Precise histological knowledge of the tumour is essential for treatment and prognosis.
The histological report should precisely describe the sample specimens received (with potential artefacts such as specimen opened by the surgeon), the possibility of precisely orienting the surgical specimen with respect to its initial in vivo orientation, the number of received nodes.
It then describes, with the same precision, the histological type and the differentiation grade incuding, if necessary, specific staining and immunohistochemistry studies.
It should also specify the status of the surgical limits (with frankness vis-à-vis the surgeon since further treatment may be possible), the distance between the tumour and the specimen limits, the number and location of pathological nodes.
The histological report is a legal part of the medical record.
The surgeon will perform a mastectomy or an amputation according to pathologist's diagnosis following extemporaneous examination. Therefore, there should be mutual trust between the pathologist and the surgeon in order to establish a confident team.
The final report sometimes involves very important details modifying therapy. For instance, histological grading for breast cancer will determine whether adjuvant chemotherapy should be performed or not.
Another example is testicular cancer: if the histology is in favour of seminoma, this is a highly radiosensitive tumour; whereas if histology does not reveal seminoma (non seminomatous tumour), it is chemosensitive. If an atypical subset exists in a seminoma, it should be treated by chemotherapy.
Requests for new slide readings for new interpretation or the execution of specific staining are frequent. Some tumours are difficult to classify and require specific expertise.
A pathologist should not be ashamed of asking for confirmation from a more specialised colleague: it is in the patient's best interest. Collegiality between pathologists enables trouble-free new slide reading.
It is the physician’s duty to correctly interpret the histological tumour type before beginning treatment.
The pathologist should therefore be totally integrated within the multidisciplinary team during the discussion on treatment, in order to ensure that physicians correctly interpret his/her findings.
If necessary, the pathologist can himself request complementary examinations or molecular biology on histological slides.
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