait alone is not enough to tell you what the diagnosis will be.
Later results may be added to your report as an addendum, or sent as a separate report. If you are not sure your report is complete, ask your doctor's office.
In some places, results appear in a patient portal before your doctor has had a chance to go over them. If that happens, you can note your questions and wait for the explanation, or call the office.
Questions to bring to your doctor
In newsletter Edition 5, "Before the Result, After the Result: The Three Phases of Lab Work", we followed how a result becomes information that guides care. This conversation is part of that final step.
You don't need to interpret the report before your appointment. You need to arrive with questions. A few to consider:
- What did the sample show, and what does the diagnosis mean for me?
- Was the sample enough to answer the question we were asking?
- Is this report complete? Which results are still pending, when should I expect them, and who will tell me?
- Are there terms in the report I should understand before we talk about next steps?
- What are the next steps?
- Would a second opinion on the pathology make sense?
- Can I have a copy of the report?
What this guide is not
This is general education. It does not interpret anyone's results and it is not a substitute for a conversation with your doctor. Reports differ with the type of tissue, the reason for the biopsy and the laboratory that prepared them. Use this guide as a map for that conversation, not as a diagnosis.
Continue the journey on DoctorsDocMD: