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Understanding your pathology report

Why Was an IHC Panel — Ordered on My Biopsy?

Finding IHC results on your pathology report can feel alarming. It usually means your pathologist was being thorough — not that something was missed or has gone wrong.

Medically reviewed by Dr. Mohammed Imaduddin, Surgical Oncologist, MBBS · MS (General Surgery) · M.Ch (Surgical Oncology) · Last reviewed September 2026

  • A precision step, not a setback — IHC answers a specific question about your cells that standard microscopy cannot answer alone.
  • Positive or negative does not mean good or bad — Each result points your team toward the right next decision. Only your oncologist can interpret it in the context of your full case.
  • Not a sign the diagnosis was missed — IHC is ordered routinely — including when the initial finding is already clear — to confirm the exact subtype.
  • The report is a clinical tool, not a verdict — Your oncologist reads IHC results alongside imaging, blood tests and your history — never in isolation.
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IHC — immunohistochemistry — applies chemical stains to your biopsy tissue to identify proteins on the cells. Your pathologist ordered it to answer a specific question: what type of cell this is, where it came from, or whether a particular protein is present. IHC is a sign of careful, precise diagnosis.

What do the words and symbols on an IHC report mean?

IHC (Immunohistochemistry)
A laboratory technique that applies chemical stains to thin slices of your biopsy tissue. Each stain binds to a specific protein and changes colour under the microscope, telling the pathologist which proteins are present in your cells.
Positive (+)
The protein that stain was designed to detect is present. Whether this matters, and what it means, depends entirely on which marker is positive and what question your pathologist was trying to answer.
Negative (−)
The protein was not detected. A negative result is as useful as a positive one — it rules out certain diagnoses and helps narrow the picture. Pathologists read the whole panel together, not each stain alone.
Panel
A group of stains ordered together. Because many proteins overlap between cancer types, a single stain is rarely enough. A panel gives the pathologist a pattern of results to work from rather than one isolated answer.
Score or intensity (0, 1+, 2+, 3+)
Some markers are graded on how strongly the cells stained. A higher number means more of that protein is present. What a score means for your diagnosis is something your oncologist will explain from the full report — scores are not read in isolation.

Why would a pathologist order IHC in the first place?

  • To identify the exact type of cancer cell when biopsy appearance alone is not conclusive
  • To determine whether a cancer in one part of the body started there or spread from somewhere else
  • To check whether specific proteins are present that help your team make treatment decisions
  • To distinguish between two cancer types that look similar under the microscope
  • To confirm whether tissue is cancerous, pre-cancerous, or non-cancerous
  • To assess certain properties of the tumour that affect how it behaves

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Does ordering IHC mean the diagnosis is unclear?

Not necessarily. IHC is ordered for two distinct reasons: to resolve genuine uncertainty, and to add precision to a diagnosis that is already broadly clear.

Your pathologist may have seen cells that clearly look like one type of cancer and still ordered IHC to confirm the exact subtype. That is not the same as not knowing what you have — it is making sure the answer is specific enough to act on safely.

In some reports, IHC results sit alongside the main diagnosis without ever raising doubt. The stains were a standard step in thorough reporting, not a flag that something looked wrong.

Does IHC cost extra, and do you need to do anything?

IHC is an additional laboratory procedure and does attract an extra charge in most private settings. The number of stains in the panel affects the cost. Your care coordinator can clarify what is covered under your insurance or any package arrangement you have.

You do not need to be present or provide any further sample. IHC is performed entirely on the tissue that was already collected during your biopsy. No additional procedure is needed from you.

Keep a copy of the IHC report. Your oncologist may refer back to the marker results at several points in your care, and having the original document available saves time.

What can IHC tell your team — and what can it not?

QuestionCan IHC answer this?What actually answers it
What type of cancer cell this isYes — this is what IHC is designed forThe panel result, interpreted by your pathologist
Where the cancer originally startedPartly — narrows the originIHC plus imaging together confirm the primary site
Whether a specific protein is presentYesThe positive or negative result for that marker
How advanced the cancer isNoStaging scans and clinical assessment
Whether a treatment will workNoYour oncologist, using the full picture
What your prognosis isNoA conversation with your oncologist, who knows your complete case

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Common questions

Frequently asked questions

What does it mean if a marker comes back positive on my IHC report?

A positive result means the protein that stain was looking for is present in your cells. Whether that is significant depends entirely on which marker it is and what question the pathologist was trying to answer. Your pathologist records the finding; your oncologist translates it into a decision. Do not read a single positive result as good or bad news without that context — the meaning only becomes clear when your oncologist reads the full panel alongside your diagnosis.

What does a negative IHC result mean?

A negative result means that protein was not detected in the cells. Negative findings are just as informative as positive ones — they help rule out certain diagnoses and narrow the picture. Pathologists interpret the pattern of all the results in a panel together, not each stain in isolation. A negative on one marker alongside a positive on another is a meaningful combination, and your oncologist will explain what the pattern points to.

How long does IHC take to come back?

IHC requires additional laboratory steps beyond standard biopsy processing. Most panels take several working days from the time the pathologist requests the stains, though this varies between laboratories and depends on the number of stains ordered. If your report is taking longer than your team indicated, ask your care coordinator to follow up with the laboratory rather than assuming something has gone wrong.

My report shows a score like 2+ or 3+. What does that mean?

Intensity scores — typically 0, 1+, 2+, or 3+ — describe how strongly the cells stained for a particular protein. A higher score means more of that protein is present in the cells. What a specific score means for your diagnosis is something your oncologist will explain from the full context of your report. Scores mean different things for different markers and different cancer types; reading one number without that context will not give you a reliable answer.

Should I get a second opinion on my IHC report?

A second pathology opinion is a reasonable and accepted step, particularly for unusual or borderline findings, or if you are considering treatment at a different centre. To seek one, ask your oncologist for the original glass slides and the paraffin-embedded tissue block, along with a copy of the report. Many specialist pathology laboratories and academic centres offer formal pathology review. Your oncologist can advise on where to send samples for your cancer type.

Is there anything I need to do before or after IHC testing?

Nothing. IHC is performed entirely on the biopsy tissue that was already collected. No further sample, preparation, or procedure is needed from you. The testing takes place in the pathology laboratory, and the results are added to your report and sent to your oncologist. Your next step is the appointment where your oncologist walks you through what the results mean for your care.

Full index

Browse all 701 biopsy topics

Every page in this section, grouped by the part of the journey it belongs to. Pick a group to see what is in it.

What Is a Biopsy?

What Is a Biopsy? Everything You Need to Know →

Types of Biopsy Compared

Which Biopsy Will You Have? Techniques Compared →

Preparing for a Biopsy

What to Expect on the Day of Your Biopsy →

Recovery and Aftercare

After a Biopsy: Recovery, Aftercare and Warning Signs →

Biopsy by Body Part

Biopsy by Body Part: What to Expect at Each Site →

Understanding Your Report

How to Read a Biopsy Report: Terms Explained →

IHC and Molecular Markers

IHC and Molecular Markers on a Biopsy: What They Mean →

Grading and Scoring Systems

Cytology & Prostate Scoring Systems Explained →

How Accurate Is a Biopsy?

How Accurate Is a Biopsy? Errors and Second Opinions →

If Your Result Is Benign

Your Biopsy Is Benign: What It Means and What Comes Next →

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