This document discusses the importance of pathology reports in clinical decision making. It provides definitions and outlines the typical contents of a pathology report, including patient information, gross description, microscopic description, diagnosis, other tests, and pathologist information. Examples of pathology reports are also presented to demonstrate the clinical significance of various items, such as tumor size and capsule integrity, which can influence treatment decisions. The goal is to improve communication between pathologists and oncologists by standardizing report elements and ensuring key information is conveyed.

1. Pathology Report
Interpretation
By
Osama El-Zaafarany

2. Aim:
Good communication and transfer of information
between the pathologist and the oncologist.
To interpret the items and terms in pathology
report to clinical data and appropriate treatment
decisions.

3. Contents:
1)
2)
3)
4)
5)
Definition of pathology report.
Introduction.
Items of pathology report. (according to NCI)
Examples of pathology reports.
Clinical significance of pathology report
items.

4. 1) Definition of pathology report.
2) Introduction.
3) Items of pathology report. (according to NCI)
4) Examples of pathology reports.
5) Clinical significance of pathology report
items.

5. What is pathology report?
 A pathology report is a document that
contains the diagnosis determined by
examining cells and tissues under a
microscope.
 Created by a pathologist; who is a doctor
who does this examination and writes the
pathology report.

(According to National Cancer Institute.)

6. 1) Definition of pathology report.
2) Introduction.
3) Items of pathology report. (according to NCI)
4) Examples of pathology reports.
5) Clinical significance of pathology report
items.

7. Introduction
Eighty-two million surgical pathology and cytology reports
were issued in the United States during 2007,
a subset of these reports will be misunderstood by
readers.
Recent attention has focused on standardizing the
content of pathology reports, particularly for common
malignancies, to facilitate transmission of required
information.
‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬
Arch Pathol Lab Med. 2008; 132: 84–94

8. In the early 1990s, a number of pathology professional
societies began issuing recommendations; variously called
guidelines, protocols, templates, practice parameters, or
checklists. Specifying a minimum Set of data elements that
should be included in pathology reports for particular tissue
types or pathologic diagnoses.
In 2004, the American College of Surgeons’ Commission on
Cancer required as a condition of cancer program
accreditation that surgical pathology cancer reports conform
to the College of American Pathologists (CAP) Cancer
reporting protocols

9. Several multi-institutional studies of pathology reports
have demonstrated gaps between data elements
recommended for inclusion in reports and the elements
actually included.
For example, in a review of 7300 pathology biopsy reports
on mammographically detected breast lesions only 62%
of reports correlated the mammographic abnormality
with the microscopic findings.
In only 92% of malignant cases was
the margin status reported, and only
77% of reports specified the lesion size.
‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬
Nakhleh RE, Jones B, Zarbo RJ. Mammographically directed breast biopsies:
A College of American Pathologists Q-Probes study of clinical physician expectations and of specimen
handling and reporting characteristics in 434 institutions.
Arch Pathol Lab Med. 1997; 121: 11–18

10. ‫‪The CAP has developed a list of specific features that define synoptic reporting‬‬
‫:‪formatting‬‬
‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬
‫_‪http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/synoptic_report_definition‬‬
‫‪and_examples.pdf‬‬

11. 1) Definition of pathology report.
2) Introduction.
3) Items of pathology report. (according to NCI)
4) Examples of pathology reports.
5) Clinical significance of pathology report
items.

12. What information does a pathology report
usually include?
o Patient information: Name, birth date,
biopsy date, procedure.
o Gross description: type, Color, weight, and
size of tissue as seen by the naked eye
o Microscopic description:
How the sample looks
under the microscope
and how it compares
with normal cells

13. o Diagnosis:
Type of tumor/cancer
More information which may guide the
treatment line for the patient (risk factors):
- grade.
- lymphovascular invasion.
- perineural invasion.
- margin invasion.
- LNs infilteration.

14. o Other tests: immunuhisto-chemistery (e.g:
CDs), molecular diagnostic and cytogenetic
studies.
o Pathologist’s signature and name and address
of the laboratory.

15. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬
‫49–48 :231 ;8002 .‪Arch Pathol Lab Med‬‬

16. 1) Definition of pathology report.
2) Introduction.
3) Items of pathology report. (according to NCI)
4) Examples of pathology reports.
5) Clinical significance of pathology report
items.

17. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬
‫‪http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/synoptic_report_definition_and_examples.pdf‬‬

18. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬
‫‪http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/synoptic_report_definition_and‬‬
‫‪_examples.pdf‬‬

19. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬
‫‪http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/synoptic_report_definition_and_examples.pdf‬‬

20. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬
‫49–48 :231 ;8002 .‪Arch Pathol Lab Med‬‬

21. 1) Definition of pathology report.
2) Introduction.
3) Items of pathology report. (according to NCI)
4) Examples of pathology reports.
5) Clinical significance of pathology
report items.

22. Important notes for oncologists:
(1) Gross description:
Tumor size: Impact on treatment decision e.g breast
cancer if the mass > 1 cm, this patient should receive
chemo.
Capsule: in some ovarian tumors if it ruptures it will
increases risk of recurrence.
Number of the masses: multifocality & multicentericity.
Necrosis: aggressive tumor, rapid growth.
Number of Lymphnodes: indicates appropriate surgical
dissection e.g breast cancer, cancer colon and impact
treatment decision.

23. (2) Microscopic description
Type of tumor:
Breast cancer:
ILC: bilaterality
Medullary carc. : good prognosis.
Shape of the cells:
Lymphoma: large cells.
Small round cells: guide further investigations.
Signet ring: poor prognosis.

24. Configuration & arrangement of the cells:
Lymphoma: diffuse, follicular.
Background:
Hodgkin lymphoma: increase no. of lymphocytes may indicate good
prognosis.
Grade:
Breast cancer: prognostic factor and guide the treatment decision
(need for adjuvant chemotherapy).
Soft tissue sarcoma: high grade tumors needs adjuvant chemo.

25. Lympho-vascular invasion:
Risk factor in breast carcinoma and guide treatment decision.
peri-neural invasion:
Risk factor in head and neck squamous cell carcinoma, and guide the
use of adjuvant radiotherapy.
Margin status:
In soft tissue sarcoma, if positive the treatment decision may be surgical
re-excision or radiotherapy.
Also in breast conservative surgery it is very important.
And in head and neck cancers; positive and close margins indicate the
need for adjuvant radiotherapy.
In some cancers it is important to know the free margins in centimeters,
as in melanoma.

26. Lymphnodes infilteration:
Infilterated or not: in cancer colon it raised the stage from II to III
and mandate the use of adjuvant chemotherapy.
Number of infilterated LNs: in breast cancer in guide the treatment
plan; use of adjuvant radiotherapy and type of chemo. (Taxanes).

28. The method of writing pathology reports should be
standardized to facilitate information transmission
between pathologists and oncologists, which will
optimize patient care.
This could be achieved by following the CAP
protocols.
The oncologists should be trained on how to interpret
pathology reports.