Patient Rights Navigating Your Diagnosis What Is Histopathology? Expertise, specialities, and training By Indranil Mallick, MD Indranil Mallick, MD LinkedIn Twitter Indranil Mallick, MD, DNB, is a radiation oncologist with a special interest in lymphoma. Learn about our editorial process Updated on February 21, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Rony Kampalath, MD Medically reviewed by Rony Kampalath, MD Rony Kampalath, MD, is a board-certified diagnostic radiologist specializing in imaging of the abdomen. Learn about our Medical Expert Board Fact checked Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more. by James Lacy Fact checked by James Lacy LinkedIn James Lacy, MLS, is a fact-checker and researcher. James received a Master of Library Science degree from Dominican University. Learn about our editorial process Print Table of Contents View All Table of Contents How Is Histopathology Performed? Components of a Report Interpreting the Results Other Sampling Techniques Histology is the study of tissues, and pathology is the study of disease. Histopathology means the study of tissues related to disease. A histopathology report describes the tissue that the pathologist examined. It can identify features of what cancer looks like under the microscope. A histopathology report is also sometimes called a biopsy report or a pathology report. This article explains what is in a histopathology report and how to interpret results. Hero Images / Getty Images How Is Histopathology Performed? A specialist doctor who examines tissue under a microscope is called a pathologist. Pathologists study samples of tissue in a lab. Pathologists process and cut tissue into very thin layers, called sections. Then, they stain and examine it with a microscope. Using a microscope, they can observe and document the tissue's details. 1:38 Click Play to Learn All About Histopathology This video has been medically reviewed by Anju Goel, MD, MPH. Identifying Disease Samples of tissue can be obtained with procedures such as endoscopy, colonoscopy, and colposcopy, or with surgical procedures such as a breast biopsy. A variety of diseases can be identified with a histopathology examination, including ulcerative colitis, Crohn's disease, uterine fibroids, cancer, and even infections. Frozen Section For some diseases, a sample of the tissue can be interpreted very quickly using frozen sections (also called a cryosection) that are obtained during surgery. Frozen sections are examined immediately in the lab to provide a result within about 20 minutes. This type of pathology is most commonly used to evaluate tumor margins during surgery so that a surgeon can decide if more tissue should be removed for full removal of cancer. The use of frozen sections during surgery depends on the type of cancer being removed and other factors. Lymph and Blood Cancers Lymph nodes are often biopsied to evaluate for certain types of blood cancer and to identify metastases of solid tumors (such as breast cancer and lung cancer). A bone marrow biopsy may also be required for a definitive diagnosis for many types of blood cancers. What Hodgkin Lymphoma Looks Like Under a Microscope Components of a Histopathology Report Histopathology reports on surgical cancer specimens can be complex. They may include: A description of the appearance of the involved tissueA diagnosisA synoptic report detailing the findings of the casePathologist's comments Histopathology reports can be challenging to understand, so it's essential to go over them with a healthcare provider. Knowing which components are going to be included in your report may help you prepare for your appointment. Interpreting the Results Many of the pathologist's findings are used to help determine prognosis, especially in cases of cancer. Prognosis Prognosis is the prediction or estimate of survival or recovery from a disease. Prognostic indicators may include: Size and severity of the diseaseTumor gradeIndications that cancer has spread and extent of spread Grading systems differ depending on the kind of cancer. In general, the cells are scored based on how abnormal they appear under the microscope. For example, Grade 1 tumors appear nearly normal, whereas Grade 4 tumors reflect more abnormalities. The more abnormal the cells look, the higher the grade. Grading is not the same as staging. Staging is based on where the cancer is found in the body and how far it has spread. Other Sampling Techniques In addition to histopathology, pathologists may use other techniques to assess the presence of cancer in the tissues. Molecular Techniques Molecular techniques refer to the ability to analyze cells and tissues at the molecular level, which is at the level of proteins, receptors, and genes. Pathologists diagnose cancer, such as leukemia, through a combination of techniques, including: Cytochemistry: How the sampled cells take up certain stains Immunophenotype: Looks for unique surface proteins Karyotype: Chromosomal changes Morphology: How the cells look Immunohistochemistry Often in lymphomas and other cancers, doctors use immunohistochemistry to help assess the tumor type, prognosis, and treatment. What Is Immunohistochemistry? Immunohistochemistry involves using antibodies to stick to particular tags or markers outside the cancer cells. These markers that the antibodies attach to often have "CD" in their name, which stands for "cluster of differentiation." CDs identify cell phenotypes, which identify different cancers. For example, if CD23 and CD5 are present in the cancer cells, it might support the notion that chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) is a possible diagnosis. However, these same markers are also present in other malignancies. So doctors use this method in combination with other identifying features. Chromosomal Studies Pathologists may perform molecular and chromosomal studies to look at gene rearrangements and specific changes to the chromosomes. Sometimes inserted or deleted genes correlate to prognosis. Genetic changes present in a cancer tissue sample may be hereditary or acquired. For instance, in CLL, a specific piece of a chromosome (17p) is lost. Along with the missing chromosome, a gene that helps suppress cancer is often lost. The 17p deletion is found in about 5-10% of people with CLL overall. The 17p deletion CLL is a form of CLL that is harder to treat with conventional chemotherapy. Recap Doctors may use additional pathology techniques to diagnose cancer. For example, molecular techniques look at proteins, receptors, and genes, which help identify cancer subtypes. Immunohistochemistry looks for markers on cancer cells to narrow down what type of cancer a person has and chromosomal studies look at gene differences to develop a prognosis. Summary Histopathology studies tissue to look for disease. Pathologists perform histopathology in a lab. They examine tissue under a microscope and develop a report of their findings. Histopathology reports can include descriptions of the tissue, diagnosis, and prognosis. In addition to evaluating the shape and structure of cells, pathologists may also use other techniques to assess and diagnose cancer. A Word From Verywell Histopathology reports can be confusing. That's why it's best not to jump to conclusions before going over them with a healthcare provider. Your report will contain information about your tissue sample, offer a diagnosis or suggestions for further testing, and a prognosis if enough information is available. These details will help a doctor manage your treatment in the future. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 7 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Cancer Institute. NCI dictionary of cancer terms. UC Davis Health. Best practices in frozen section analysis. Taxy JB, Husain AN, Montag AG. Biopsy Interpretation: The Frozen Section. Philadelphia, PA: Lippincott Williams & Wilkins; 2012. College of American Pathologists. How to read your pathology report. Schafer KA, Eighmy J, Fikes JD, et al. Use of severity grades to characterize histopathologic changes. Toxicol Pathol. 2018;46(3):256-265. doi:10.1177/0192623318761348 Ho C, Rodig SJ. Immunohistochemical markers in lymphoid malignancies: Protein correlates of molecular alterations. Semin Diagn Pathol. 2015;32(5):381-91. doi:10.1053/j.semdp.2015.02.016 Yu L, Kim HT, Kasar S, et al. Survival of Del17p CLL depends on genomic complexity and somatic mutation. Clin Cancer Res. 2017;23(3):735-745. doi:10.1158/1078-0432.CCR-16-0594 Additional Reading Taylor J, Xiao W, Abdel-wahab O. Diagnosis and classification of hematologic malignancies on the basis of genetics. Blood. 2017;130(4):410-423.