The short version
- Your pathology report describes the cancer cells from your biopsy or surgery: the type, size, grade, whether lymph nodes are affected, and whether the cells have hormone receptors or HER2.1
- These results help your team decide which treatments will work best.
- You can ask for a copy, and ask your breast care nurse to go through it with you.
What’s in the report
| Term | What it means |
|---|---|
| Invasive or in situ | Invasive cancer has spread from the ducts or lobules into nearby breast tissue. In situ (such as DCIS) is still inside the ducts.1 |
| Type | For example no special type (NST) or lobular. See types of breast cancer. |
| Size | The size of the cancer, usually in millimetres.1 |
| Grade | How different the cells look from normal cells, from 1 (slow-growing) to 3 (faster-growing).2 |
| Margins | Whether there are cancer cells at the edge of the tissue removed. Clear margins mean no cancer cells at the edges. If cells are at the edge, more surgery may be needed.1 |
| Lymph nodes | How many nodes were removed and whether any contain cancer.1 |
| Lymphovascular invasion (LVI) | Whether cancer cells were seen in small blood or lymph vessels near the tumour.1 |
| ER and PR | Oestrogen and progesterone receptors. If positive, hormone therapy is likely to help.1 |
| HER2 | A protein that can make cancer grow. See below.1 |
| Ki-67 | A measure of how quickly the cells are dividing. Not all hospitals test for it.1 |
Hormone receptors
Hormone receptor results are often given as a score. In the UK, many hospitals use the Allred score (from 0 to 8), where a higher number means more receptors. Ask your team what your score means for you.
HER2 results
HER2 is usually tested in two steps:1
- IHC test: scored 0, 1+, 2+ or 3+. A score of 0 or 1+ is HER2-negative, and 3+ is HER2-positive.
- 2+ is borderline, so a second test (ISH or FISH) checks for extra copies of the HER2 gene to decide whether it’s positive or negative.
If your cancer is HER2-positive, targeted treatments such as trastuzumab are usually recommended.
Genomic tests
For some people with early breast cancer that is ER-positive and HER2-negative, a test on the tumour, such as Oncotype DX, EndoPredict or Prosigna, may be used to help decide whether chemotherapy is likely to be worthwhile. NICE recommends these tests for some groups, depending on lymph node status and menopausal status.3 Ask your team whether a test is suitable for you.
Tips for understanding your report
- Ask for a copy, and keep it with your other papers.
- Go through it with your breast care nurse, who can explain the words and what they mean for you.
- Write down questions before your appointment.
- Be careful comparing your results with other people’s. The same result can mean different things alongside your other test results.
Related pages
- Types of breast cancer explained
- Breast cancer stage and grade
- Questions to ask after a breast cancer diagnosis
Everyone’s treatment is different, so talk to your cancer team about what is right for you.
References
- Breast Cancer Foundation NZ. Understanding your pathology report. www.breastcancerfoundation.org.nz/breast-cancer/tests-and-diagnosis/understanding-your-pathology-report
- Macmillan Cancer Support. Staging and grading of breast cancer. www.macmillan.org.uk/cancer-information-and-support/breast-cancer/staging-and-grading-of-breast-cancer
- National Institute for Health and Care Excellence. Tumour profiling tests to guide adjuvant chemotherapy decisions in early breast cancer (HTG719, formerly DG34). www.nice.org.uk/guidance/HTG719/chapter/1-recommendations