After surgery, pathology reports are usually available in about 1 week, and occasionally in some patients with specific types of pathology, it may take about 2 weeks to get a report.
A complete postoperative pathology report may have a lot of content, so as a patient, what do you focus on?
The pathology report is divided into four main sections:
Pathology type
This is the most important part of the pathology report and the first part to look at.
First look at benign and malignant. Common benign tumors include nodular goiter, follicular adenoma, and Hashimoto’s thyroiditis. After surgical removal, there is basically no need for additional adjuvant therapy.
Malignant tumors usually have the word “cancer” in them, and once you see that they are cancerous, you have to define the specific pathology, because the follow-up and outcome are completely different for different pathologies.
Papillary carcinoma is the most common type of thyroid malignancy, accounting for more than 90% of cases, and is very well treated with surgery and requires lifelong thyroxine tablets after surgery;
Follicular carcinoma also requires lifelong medication; in addition, it may require supplemental removal of the entire thyroid gland followed by iodine-131 therapy;
Medullary carcinoma is relatively prone to recurrence and requires a blood test for calcitonin at follow-up to monitor changes in disease;
Lowly differentiated and undifferentiated cancers, which are prone to recurrence and have a poor outcome, may require adjuvant radiotherapy.
There is also the possibility of rare pathologies such as lymphoma. Although not “cancer,” it is still a malignancy and requires subsequent chemotherapy.
It is important to know the specific pathology of thyroid tumors to help with future treatment and follow-up.
Tumor-related conditions
Including the number, size, and location of the tumor, whether it invades surrounding tissues, whether it invades blood vessels and/or nerves, and whether it is combined with other thyroid diseases.
Lymph node metastasis
Includes lymph node location (zonation), number, size, and absence of perineural invasion. It is often written as a/b, indicating that a total of b lymph nodes were cleared, of which a was found to have tumor metastasis.
“a” and “b” determine the staging of the tumor. But in thyroid cancer, staging is usually not critical, but rather is something that is taken to the surgeon to assess whether the surgery is complete, how high the risk of recurrence is, whether iodine-131 therapy is needed, and so on, so that the surgeon can consider whether the next step in treatment is needed on a case-by-case basis.
As a patient, you don’t need to get too hung up on this, and you don’t need to worry too much when you see lymph node metastases, just listen to your doctor.
Immunohistochemistry
CK19, Gal-3, TPO …. What do these all mean?
This part is actually used by the pathologist to diagnose the type of thyroid cancer pathology, and as a patient, you can completely ignore it, because the conclusion is the type of pathology stated on the report.
Summary
Usually when patients get a pathology report, they first look at whether it is benign or malignant and then understand the type of pathology. The rest of the pathology report does not need to be looked at too deeply, just wait until the follow-up appointment and bring it to the primary surgeon for him to look at and let him decide.
Extended reading:
What is an immunohistochemistry test?
In many cases, pathology sections, by virtue of plain staining, only yield preliminary results and do not allow for precise typing of tissue cells and accurate determination of tissue origin, which is where immunohistochemistry is needed.
It is based on the principle that any cell can secrete a specific protein as an “identity marker” and when the tissue cell is treated with a known antibody (equivalent to a “decoy”), it binds to the specific protein (i.e., antigen) and is revealed by a chromogenic agent, which allows the physician to determine the origin of the tissue or the cell. This allows the physician to determine the origin of the tissue or cell type.
Co-written by Dr. Yiming Cao, Fudan University Cancer Hospital