Overview
Histopathology is the examination of tissue under a microscope to identify disease and study its characteristics. In cancer care, it plays a central role in confirming whether a tissue sample is cancerous, identifying the type and subtype of tumour, and assessing features that may influence prognosis and treatment.
Tissue may be obtained through a needle biopsy, endoscopic biopsy, surgical biopsy or cancer surgery. Depending on the specimen, histopathology may also provide information about tumour grade, local extent, lymph-node involvement, surgical margins and response to treatment given before surgery. The findings are interpreted alongside the patient’s clinical history, imaging and, when required, immunohistochemistry or molecular test results.
Samples and Methods
Biopsy Samples
Small tissue samples may be collected through core-needle biopsy, endoscopic biopsy, punch biopsy or surgical biopsy. These samples help establish a diagnosis and may support additional biomarker testing when sufficient tissue is available.
Surgical Specimens
Tissue removed during surgery may include the tumour, surrounding tissue and regional lymph nodes. Examination may provide information required for pathological staging and further treatment planning.
Routine Staining
Hematoxylin and eosin, commonly called H&E, is the standard stain used to examine tissue structure and cellular features under a microscope.
Special Stains
Selected stains may be used to identify microorganisms, tissue components or substances that are not adequately demonstrated by routine staining.
Additional Testing
Immunohistochemistry, in-situ hybridisation or molecular testing may be added when further tumour classification or biomarker assessment is required.
How It Is Performed
- Sample Receipt: The tissue is received in the laboratory with identifying details, the specimen site and relevant clinical information. Correct labelling and appropriate preservation are essential for reliable evaluation.
- Gross Examination: The specimen is inspected and described, including its size, appearance and visible abnormalities. Representative areas are selected for microscopic examination.
- Tissue Processing: The selected tissue is usually preserved in formalin, processed and embedded in paraffin wax. Very thin sections are then cut, placed on glass slides and stained.
- Microscopic Examination: A pathologist examines the prepared slides and correlates the findings with the available clinical and imaging information. Additional stains or molecular tests may be requested before the diagnosis is finalised.
- Pathology Reporting: The final report summarises the diagnosis and other clinically relevant findings. For surgical specimens, this may include tumour type, grade, margins, lymph-node status and pathological stage, where applicable.
Advantages
- Confirms many cancers and distinguishes malignant tumours from non-cancerous conditions.
- Identifies the tumour’s type, subtype and, where applicable, grade.
- Helps assess tumour extent, lymph-node involvement and pathological stage.
- Determines whether cancer cells are present at the examined surgical margins.
- Supports biomarker testing that may help guide treatment decisions.
- Allows stored tissue blocks and slides to be reviewed or tested again when required.
Frequently Asked Questions
01
Does histopathology confirm cancer?
Histopathology is generally the definitive method for diagnosing many cancers. However, some cases require immunohistochemistry, molecular testing, clinical correlation or additional tissue before a conclusive diagnosis can be made.
02
What is the difference between tumour type and tumour grade?
Tumour type describes the kind of cancer and the cells or tissue from which it developed. Grade describes how abnormal or differentiated the tumour cells appear and may provide information about their likely behaviour.
03
What are surgical margins?
Margins are the edges of tissue removed during surgery. A negative margin means that no cancer cells were identified at the examined edge, while a positive margin means that cancer cells extend to the edge. The significance depends on the cancer and surgical context.
04
Why can the report take several days?
Tissue must undergo fixation, processing, sectioning, staining and microscopic examination. Complex specimens or additional tests may require more time.
05
Can pathology slides be reviewed for a second opinion?
Yes. Slides and, when necessary, tissue blocks may be reviewed by another pathologist, particularly when a tumour is uncommon or diagnostically complex.
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