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Pathological Examinations
Histologic examination (study of tissue) and cytologic examination (study of cells) provide the most accurate methods for diagnosing cancer. The microscopic examination of tissue removed from the site of a suspected cancer or cells contained in the fluid that surround the abnormal area enables pathologists to determine the characteristics indicative of a malignancy.
Histologic information is submitted on a Pathology Report, sometimes called the Histopathology Report. Cytologic information is reported on a Cytology Report, sometimes called a Cytopathology Report, but it may be submitted on a Pathology Report.
Along with the operative report, the pathologic studies will provide the best evidence regarding the presence or absence of cancer. A cancer registrar should be familiar with all parts of a pathology report and be able to extract the important diagnostic information and extent of disease for the cancer abstract. If there is a discrepancy between the operative report and the pathology report with respect to involvement of excised tissues, the pathology report takes precedence over the operative report.
| Histologic Examination | Cytologic Examination |
|---|---|
| Biopsy material | Sputum |
| Frozen section | Breast Secretion |
| Bone marrow biopsy/aspiration (tissue) | Gastric fluid |
| Operative specimen | Peritoneal fluid |
| Autopsy specimen | Pleural fluid |
| Bone marrow aspiration (cells) | |
| Bronchial brushing | |
| Bronchial washing | |
| Prostate secretion | |
| Spinal fluid | |
| Urinary sediment | |
| Cervical & vaginal smears | |
| Tracheal washing |
Histologic Examination
The study of the tissue from a suspected cancerous site provides optimal evidence regarding the presence or absence of cancer. A histologic examination may be made
- from a biopsy specimen
- from a surgical (operative) specimen
- at autopsy.
A physician may elect to examine more than one site or do multiple procedures at different times which may result in more than one pathology report in a patient’s medical record. A cancer registrar should summarize each report significant to the diagnosis of the patient’s cancer in the cancer abstract. Important information to include
- the name of the procedure performed,
- the date the procedure was performed,
- the slide number(s) of the specimen,
- the source of the specimen,
- primary site,
- tumor size (operative report), and
- the pertinent positive and/or negative findings that establishes extent of disease.
Cytologic Examination
While histology is the study of tissue specimens, cytology is the study of cells. Cells are continually shed (exfoliated) from tissues that line the cavities and hollow organs of the body. Exfoliated cells may float in the fluid and mucous material surrounding tissues and organs. These cells can be examined microscopically to determine their tissue of origin and whether or not they are malignant.
The three body cavities, the pleura (enclosing the lungs), the peritoneum (enclosing the intestinal tract), and the pericardium (enclosing the heart), may be checked for fluid. The normal fluids within the body cavities are limited to an insignificant lubricating layer that cannot be aspirated. Therefore, fluid in any body cavity which can be aspirated indicates a pathological process, commonly malignant and metastatic.
There are a variety of procedures employed to obtain material for cytologic examination
- Brushings: The procedure of brushing the lining of an organ for the purpose of obtaining cells
- Punctures: Inserting a hollow needle into a cavity or organ for the purpose of removal of some portion of the contents (fluid, bone marrow, tissue)
- Paracentesis: Surgical puncture of a cavity for aspiration of fluid, such as the abdominal cavity
- Thoracentesis: Surgical puncture for aspiration of fluid from the chest
- Scrapings: The procedure of scraping the lining of a structure with an instrument for the purpose of obtaining cells.
- Swabs: Using a swab or similar device to obtain fluid and secretions which then can be used to make a smear.
- Washings: The removal of fluid from a hollow organ or structure for the purpose of collecting any cells in the fluid which may be exfoliated.
A cytology report recorded as suspicious is not considered as diagnostic of cancer and unless supported by a positive biopsy or by a clinical impression of cancer. A cancer registrar should not abstract cases that are only suspicious by cytology.
The Biopsy Report
The term biopsy (Bx) refers to the removal and examination, gross and microscopic, of tissue or cells from the living body for the purpose of diagnosis.
A variety of techniques exist for performing a biopsy of which the most common ones are
- Aspiration biopsy or bone marrow aspiration: Biopsy of material (fluid, cells or tissue) obtained by suction through a needle attached to a syringe.
- Bone marrow biopsy: Examination of a piece of bone marrow by needle aspiration; can also be done as an open biopsy using a trephine (removing a circular disc of bone).
- Curettage: Removal of growths or other material by scraping with a curette.
- Excisional biopsy (total): The removal of a growth in its entirety by having a therapeutic as well as diagnostic purpose.
- Incisional biopsy: Incomplete removal of a growth for the purpose of diagnostic study.
- Needle biopsy: Same as aspiration biopsy.
- Percutaneous biopsy: A needle biopsy with the needle going through the skin.
- Punch biopsy: Biopsy of material obtained from the body tissue by a punch technique.
- Sponge (gel foam) biopsy: Removal of materials (cells, particles of tissue, and tissue juices) by rubbing a sponge over a lesion or over a mucous membrane for examination.
- Surface biopsy: Scraping of cells from surface epithelium, especially from the cervix, for microscopic examination.
- Surgical biopsy: Removal of tissue from the body by surgical excision for examination. Total biopsy: See excisional biopsy.
The Operative Pathology Report
The Operative Pathology Report (Surgical Specimen)
The operative pathology report of the surgical specimen contains a description of the gross and microscopic examination of the surgical specimen. This report is a valuable resource to the cancer registrar because it may recall which structures and organs of the body are involved by cancer. It will verify the primary site of the cancer and describe the extent to which it has spread. This information is necessary to complete the cancer abstract.
Abstracting the Pathology Report
Important features of the pathology reports are
Date of the procedure/collection
Date and time the specimen was collected.
Date of report
Date and time the pathologist reported the diagnosis.
Clinical history of the patient
Description of the patient’s signs/symptoms leading to procedure.
Previous diagnosis information
(biopsy or surgical resection)
Diagnosis from a previous biopsy or surgical resection done, if performed.
Pre-operative diagnosis
Diagnosis based on the physical examination and/or on a statement provided by a referring physician.
Gross description
Pathologist’s description of the material received for examination and will include the source of the specimen. The size of the tissue fragments taken at biopsy and how they were received, and the size of the surgical specimen are not important to the abstractor and should not be reported, but if the tumor size is given it should be recorded.
The tissue removed during a biopsy or surgery must be cut into thin sections, placed on slides, and stained with dyes before it can be examined under a microscope. Two methods are used to make the tissue firm enough to cut into thin sections: frozen sections and paraffin-embedded (permanent) sections. All tissue samples are prepared as permanent sections, but sometimes frozen sections are also prepared.
Permanent sections are prepared by placing the tissue in fixative (usually formalin) to preserve the tissue, processing it through additional solutions, and then placing it in paraffin wax. After the wax has hardened, the tissue is cut into very thin slices, which are placed on slides and stained. The process normally takes several days. A permanent section provides the best quality for examination by the pathologist and produces more accurate results than a frozen section.
Frozen sections are prepared by freezing and slicing the tissue sample. They can be done in about 15 to 20 minutes while the patient is in the operating room. Frozen sections are done when an immediate answer is needed; for example, to determine whether the tissue is cancerous so as to guide the surgeon during the course of an operation.
Microscopic description
Pathologist's description of the specimen(s) examined. Of special significance is the total size of the tumor, and where it has extended or metastasized. Size will usually be reported in centimeters (cm), and often the length, breadth, and thickness of the tumor will be given. The abstractor need only report the largest dimension of the tumor. If there is a discrepancy between the microscopic and gross description of the excised tumor, the microscopic takes precedence.
Synoptic section
Summary of the microscopic findings for each specimen examined. The diagnosis confirms or denies gross findings or malignancy, giving the histologic type of the cancer and, in some instances, giving the grade or degree of differentiation (the degree to which the malignant cells resemble the normal tissue they originated from).
Physical/chemical characteristics
of tissue
Results of additional tests on the tumor. For example, the pathology report may include information obtained from immunochemical stains (IHC). IHC uses antibodies to identify specific antigens on the surface of cancer cells.
Genetic information
Provide genetic information about cells, particularly genetic alterations. Some genetic alterations are markers or indicators of a specific cancer and can provide information about prognosis, which helps the doctor make treatment recommendations.
Addendum
Reports new information that becomes available after the final report has been issued. Newly obtained clinical information, findings on additional histologic sections or review of archival material, the results of special studies such as immunohistochemistry, and the results of consultations may be included in an addendum report. An addendum report may or may not change the original diagnosis; when issued after a provisional report, the addendum report may actually represent the final report. http://www.captodayonline.com/Archives/q_and_a/
qa_0502.html
https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/pathology-reports-fact-sheet
Updated: December 28, 2023