Key points
- A pathology report is a report from a doctor who diagnoses disease from tissue (a pathologist) about what they saw under the microscope; the definite diagnosis of cancer, the stage and the treatment plan are based on it [1].
- "Positive" means something different in each part of the report: a positive margin or lymph node means cancer cells were seen there, but a positive hormone receptor means hormone therapy will probably help [1, 9].
- A clear margin means no cancer cells were seen at the edge of the removed tissue; an involved margin raises the risk of the cancer coming back in the same place, and another operation may be needed [1, 5].
- The pathology report is usually ready within 10 days of the biopsy or surgery [1].
- Go through the report with your doctor; if you wish, you can ask another pathologist for an opinion by getting the slides and the paraffin block [1].
What is a pathology report?
When a doctor removes a piece of tissue with a biopsy or surgery, it is sent to the pathology laboratory. A doctor who specialises in diagnosing disease from tissue (a pathologist) examines the tissue with the naked eye and under the microscope and writes the result in a report, which we call the "pathology report" [1]. This report gives the definite diagnosis, and your doctor uses it to work out the stage and choose the treatment [1].
A pathology report is full of technical words, so do not worry if you do not understand everything. This guide helps you know what each part says; but your doctor is the one who should explain exactly what your result means for you. Read about the biopsy itself: What is a biopsy?
What does a positive or negative pathology result mean?
In everyday conversation, a "positive pathology result" means cancer cells were found, and "negative" means they were not. But on the report itself, positive and negative mean different things in each part; so "positive" is not always bad news and "negative" is not always good news. Read each word in its full sentence:
| What you read on the report | What it means in plain words |
|---|---|
| Negative for malignancy, or Benign | No cancer was seen in this sample; a benign tumour does not invade nearby tissue and does not spread [1, 2] |
| Positive for malignancy, or Malignant | Cancer cells were seen [1, 2] |
| Margins negative, or clear | There are no cancer cells at the edge of the removed tissue [1] |
| Margin positive, or involved | Cancer cells reach the edge of the tissue; the risk of the cancer coming back in the same place is higher [1, 5] |
| Lymph node positive | Cancer cells were found in the lymph node [1] |
| ER or PR positive (hormone receptor positive) | The tumour has hormone receptors and will probably benefit from hormone therapy [9] |
| HER2 positive | The tumour has a lot of the HER2 protein, and anti-HER2 drugs are used for it [10] |
The pathology report, section by section
- 1
Patient and sample details
Your name, the date, and where in the body the sample came from and how it was taken, for example "right breast, needle biopsy" [1]. First check that the name and details are correct.
- 2
Gross description
What the pathologist saw with the naked eye: the colour, weight and size of the sample, and how many lymph nodes were removed with it [1].
- 3
Microscopic description
What the cells look like under the microscope, what type they are and how abnormal they look; the tumour grade usually appears here too [1]. Read what grade means in What is cancer grade?
- 4
Diagnosis
The most important part of the report: the pathologist's summary of all the findings, together with your clinical information [1]. If time is short, go through this part with your doctor first.
- 5
Comment
Here the pathologist adds more detail and sometimes suggests further tests [1].
- 6
What the main terms on a pathology report mean
| Term on the report | What it means in plain words |
|---|---|
| Benign | Not cancer; it does not invade nearby tissue and usually does not grow back once removed [2] |
| Malignant | Cancer; it can invade nearby tissue and travel to distant parts of the body [2] |
| Carcinoma | The most common type of cancer; it starts in the cells that cover the inside and outside surfaces of the body [2] |
| Adenocarcinoma | A cancer of cells that make fluid or mucus, such as most breast, colon and prostate cancers [2] |
| Sarcoma | A cancer of bone or soft tissue, such as muscle, fat and blood vessels [2] |
| Hyperplasia | There are more cells than usual, but they look normal; it is not cancer [2] |
| Atypia, or Dysplasia | The cells and the way the tissue is organised look abnormal, but they are not yet cancer; depending on the type and where it is, follow-up or removal may be needed [2, 11] |
| Carcinoma in situ | The abnormal cells have not yet broken out of where they started; it is sometimes called "stage 0" and is usually treated [2] |
| Invasive, or Infiltrating | The cancer has grown into the tissue around it [1, 2] |
| Grade, Differentiation | How abnormal the cells look and how fast the tumour is likely to grow [1] |
| Tumour size | The largest diameter of the tumour, in millimetres or centimetres [1, 3] |
| Lymphovascular invasion, or LVI | Cancer cells were seen inside small blood or lymph vessels [4, 7] |
| Perineural invasion, or PNI | Cancer cells were seen around or inside the nerve fibres next to the tumour [4, 8] |
| Lymph nodes 2/15 | 15 lymph nodes were examined and 2 contained cancer cells [1, 4] |
| pT, pN and M | The stage the pathologist set on the tissue removed at surgery: T is the size and extent of the tumour, N the lymph nodes, M spread to a distant site [3, 4] |
| IHC (immunohistochemistry) | A special stain that shows whether particular proteins, such as hormone receptors or HER2, are present in the tumour cells [9, 10] |
This table is only an introduction; ask your doctor what each word means in your own report.
What do clear and involved margins mean?
The surgeon removes the tumour together with a layer of healthy tissue around it. The pathologist paints the outer surface of the removed tissue with ink and checks under the microscope whether any cancer cells reach this edge [1, 5]. A "clear" (negative) margin means there are no cancer cells at the edge, and an "involved" (positive) margin means cancer cells reach the edge [1].
After breast-conserving surgery (lumpectomy): in invasive breast cancer, it is enough that no cancer cells lie right on the inked edge, and a wider margin does not lower the risk any further [5]. An involved margin roughly doubles the risk of the cancer coming back in the same breast, and hormone therapy or extra radiotherapy does not remove this risk; this is why doctors usually suggest another operation to remove a little more tissue [5]. In ductal carcinoma in situ of the breast (DCIS), a margin 2 mm wide is considered enough; if the margin is clear but narrower, your doctor decides on another operation based on your situation, and this alone is not a reason to remove the whole breast [6].
What do lymphovascular invasion (LVI) and perineural invasion (PNI) mean?
Lymphovascular invasion: if the report says "present", the pathologist saw cancer cells inside small blood or lymph vessels [4]. This does not mean that the cancer has spread, but it makes it more likely to come back [7]. In a large study of breast cancer, in women whose lymph nodes were not affected, lymphovascular invasion mattered about as much as cancer in 1 or 2 lymph nodes [7]. "Not identified" means nothing like this was seen.
Perineural invasion: this means cancer cells were seen around or inside the nerve fibres next to the tumour [4]. In a study of bowel cancer, patients with perineural invasion had their cancer come back much more often, and the researchers suggested taking this finding into account when deciding on chemotherapy after surgery [8].
Your doctor weighs both findings together with the stage and the other features of the tumour [7, 8].
Lymph nodes and the pathological stage (pTNM)
In cancer surgery, a few lymph nodes near the tumour are usually removed as well. A line such as "Lymph nodes: 2/15" means 15 nodes were examined and 2 contained cancer cells [1]. In bowel (colorectal) cancer, at least 12 lymph nodes should be examined to be able to say with confidence that the cancer has not reached the nodes [4].
Near the end of the report, the pathological stage usually appears as the letters TNM: T is the size and extent of the tumour, N the number of affected lymph nodes and M spread to a distant site [3, 4]. A small p means the stage was set on tissue removed at surgery. A y (as in ypT1) means the patient had treatment, such as chemotherapy, before surgery [3]. Your doctor sets the final stage by putting together the pathology report, the examination and the scans [3]. Read more: What are the stages of cancer?
What is IHC (immunohistochemistry) in pathology?
Immunohistochemistry (IHC) is a special stain on slices of tissue that shows whether particular proteins are present in the tumour cells [9, 10]. The pathologist uses it to identify the exact type of tumour; for example, to tell the lobular type of breast cancer from the ductal type [11]. More importantly, the IHC result sometimes decides the type of treatment [9, 10].
- Hormone receptors (ER and PR) in breast cancer: if at least 1 in every 100 tumour cells stains, the tumour is "ER positive" and hormone therapy will probably help; if fewer do, it is "negative" [9].
- HER2 in breast cancer: reported as a score from 0 to 3+. 3+ means HER2 positive; 2+ is unclear and needs another test on the HER2 gene (called ISH or FISH); 0 and 1+ mean HER2 negative. The difference between 0 and 1+ matters today, because in cancer that has spread, some newer drugs are also used for 1+ and 2+ [10].
Molecular or genetic tests on the tumour are sometimes done along with the pathology report and help choose the treatment [1].
Two example pathology reports in plain words
These two examples are made up and only show what common lines on a report mean. Everyone's report is different.
| Line on the report | What it means in plain words |
|---|---|
| Invasive ductal carcinoma (no special type), Nottingham grade 2 | Invasive breast cancer of the ductal type, meaning it started in a milk duct and has grown into the tissue around it; grade 2 [1, 2] |
| Tumour size: 18 mm | The largest diameter of the tumour is 18 millimetres (1.8 centimetres) [1] |
| Margins: negative; closest margin 3 mm (posterior) | There are no cancer cells at any edge; the tumour's closest distance to an edge, at the back, is 3 millimetres [1, 5] |
| Lymphovascular invasion: not identified | No cancer cells were seen inside blood or lymph vessels [7] |
| Sentinel lymph nodes: 1/3 positive (macrometastasis, 4 mm) | Of 3 lymph nodes from the armpit, 1 contained cancer cells, measuring 4 millimetres [1, 3] |
| pT1c pN1a | The tumour is larger than 1 cm and at most 2 cm; 1 to 3 lymph nodes in the armpit are affected, and at least one contains more than 2 mm of cancer [3] |
| ER: positive (90%); PR: positive (40%) | The hormone receptors are positive; hormone therapy will probably help this tumour [9] |
| HER2: IHC 1+ (negative) | HER2 is negative, and the usual anti-HER2 drugs are not used; the 1+ score matters for some newer drugs only if the cancer ever spreads [10] |
| Line on the report | What it means in plain words |
|---|---|
| Adenocarcinoma, moderately differentiated (low grade) | A cancer of gland cells, moderately differentiated; that is, grade 2 or low grade [1, 2] |
| Tumour invades through the muscularis propria into pericolorectal tissue | The tumour has grown through the muscle layer of the bowel wall into the fatty tissue around the bowel; that is, T3 [4] |
| Margins: negative | There are no cancer cells at any edge of the removed tissue [1] |
| Lymph nodes: 0/14 | 14 lymph nodes were examined and none contained cancer; that is, N0 [4] |
| Perineural invasion: present | Cancer cells were seen next to nerve fibres; your doctor takes this into account when deciding on treatment after surgery [8] |
| pT3 pN0 | If the cancer has not reached a distant site, this means stage 2 [4] |
What should I ask my doctor?
Keep a copy of your pathology report for yourself and take these questions with you [1]:
- What exactly is my diagnosis, and what type of tumour is it?
- What is the grade of the tumour, and how does it affect my treatment?
- Were the margins clear? Do I need another operation?
- How many lymph nodes were examined, and how many were affected?
- Has an IHC test or a genetic test on the tumour been done, or is one needed? When will the result be ready?
- What is the final stage of my illness, and what is the next step?
- Would a second opinion from another pathologist help in my case?
If you have just been faced with a cancer diagnosis and feel worried and anxious, read: Anxiety, depression and fear of cancer coming back
When should I contact my doctor?
- More than 10 days have passed since the biopsy or surgery and you still have no result; follow it up [1].
- Your report contains words such as malignant, involved margin, atypia, or recommends another test or biopsy; book an appointment sooner than your routine one so you can plan the next step with your doctor [1, 11].
- After a biopsy or surgery: redness and pain at the site, cloudy fluid draining from the wound, or a fever; contact your doctor the same day [12].
Bleeding from the biopsy site that does not stop with pressure, or sudden shortness of breath: go to an emergency department straight away or call your local emergency number.
Frequently asked questions
My pathology result is negative; does that mean I definitely do not have cancer?
A negative result means no cancer was seen in the sample that was examined [1]. A needle biopsy removes only a small piece and can sometimes miss the abnormal area [11]; this is why your doctor compares the result with the scans and the examination, and if they do not match, may suggest another biopsy [11].
How long does a pathology result take?
Usually up to 10 days [1]. A rapid result during surgery (a frozen section) takes about 15 to 20 minutes, but the full result takes several days [1]. Read more: How long do biopsy results take?
What do "atypia" or "atypical cells" mean? Do I have cancer?
No. Atypia means the cells look abnormal under the microscope, but they are not cancer [2]. In the breast, "atypical hyperplasia" is benign, but it raises the risk of breast cancer in later years about 4 times [11]. If it was found with a needle, removing that area with surgery is usually recommended, because sometimes a cancer is hidden next to it [11]. Your doctor will talk with you about follow-up and ways to lower your risk.
Does carcinoma in situ mean I have cancer?
Carcinoma in situ means the abnormal cells have not yet invaded the tissue around them. It is sometimes called "stage 0 cancer", but because some of these may turn into cancer, they are usually treated [2]. Read more: What is the difference between a benign and a malignant tumour?
After chemotherapy and surgery my report says ypT0 ypN0; what does that mean?
The y means you had treatment before surgery. ypT0 ypN0 means no invasive cancer was left in the tissue removed at surgery or in the lymph nodes; this is called a "complete response" [3]. Ask your doctor about the plan for the rest of your treatment.
Can I show my result to another pathologist?
Yes. If you want a second opinion, talk with your doctor and get the slides and the paraffin block of the sample from the laboratory or hospital that examined it [1].
Related pages
- What is cancer grade? Grade versus stage
- What is a biopsy, and how long do results take?
- What are the stages of cancer?
- What is the difference between a benign and a malignant tumour?
- Does a biopsy cause cancer to spread?
- Treatment of hormone receptor positive breast cancer and Treatment of HER2-positive breast cancer
Pathology reporting criteria (for doctors)
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Margins in breast-conserving surgery. SSO-ASTRO consensus 2014 (meta-analysis of 33 studies, 28,162 patients; stage I and II invasive cancer with whole-breast irradiation): a positive margin (ink on invasive carcinoma or DCIS) doubles the risk of IBTR, and this risk is not mitigated by favourable biology, endocrine therapy or a radiation boost. Margins wider than "no ink on tumour" do not significantly lower IBTR, and there is no evidence that they lower it in young patients, unfavourable biology, lobular cancers or an extensive intraductal component [5]. DCIS (SSO-ASTRO-ASCO consensus 2016; 20 studies, 7883 patients): negative margins halve the risk of IBTR compared with positive margins; a 2-mm margin minimises IBTR compared with narrower negative margins, and wider margins add no significant benefit; negative margins narrower than 2 mm alone are not an indication for mastectomy, and the need for re-excision is a matter of clinical judgement [6].
LVI and PNI. In 3812 patients with operable breast cancer (pT1–pT2, pN0–pN3, M0), definite LVI was an independent predictor of BCSS and DMFS, including in pT1a–c/pN0 and pT2/pN0 and in the ER-positive, ER-negative, HER2-negative and triple-negative classes; in N0 tumours, LVI carried a survival disadvantage equivalent to 1 or 2 involved lymph nodes, and IHC for an endothelial marker added to its prognostic value in negative or equivocal cases [7]. In 269 patients with colorectal cancer, PNI was noted in fewer than 0.5% of the original reports, but on re-review 22% of tumours had PNI; 5-year DFS was 65% versus 16% (P<0.0001) and 5-year OS 72% versus 25%, and DFS in N0 disease with PNI (29%) was worse than in stage III (56%) (P=0.0002) [8]. In the colon and rectum, at least 12 lymph nodes should be examined to confirm N0, and vascular, lymphatic and perineural invasion should be recorded with V, L and PN [4].
Receptors in breast cancer. ER should be tested by validated IHC: 1–100% of tumour nuclei = ER positive; 1–10% should be reported with the category "ER Low Positive" and a specific comment (data on endocrine therapy benefit are limited); less than 1% = ER negative. PgR is mainly prognostic in ER-positive tumours; ER testing is recommended in DCIS [9]. HER2 (ASCO-CAP 2023, affirming the 2018 recommendations): IHC 3+ positive, 2+ equivocal requiring ISH, 0 and 1+ negative. With the indication for trastuzumab deruxtecan in IHC 1+ or 2+ without gene amplification, distinguishing IHC 0 from 1+ carefully has become clinically relevant, although creating new reporting categories such as HER2-low is still considered premature [10].
Atypical hyperplasia of the breast. Seen in about 10% of benign biopsies; the relative risk of later breast cancer is about 4, and the cumulative incidence approaches 30% at 25 years. After a needle core biopsy, surgical excision is recommended (upgrade to cancer for ADH 15 to 30% or more) [11].
Stage prefixes. p for pathological classification after removal of the tumour, and yc or yp for staging after neoadjuvant therapy; with a pathological complete response (ypT0 ypN0 cM0), no anatomical stage group is assigned [3].
Related cancer types
Related guides
References
12 referencesShow all referencesClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 12About Surgical Site Infections
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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