Tumour histopathology with surgical Margins study

Cancer

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Histology of tumor + surgical margins.

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Tumour Histopathology with Surgical Margins Study - Comprehensive Information Guide

Why is it done?
- Microscopically examines tissue samples removed during surgical procedures to identify cancerous cells and determine their characteristics
- Evaluates surgical margins to determine if cancer cells have been completely removed or if residual disease remains at the edges of the excised tissue
- Confirms malignancy diagnosis and provides critical information about tumour grade, type, and stage
- Guides treatment planning and predicts prognosis based on histological findings
- Typically performed on tissue specimens obtained from excisional biopsies, lumpectomies, mastectomies, or other surgical resections
- Performed immediately or within days following surgical tumour removal to provide timely diagnostic and prognostic information
Normal Range
- Negative/Normal Result: No malignant cells identified in tissue sample; benign pathology only
- Negative Margins (Optimal): No tumour cells present at the surgical resection edges; indicates complete tumour removal
- Margin Distance Measurement: Typically reported in millimeters (mm); adequate margins usually ≥1-10 mm depending on tumour type and location
- Histological Grade (if malignant): Grade I (Low) = well-differentiated, slowest growth; Grade II (Intermediate) = moderately differentiated; Grade III (High) = poorly differentiated, fastest growth
- Interpretation Key: Negative margins and low-grade histology = best prognosis; Positive margins or high-grade histology = poor prognosis and need for additional treatment
Interpretation
- Negative Margins with Benign Pathology: Best possible outcome; indicates complete benign lesion removal with no malignancy detected; regular follow-up monitoring recommended
- Positive/Involved Margins: Tumour cells extend to the edge of resected tissue; indicates incomplete tumour removal and significantly increased recurrence risk; typically requires additional surgical resection or adjuvant therapy
- Close Margins: Tumour cells present within 1-3 mm of margin edge; borderline situation requiring careful clinical assessment and possibly re-excision or enhanced adjuvant therapy
- High-Grade Tumour (Grade III): Poorly differentiated cells with aggressive behaviour; indicates higher metastatic potential and generally requires more intensive multimodal treatment (surgery, chemotherapy, radiation)
- Low-Grade Tumour (Grade I): Well-differentiated cells with slower growth rate; better prognosis and lower metastatic risk; may allow for more conservative treatment approaches
- Lymphovascular Invasion (LVI): If present indicates cancer cells invading blood/lymphatic vessels; significant poor prognostic indicator suggesting increased nodal involvement and metastatic risk
- Perineural Invasion (PNI): If present indicates tumour growth around nerves; suggests higher recurrence risk and need for aggressive adjuvant treatment
- Factors Affecting Interpretation: Tissue handling artifacts, specimen fixation quality, tumour size, type of malignancy, anatomical location, patient age, and molecular characteristics (hormone receptors, HER2 status in breast cancer)
Associated Organs
- Primary Organs Assessed: Breast, skin, lung, colorectal, head/neck regions, soft tissues, bone, liver, and virtually any organ where malignant tumours can develop
- Associated Organ Systems: Integumentary (skin), respiratory, gastrointestinal, genitourinary, reproductive, musculoskeletal, endocrine, and hematologic systems
- Commonly Associated Malignancies: Breast cancer, melanoma, squamous cell carcinoma, adenocarcinoma, lymphoma, sarcoma, renal cell carcinoma, pancreatic cancer, ovarian cancer, prostate cancer
- Secondary Sites at Risk (if margins positive): Regional lymph nodes, bones, liver, lungs, brain, and distant organs depending on tumour type and grade
- Local Recurrence Risk: Positive margins significantly increase risk of cancer recurrence at original surgical site or nearby tissues
- Potential Complications: Disease dissemination, metastatic spread, regional lymph node involvement, increased morbidity/mortality, need for re-operation, delayed treatment due to incomplete initial resection
Follow-up Tests
- If Margins Positive or Close: Re-excision surgery or wider margin resection; additional imaging studies (MRI, CT, ultrasound)
- Lymph Node Assessment: Sentinel lymph node biopsy or axillary lymph node dissection; lymph node histopathology examination
- Molecular/Immunohistochemical Studies: Hormone receptor status, HER2/neu testing, Ki-67 proliferation index, genetic mutations (BRCA1/2, TP53), PD-L1 expression for immunotherapy planning
- Staging Studies: CT chest/abdomen/pelvis, PET-CT scan, bone scan, tumor marker tests (CEA, CA-125, PSA) depending on cancer type
- Adjuvant Therapy Planning: Chemotherapy sensitivity tests, Oncotype DX, MammaPrint (for breast cancer); radiation therapy consultation
- Periodic Surveillance: Clinical examination every 3-6 months for first 2-3 years, then annually; imaging studies as clinically indicated
- Related Complementary Tests: Intraoperative frozen section analysis, liquid biopsy (circulating tumour DNA/cells), comprehensive metabolic panel, complete blood count
Fasting Required?
- Fasting Requirement: NO
- Reason: This is an ex vivo pathological examination of surgically removed tissue; fasting status does not affect tissue analysis or histological findings
- Pre-Surgical Fasting: Fasting IS required before the surgical procedure itself (typically 6-12 hours depending on anesthesia type); this is separate from the histopathology test
- Special Instructions: Bring all previous biopsy reports and imaging studies to surgical appointment; arrange transportation as anesthesia will be used; wear comfortable, loose-fitting clothing
- Medications: Blood thinners (aspirin, warfarin, clopidogrel) should be discontinued 5-7 days before surgery per surgeon instructions; confirm with surgical team regarding all current medications
- Tissue Handling: Surgical specimens must be placed in appropriate fixative (usually 10% neutral buffered formalin) immediately and labeled correctly for proper processing and analysis

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