Pathologic Exams

The most common diagnosis and accurate methods of diagnosing cancer include microscopic examination of either tissue or cells. Cells examined are usually obtained from fluid around the suspected site of cancer. Tissues examined are usually removed from the primary or metastatic site of a cancer.

There are many kinds of biopsies to remove tissue for a cancer diagnosis. An aspiration biopsy is obtained by using a needle to suction fluid, cells, or tissue into a syringe. A bone marrow biopsy is the removal of bone marrow from one of the body's larger hollow bones such as the femur or pelvic bone.

Excisional biopsies attempt to remove the entire tumor. Incisional biopsies remove only a portion of the tissue. Often, the biopsy specimens are quickly frozen, thinly sliced, and examined to determine the presence of absence of cancer cells (frozen sections). Permanent sections are then made, and the diagnosis from the permanent sections should take precedence over frozen section reports.

Surgical resections involve removing more tissue from the body, including margins of normal tissue and/or regional lymph nodes. The pathologist can often determine staging by examining the primary tumor, surrounding tissues, and regional nodes when there is a "total" resection of the tumor. The information from a total resection takes precedence over biopsy reports and operative notes.

Quite often, there are several tissue samples, biopsies, or surgical resections for one cancer. When staging a cancer, it is important to review all pathological reports for the clinical diagnosis, gross description of the specimen and postoperative diagnosis.

The gross description of the specimen should include the total size of the tumor. Both the gross and the microscopic descriptions should state whether the surgical margins are involved by tumor. The pathology report should contain information about the primary site and the spread of the disease in surrounding tissues. It is important to note all areas, organs, or structures involved with tumor.

The pathology report contains the histologic type of cancer and the grade of the tumor (how closely the cancer cells resemble normal tissue). Grade is normally expressed as Grade I through III or as well differentiated, moderately differentiate, and poorly differentiated, respectively. Tumors can also be described as anaplastic or undifferentiated (Grade IV).

The final diagnosis of the histological type takes precedence over preliminary reports and frozen sections. The microscopic description takes precedence over the gross description. Occasionally, pathological specimens are sent to other centers for consultation, and the final pathology report may not be signed until all consultations have been returned.

The most important information in a pathology report includes source of the specimen, primary site, tumor size, histologic type of cancer, grade of tumor, and the extent of the disease within the organ of origin and beyond. The type, size, location and number of lymph nodes removed, and number of nodes containing tumor should be noted. This information is often required for accurate staging.

Pieces of chips of tumor should not be added together to determine tumor size. If the patient has received preoperative radiation therapy, the size of the tumor should be recorded as found in radiology reports prior to radiation therapy. Multifocal and multicentric are synonymous terms. The size of the largest of the multifocal tumors should be used for staging.

Autopsy reports are a type of pathology report that contains detailed information about organs and structures of the body. An autopsy is considered to be an ultimate pathology report. In summary, pathology reports, or reports of tissue, contain information about biopsies, frozen sections, tissue aspiration or biopsy of bone marrow, surgical specimens and autopsies.

Cytology reports describe the microscopic examination of cells in body fluids such a sputum, bronchial washings and brushings, pleural fluid, peritoneal fluid, spinal fluid, aspirations from bone marrow, and cervical smears. The Papanicolaou (Pap) smear, used for detection of abnormal cervical cells, is probably the most widely known cytology specimen. Cells can also be obtained by fine-needle aspiration to diagnose cancers of the liver, pancreas, breast, and lung. The most common ways of obtaining cells include brushing the lining of an organ, puncturing the cavity and removing fluid, scraping the lining, or using a swab to obtain secretions.

Thoracentesis is a puncturing of the thoracic, or chest cavity for the removal of fluid. Paracentesis is the puncture of the abdominal cavity for removal of fluid.

There may be multiple cytology reports. It is important to note the source of the specimen, the histologic description, and pertinent findings, along with interpretations.