Histopathology at Cheltenham Hospital

Why might I need histopathology?

You won't usually request histopathology directly. Instead, it happens automatically if you've had:

• a biopsy, where a small sample of tissue is taken to investigate symptoms or an abnormal finding
• an operation to remove tissue, such as a lump, polyp, or an organ affected by disease.

Histopathologists examine tissue for many conditions, not just cancer, including inflammatory conditions such as ulcerative colitis and Crohn's disease. If cancer is suspected, examining the tissue is usually the only way to confirm whether cancer cells are present.

What are the benefits of histopathology?

Many biopsies are reassuring: they're taken to rule out cancer, and don't show it, though they may show something else, such as inflammation, that explains your symptoms. If cancer is found, histopathology can tell your doctors what type of cancer it is, how aggressive it looks, and sometimes whether it's likely to respond to certain treatments, helping the team plan your care.

Are there different types of histopathology?

• Histology: examining thin slices of solid tissue, cut from a biopsy or a larger surgical specimen, after they've been processed and mounted on glass slides.
• Cytology: examining loose cells, such as those collected during cervical screening or by using a fine needle to sample a lump, which can usually be looked at directly without the same processing.
• Autopsy, also called a post-mortem examination: examining tissue after death, to help confirm the cause of death or the effect of a disease. This is requested either by the doctor who cared for the person, with the family's permission, or by a coroner.

Most histopathologists spend some of their time on histology and some on cytology, though there are specialist cytopathologists who focus on cytology alone.

How do I prepare for histopathology?

There's nothing specific you need to do to prepare for histopathology itself. Since it happens after your tissue sample has already been taken, any preparation, such as fasting or stopping certain medicines, relates to the biopsy or operation used to collect the sample, rather than to the histopathology process itself.

What happens during histopathology?

1. Your tissue sample is placed in a chemical called a fixative, usually formalin, which preserves it and stops it decaying.
2. A pathologist examines the sample, selects the most useful areas, and cuts small pieces for further processing.
3. These pieces are treated to remove water and then embedded in wax, so they're firm enough to cut into very thin slices.
4. The thin slices are placed on glass slides and stained with dyes, usually a combination called haematoxylin and eosin, which colours different parts of the cells so they can be told apart under a microscope.
5. A histopathologist examines the slides under a microscope, looking for changes that might explain your illness.
6. They write a report describing what they've found, which is shared with the doctor looking after you.

For a straightforward specimen, examining a piece of tissue under the microscope can take around 30 to 60 minutes, though larger or more complex specimens, such as a breast lump, can take longer, since the edges and surrounding tissue need careful examination too.

Occasionally, if a result is needed urgently during an operation, a sample can be frozen and examined within minutes, known as a frozen section, though this gives a less detailed picture than the usual process.

What happens after histopathology?

Your results are sent as a report to the doctor who arranged your biopsy or operation, who will usually go through them with you. Results can take several days to a few weeks, depending on how complex the sample is and whether extra tests, such as special stains, are needed.

If your report shows an abnormality, your doctor will explain what it means and what happens next. For cancer, histopathology results are often discussed at a multidisciplinary team meeting, where specialists such as surgeons, oncologists and radiologists work together to plan your care.

What are the risks and limitations of histopathology?

Histopathology itself doesn't carry direct risks to you, since it's carried out on a sample that's already been taken; any risks come from the biopsy or operation used to collect it. That said, it's worth knowing:

• results aren't always immediate, and complex samples, or those needing special stains, can take longer to report
• rarely, changes in the way tissue looks under a microscope can be difficult to interpret, and a pathologist may seek a second opinion or ask for a further sample
• a frozen section, used for a same-day result during surgery, gives a less detailed picture than the standard process, so a small number of these are amended once the full result is available.