Understanding pathology reports: the key to disease diagnosis and treatment

Author: Fan Ruirui, MD, Xiamen University Xiang'an Hospital

Reviewer: Zhang Bo, Professor and Chief Physician, Peking University Third Hospital

Pathology reports, as the "gold standard" for disease diagnosis, are an indispensable basis for guiding clinical treatment and evaluating patient prognosis. Its content covers in-depth analysis of abnormalities in histology, cytology, and molecular biology. The interpretation of pathology reports is a crucial part of the patient's entire diagnosis and treatment process. Today we will explain to you how to read a pathology report.

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1. Basic components of a pathology report

1. Basic patient information: including name, gender, age, pathology number (i.e. the unique number of the patient's pathology examination), hospitalization number or outpatient number, etc.

2. Specimen information: Describe in detail the specimen type (such as surgical resection specimens, biopsy specimens and cytological examination specimens, etc.), name, quantity, size, shape, color, texture and other characteristics.

3. Picture interpretation: Pictures are used to show the morphology of the specimen, the morphology of tissue cells under the microscope, the results of immunohistochemical staining or special staining, etc., to help understand the characteristics of the lesion.

4. Microscopic description: A detailed description of abnormal tissues and cells observed under a microscope, including the atypia of tissue structure; cell morphology, arrangement and atypia; morphology and atypia of cell nuclei, etc. Atypia refers to the difference in structure and cell morphology between diseased tissue and normal tissue.

5. Pathological diagnosis: As the core part of the pathology report, it clearly indicates the benign or malignant nature of the lesion, the specific type, grade and stage. This is the disease diagnosis made by the pathologist based on observation under the microscope and combined with clinical information, immunophenotype and molecular test results. It usually includes the name of the disease, tumor size, gross classification, histological classification, grade (assessment of the malignancy of the lesion), stage (assessment of the spread and progression of the disease), whether there is nerve and vascular invasion, and whether there is residual lesions at the resection margin of the surgical specimen.

6. Notes and suggestions: Provide additional information related to the pathological diagnosis, such as the specificity of the lesion and suggestions for follow-up treatment or examination.

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2. Medical terms in common pathology reports

Pathology reports often contain many medical terms that may be difficult for patients and their families to understand, but understanding the meaning of these terms is crucial to accurately interpreting the report. For example, "dysplasia" usually refers to precancerous lesions; "cervical carcinoma in situ" refers to high-grade cervical intraepithelial lesions, but the lesions have not yet broken through the basement membrane of the epithelium; "invasive cancer" means that cancer cells have broken through the basement membrane and are growing invasively deeper. In addition, it is worth noting that pathology reports are not absolutely clear, because clinical biopsy specimens are sometimes less in tissue. If their morphology under the microscope is atypical, pathologists usually use expressions such as "considered to be ××" and "tends to be ××", which means that there is a certain degree of uncertainty in the diagnosis, which requires a comprehensive judgment based on clinical information and other test results.

3. Understanding Pathological Diagnosis

Pathological diagnosis reveals the nature of the disease. To understand pathological diagnosis, we need to pay attention to the following points:

1. Nature of the lesion: Clarifying whether the lesion is benign or malignant is the key to formulating subsequent treatment plans.

2. Disease name: Understand the specific name and classification of the lesion. Different disease names or classifications represent different disease types and biological behaviors.

3. Grading and staging: Grading and staging are important indicators for assessing the severity of the disease and prognosis. Grading usually reflects the degree of differentiation of the disease (i.e., the degree of similarity between the diseased tissue and normal tissue), while staging mainly involves factors such as the depth of disease infiltration, lymph node metastasis, and distant metastasis.

IV. Precautions

1. Accuracy of pathology report: An accurate pathology report is crucial to the precise treatment of patients. Pathology reports are usually prepared by two experienced pathologists who work closely together to read the films under a microscope and issue them after review to ensure the accuracy of the report.

2. Pay attention to notes and suggestions: Notes and suggestions provide additional information related to disease diagnosis, including treatment recommendations and precautions, which provide important clues for developing individualized treatment plans and prognostic interventions. For example, when the pathology report contains information such as "molecular testing is recommended to clarify the diagnosis or guide treatment" or "the biopsy tissue is small and the sample is limited, so pay attention to close follow-up", patients and clinicians should pay great attention to it to avoid delaying the disease.

3. Consult a pathologist: If the patient still has doubts about certain contents in the pathology report, he or she can consult a pathologist. The pathologist can provide detailed explanations and suggestions to the patient based on the patient's specific situation and the contents of the pathology report.

In short, the content of the pathology report is directly related to the patient's condition, and accurate understanding of the pathology report is crucial to the patient's treatment and prognosis. With the interpretation guide in hand, you can understand the pathology report!