Table of ContentsView AllTable of ContentsSpecimenClinical HistoryGross DescriptionNoninvasive vs. InvasiveTumor StageTumor GradeHormone Receptor StatusHER2 StatusTumor MarginsLymphovascular InvasionFinal Diagnosis
Table of ContentsView All
View All
Table of Contents
Specimen
Clinical History
Gross Description
Noninvasive vs. Invasive
Tumor Stage
Tumor Grade
Hormone Receptor Status
HER2 Status
Tumor Margins
Lymphovascular Invasion
Final Diagnosis
Once breast cancer is diagnosed, the pathologist performs additional tests on the breast tissue. These tests aim to understand the cancer better, including its type, how fast it’s expected to grow, and what treatments it may respond to.
Navigating a breast cancer diagnosis and the wealth of information that comes with it is often overwhelming. This article will hopefully help you better understand and “decode” the medical language you might read in a breast cancerpathology report.
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A pathologist provides details about the breast tissue sample, often called aspecimen.
Such information might include:
What Are the Types of Breast Biopsies?
This section of the pathology report summarizes how the cancer was discovered, such as through a screeningmammogram. Relevant medical history, like a personal or family history of breast cancer, is also disclosed.
Early Signs of Breast Cancer
A gross description is what the pathologist sees with their naked eyes before looking at the tissue under a microscope. In this section, a pathologist reports the tissue’s size in millimeters (mm), weight, color, texture, and consistency.This can include the presence of friability (is able to be broken up) or exudate (seepage). They also report how many lymph nodes were received.
The Parts of the Breast
This part of the report states whether the cancer is noninvasive or invasive.
Noninvasive breast canceris also called in situ breast cancer, meaning the cancer has stayed in the same place where it began growing.
Ductalcarcinomain situ (DCIS)is a noninvasive breast cancer that starts and remains in a milk duct. It’s the earliest form of breast cancer, making up around 20% of new breast cancer diagnoses.
Invasive breast cancermakes up around 75% of all breast cancers and occurs when the cancer cells have spread to surrounding breast tissue.There are several invasive breast cancers, the most common beinginvasive ductal carcinoma.
Tumor stage refers to the spread or extent of cancer in a person’s body.
Breast cancer stages range from stage 0 (carcinoma in situ) to stage 4 (metastatic).Metastatic breast canceris when the cancer has spread to distant parts of the body, most commonly the bones, brain, lungs, or liver.
Overall, the lower the stage number, the less the cancer has spread.
The tumor, node, metastasis (TNM) system is an internationally accepted method for determining breast cancer stage.
“T” stands for the tumor size and is defined as follows:
Lymph Node StatusThe lymph nodes under your arm (axillary lymph nodes) are where breast cancer usually goes first if it spreads. These lymph nodes may be sampled or removed simultaneously with your breast biopsy or surgery and checked for cancer cells.
Lymph Node Status
The lymph nodes under your arm (axillary lymph nodes) are where breast cancer usually goes first if it spreads. These lymph nodes may be sampled or removed simultaneously with your breast biopsy or surgery and checked for cancer cells.
The pathologist reports “N” as N0, N1, N2, or N3. The higher the number after N, the more lymph node involvement.
Breast Cancer Staging: What You Need To Know
Tumor grade describes the degree to which the cancer cells look like normal, healthy cells. Overall, the lower the grade, the less aggressive the breast cancer is; the higher the grade, the more aggressive. An aggressive cancer is likely to grow and spread rapidly.
Cancer Cells vs. Normal Cells: How Are They Different?
Ductal Carcinoma In Situ (DCIS) Grade
DCIS grade is scored as 1, 2, or 3. The terms “low-grade,” “intermediate-grade,” or “high-grade” are also sometimes used on the pathology report.
Lobular Carcinoma In Situ (LCIS) Grade
Unlike DCIS, LCIS rarely develops into invasive breast cancer if left untreated. Having LCIS is generally considered a risk factor, not a precancer diagnosis.
The pathologist will examine the LCIS cells and report on a pathology report if they appearpleomorphicornecrotic, as these features can affect the treatment plan.
The variantpleomorphic LCISdiffers from classic LCIS because the cells are larger and more abnormal.LCIS with necrosis(also known as florid LCIS) is another variant in which the cells grow together, forming a mass with an area of dead cells in the middle.
Invasive Breast Cancer Grade
The grading system for invasive breast cancer involves the pathologist looking for three features within the tumor under the microscope.
The three features are first scored individually like so:
Then, the pathologist adds the individual scores to get a number (called theNottingham score) between 3 and 9, as follows:
Hormone receptors are proteins on the surface of breast cancer cells.Estrogenorprogesteronecan bind to the receptors, stimulating cell growth.
Knowing whether a breast tumor has hormone receptors helps determine the cancer stage and whether the tumor can be treated withendocrine (hormone) therapy.
Breast tumors with estrogen receptors (ER+) or progesterone receptors (PR+) are hormone receptor-positive (HR+). Tumors with very few or no estrogen or progesterone receptors are hormone receptor-negative (HR-).
How Common Is Hormone Receptor-Positive Breast Cancer?Approximately 80% of female breast cancer cases are hormone receptor-positive.(Note that the terms for sex or gender from the cited source are used.)
How Common Is Hormone Receptor-Positive Breast Cancer?
Approximately 80% of female breast cancer cases are hormone receptor-positive.(Note that the terms for sex or gender from the cited source are used.)
Different pathology laboratories can have slightly distinct ways of reporting the hormone receptor status of the breast tumor. For example, hormone receptor status might be reported as a number or percentage between 0 and 100 or a number (0, 1+, 2+, 3+).
Regardless of the unique scoring, the cancer is definitivelyHR-when the score is 0. Moreover, the higher the number, the more hormone receptors are present on the breast cancer cells.
Hormone Receptor Status in Breast Cancer
Invasive or metastatic (has spread to distant parts of the body) breast tumors are also tested for human epidermal growth factor receptor 2 (HER2). HER2 is a protein that regulates cell growth and is found on normal cells' surfaces.
Breast cancers that overproduce the HER2 protein areHER2-positive, whereas breast cancers that make minimal or no HER2 protein areHER2-negative.
There is also a subtype calledHER2-lowthat has some HER2 protein on the surface of the cancer cells but not enough to be considered HER2-positive.
Like hormone receptor status, the presence and level of HER2 protein help determine the cancer stage and whether the cancer can be treated with specific drugs, namelyHER2-targeted therapies.
If the score is 2+, the result is considered equivocal, and a second test,fluorescence in situ hybridization(FISH),is performed.
FISH detects the number of HER2 gene copies in the cancer cells. If FISH is positive (two copies of the gene are present), the cancer isHER2-positive; if negative, the tumor isHER2-low.
HER2-Low Breast Cancer Treatment
The term “lymphovascular invasion” describes the presence of cancer cells in small blood vessels and/or lymph vessels (channels that carry lymph away from tissues). Cancer cells in blood or lymph vessels may suggest a more aggressive cancer.
Besides noting thetype of breast cancer, this part of the pathology report summarizes the key characteristics of the tumor, including cancer grade, hormone receptor status, HER2 status, and lymph node involvement.Types of invasive breast cancer include:
Rare types of breast cancers include:
What You Won’t Find in a Pathology ReportYour cancer care team will use the pathology report to help devise a personalized treatment plan. Specific therapies, however, will not be recommended in the actual report.
What You Won’t Find in a Pathology Report
Your cancer care team will use the pathology report to help devise a personalized treatment plan. Specific therapies, however, will not be recommended in the actual report.
How Breast Cancer Is Treated
Summary
To ensure an informed and proactive role in your cancer care, carefully review your pathology report with youroncologist(cancer doctor) or with the pathologist, and please do not hesitate to ask questions or voice concerns.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Breastcancer.org.Understanding your pathology report.Barrio AV, Van Zee KJ.Controversies in the treatment of ductal carcinoma in situ.Annu Rev Med. 2017;68:197-211. doi:10.1146/annurev-med-050715-104920Wen HY, Brogi E.Lobular carcinoma in situ.Surg Pathol Clin. 2018;11(1):123-145. doi:10.1016/j.path.2017.09.009.American Cancer Society.Types of breast cancer.Wu Q, Li J, Zhu S, et al.Breast cancer subtypes predict the preferential site of distant metastases: a SEER based study.Oncotarget. 2017;8(17):27990-27996. doi:10.18632/oncotarget.15856Zhu H, Doğan BE.American Joint Committee on Cancer’s Staging System for Breast Cancer, Eighth Edition: Summary for Clinicians.Eur J Breast Health. 2021 Jun 24;17(3):234-238. doi:10.4274/ejbh.galenos.2021.2021-4-3American Cancer Society.Breast cancer stages.American Cancer Society.Breast cancer grade.Beikman S, Gordon P, Ferrari S, et al.Understanding the implications of the breast cancer pathology report: a case study.J Adv Pract Oncol. 2013;4(3):176-181. doi:10.6004/jadpro.2013.4.3.6National Cancer Institute.Cancer stat facts: female breast cancer subtypes.Sleightholm R, Neilsen BK, Elkhatib S, et al.Percentage of hormone receptor positivity in breast cancer provides prognostic value: a single-institute study.J Clin Med Res. 2021;13(1):9-19. doi:10.14740/jocmr4398Asif HM, Sultana S, Ahmed S, Akhtar N, Tariq M.HER-2 positive breast cancer - a mini-review.Asian Pac J Cancer Prev. 2016;17(4):1609-1615. doi:10.7314/apjcp.2016.17.4.1609Zhang H, Peng Y.Current biological, pathological and clinical landscape of HER2-low breast cancer.Cancers (Basel).2022;15(1):126. doi:10.3390/cancers15010126Wolff AC, Hammond MEH, Allison KH, et al.Human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline focused update.J Clin Oncol. 2018;36(20):2105-2122. doi:10.1200/JCO.2018.77.8738
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Breastcancer.org.Understanding your pathology report.Barrio AV, Van Zee KJ.Controversies in the treatment of ductal carcinoma in situ.Annu Rev Med. 2017;68:197-211. doi:10.1146/annurev-med-050715-104920Wen HY, Brogi E.Lobular carcinoma in situ.Surg Pathol Clin. 2018;11(1):123-145. doi:10.1016/j.path.2017.09.009.American Cancer Society.Types of breast cancer.Wu Q, Li J, Zhu S, et al.Breast cancer subtypes predict the preferential site of distant metastases: a SEER based study.Oncotarget. 2017;8(17):27990-27996. doi:10.18632/oncotarget.15856Zhu H, Doğan BE.American Joint Committee on Cancer’s Staging System for Breast Cancer, Eighth Edition: Summary for Clinicians.Eur J Breast Health. 2021 Jun 24;17(3):234-238. doi:10.4274/ejbh.galenos.2021.2021-4-3American Cancer Society.Breast cancer stages.American Cancer Society.Breast cancer grade.Beikman S, Gordon P, Ferrari S, et al.Understanding the implications of the breast cancer pathology report: a case study.J Adv Pract Oncol. 2013;4(3):176-181. doi:10.6004/jadpro.2013.4.3.6National Cancer Institute.Cancer stat facts: female breast cancer subtypes.Sleightholm R, Neilsen BK, Elkhatib S, et al.Percentage of hormone receptor positivity in breast cancer provides prognostic value: a single-institute study.J Clin Med Res. 2021;13(1):9-19. doi:10.14740/jocmr4398Asif HM, Sultana S, Ahmed S, Akhtar N, Tariq M.HER-2 positive breast cancer - a mini-review.Asian Pac J Cancer Prev. 2016;17(4):1609-1615. doi:10.7314/apjcp.2016.17.4.1609Zhang H, Peng Y.Current biological, pathological and clinical landscape of HER2-low breast cancer.Cancers (Basel).2022;15(1):126. doi:10.3390/cancers15010126Wolff AC, Hammond MEH, Allison KH, et al.Human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline focused update.J Clin Oncol. 2018;36(20):2105-2122. doi:10.1200/JCO.2018.77.8738
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Breastcancer.org.Understanding your pathology report.Barrio AV, Van Zee KJ.Controversies in the treatment of ductal carcinoma in situ.Annu Rev Med. 2017;68:197-211. doi:10.1146/annurev-med-050715-104920Wen HY, Brogi E.Lobular carcinoma in situ.Surg Pathol Clin. 2018;11(1):123-145. doi:10.1016/j.path.2017.09.009.American Cancer Society.Types of breast cancer.Wu Q, Li J, Zhu S, et al.Breast cancer subtypes predict the preferential site of distant metastases: a SEER based study.Oncotarget. 2017;8(17):27990-27996. doi:10.18632/oncotarget.15856Zhu H, Doğan BE.American Joint Committee on Cancer’s Staging System for Breast Cancer, Eighth Edition: Summary for Clinicians.Eur J Breast Health. 2021 Jun 24;17(3):234-238. doi:10.4274/ejbh.galenos.2021.2021-4-3American Cancer Society.Breast cancer stages.American Cancer Society.Breast cancer grade.Beikman S, Gordon P, Ferrari S, et al.Understanding the implications of the breast cancer pathology report: a case study.J Adv Pract Oncol. 2013;4(3):176-181. doi:10.6004/jadpro.2013.4.3.6National Cancer Institute.Cancer stat facts: female breast cancer subtypes.Sleightholm R, Neilsen BK, Elkhatib S, et al.Percentage of hormone receptor positivity in breast cancer provides prognostic value: a single-institute study.J Clin Med Res. 2021;13(1):9-19. doi:10.14740/jocmr4398Asif HM, Sultana S, Ahmed S, Akhtar N, Tariq M.HER-2 positive breast cancer - a mini-review.Asian Pac J Cancer Prev. 2016;17(4):1609-1615. doi:10.7314/apjcp.2016.17.4.1609Zhang H, Peng Y.Current biological, pathological and clinical landscape of HER2-low breast cancer.Cancers (Basel).2022;15(1):126. doi:10.3390/cancers15010126Wolff AC, Hammond MEH, Allison KH, et al.Human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline focused update.J Clin Oncol. 2018;36(20):2105-2122. doi:10.1200/JCO.2018.77.8738
Breastcancer.org.Understanding your pathology report.
Barrio AV, Van Zee KJ.Controversies in the treatment of ductal carcinoma in situ.Annu Rev Med. 2017;68:197-211. doi:10.1146/annurev-med-050715-104920
Wen HY, Brogi E.Lobular carcinoma in situ.Surg Pathol Clin. 2018;11(1):123-145. doi:10.1016/j.path.2017.09.009.
American Cancer Society.Types of breast cancer.
Wu Q, Li J, Zhu S, et al.Breast cancer subtypes predict the preferential site of distant metastases: a SEER based study.Oncotarget. 2017;8(17):27990-27996. doi:10.18632/oncotarget.15856
Zhu H, Doğan BE.American Joint Committee on Cancer’s Staging System for Breast Cancer, Eighth Edition: Summary for Clinicians.Eur J Breast Health. 2021 Jun 24;17(3):234-238. doi:10.4274/ejbh.galenos.2021.2021-4-3
American Cancer Society.Breast cancer stages.
American Cancer Society.Breast cancer grade.
Beikman S, Gordon P, Ferrari S, et al.Understanding the implications of the breast cancer pathology report: a case study.J Adv Pract Oncol. 2013;4(3):176-181. doi:10.6004/jadpro.2013.4.3.6
National Cancer Institute.Cancer stat facts: female breast cancer subtypes.
Sleightholm R, Neilsen BK, Elkhatib S, et al.Percentage of hormone receptor positivity in breast cancer provides prognostic value: a single-institute study.J Clin Med Res. 2021;13(1):9-19. doi:10.14740/jocmr4398
Asif HM, Sultana S, Ahmed S, Akhtar N, Tariq M.HER-2 positive breast cancer - a mini-review.Asian Pac J Cancer Prev. 2016;17(4):1609-1615. doi:10.7314/apjcp.2016.17.4.1609
Zhang H, Peng Y.Current biological, pathological and clinical landscape of HER2-low breast cancer.Cancers (Basel).2022;15(1):126. doi:10.3390/cancers15010126
Wolff AC, Hammond MEH, Allison KH, et al.Human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline focused update.J Clin Oncol. 2018;36(20):2105-2122. doi:10.1200/JCO.2018.77.8738
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