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Your biopsy report

Why Extra Stains Were Added — to Your Biopsy

Extra tests on biopsy tissue are rarely a sign of bad news. They are usually the pathologist's way of getting a precise answer before any treatment decision is made.

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

  • Precision, not alarm — Additional stains are ordered when the first slide does not give enough detail to name the cancer type with confidence.
  • Same tissue, new slides — No new biopsy is needed. The lab cuts more sections from the original biopsy block.
  • Required for many treatments — NCCN and ESMO guidelines require specific markers before certain treatments can be recommended.
  • Your team interprets the result — All findings go to your treating oncologist, who will explain what they mean for your care.
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Additional stains — called immunohistochemistry or IHC — are added when the first stain does not give the pathologist enough information to name the cancer type with confidence. It is a precision step, not a sign that something new was found. NCCN and ESMO guidelines require specific IHC markers before treatment decisions can be made for many cancer types.

What does the lab actually do when extra stains are ordered?

  1. The pathologist reviews the first stain

    The initial slide uses a standard haematoxylin and eosin stain that shows the tissue's structure. If the cells look ambiguous — possibly from more than one cancer type or organ — the pathologist notes that more information is needed before a confident conclusion can be reached.

  2. Specific antibody tests are selected

    The pathologist chooses IHC markers suited to the suspected diagnosis. Each marker is an antibody that binds to a specific protein, revealing which cell type or cancer origin the tissue belongs to. Different cancers express different proteins.

  3. New slides are prepared from the same tissue block

    The laboratory cuts additional thin sections from the original biopsy block and applies the selected antibodies to each section. You do not need another procedure.

  4. The stained slides are examined

    Once the slides are processed, the pathologist reads the protein pattern and matches it to known cancer types. In some cases this confirms the initial impression; in others it narrows a broader differential down to one diagnosis.

  5. A complete report is issued

    All findings — the first stain and the IHC results — are combined into one report. That report goes to your treating doctor, who reviews it and explains what it means for your care.

Does it mean something bad was found?

Usually not. The most common reason for additional stains is that the first slide gave a strong hint but not a definitive answer. The pathologist is doing exactly what they should — not releasing a report until they are confident.

There are situations where extra stains are ordered to rule something in or out, and those results can go either way. But the act of ordering them is not itself news. It is the result that your doctor will explain.

If you have been waiting longer than you expected, it is reasonable to call your treating team and ask where the report stands.

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Send your reports across and a specialist will walk you through what they mean — what is known, what is not, and what the options actually are.

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How much longer will the results take?

IHC adds time. The extra slides need to be prepared, stained, processed and reviewed before the report can be finalised. Your treating team can tell you when the result is expected.

Do not rely on estimates from the lab directly — the report goes to your treating doctor first, and they interpret it in the context of your full clinical picture before explaining the findings to you. A number from the lab has no meaning outside that context.

Ask your treating team for an update if you have heard nothing and are unsure what to expect.

While you are waiting

  • Write down the questions you want to ask when the result comes back.
  • Note any new symptoms and when they started — your doctor will ask.
  • Contact your treating team if you feel unwell, regardless of where the report stands.
  • Do not interpret any preliminary numbers from the lab without your doctor's input.
  • Let a family member know when your next appointment is so they can join you.

Did you know?

NCCN and ESMO guidelines require IHC marker testing for a wide range of cancer types before treatment recommendations can be made — which means a biopsy report without additional stains would, in many cases, be incomplete.

The extra wait is part of getting the answer right.

Source: NCCN Guidelines for Pathology Reporting; ESMO Clinical Practice Guidelines

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Common questions

Frequently asked questions

My report was supposed to be ready yesterday. Is something wrong?

A delay does not mean the news is bad or that something unexpected was found. IHC takes longer to process than the initial slide, and turnaround varies between laboratories. The most practical step is to call your treating team's coordinator and ask for an update. They can give you a realistic timeline and will contact you as soon as the result is available.

What is immunohistochemistry and why does it take longer?

Immunohistochemistry is a method that uses antibodies to detect specific proteins in tissue sections. The laboratory applies antibodies to a new slide, allows them to bind, and then reads the result under a microscope. Each step — cutting, staining, processing and review — adds time. Some panels involve multiple markers and each one runs separately. The process is thorough because the result has to be reliable enough to guide treatment.

Could the extra stains change the diagnosis completely?

They can refine or confirm it, and in some cases they do shift it. A tumour that looked like one cancer type under the first stain may turn out to originate from a different organ, which changes the treatment approach. This is not the most common outcome, but it is exactly why the pathologist requested more information before finalising the report. A refined diagnosis is more useful to your treating team than a quick conclusion that later needs correcting.

Do I need to give more tissue or have another biopsy?

Almost never, for IHC. The additional stains are prepared from the same block already collected. The laboratory cuts more thin sections from that block and applies the new antibodies to them. Occasionally the original sample is too small to yield enough sections, and in that situation your team will discuss it with you directly. But this is not the usual case, and the lab will flag it early rather than leaving you waiting without explanation.

Who tells me what the result means?

Your treating oncologist. The pathology report is a technical document written for doctors, and parts of it need clinical context — your stage, your imaging, your history — to interpret correctly. The pathologist's role is to describe the tissue; your oncologist's role is to explain what that means for you and what comes next. Ask at your appointment for the result to be explained in plain terms, and ask for a copy of the report if you would like to keep one.

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?

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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

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IHC and Molecular Markers

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

Grading and Scoring Systems

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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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