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Your Pathology Report — Line by Line
You were handed a page of dense technical language and probably read it at home, alone, before anyone explained it. This page goes through what actually appears on an endometrial cancer histopathology report and translates each line — type, grade, depth of invasion, LVSI, margins, lymph nodes, mismatch repair and p53. It also corrects the two phrases most often misread, because both cause real distress: “positive” on a pathology report means present, not good, and lymphovascular invasion is not the same thing as an involved margin, though they sound similar and are constantly confused.
- Every line has a purpose — and together they give the stage
- “Positive” means present — not favourable — the commonest misreading
- LVSI is not an involved margin — two different findings entirely
- Biopsy reports are provisional — the definitive one comes after surgery
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What Each Line Means
Roughly in the order these appear on a typical report. Not every report contains every line.
| What it says | What it means |
|---|---|
| Histological type | What kind of cancer it is. Endometrioid adenocarcinoma is much the commonest and generally the least aggressive. Serous, clear cell and carcinosarcoma behave differently and are treated more intensively. See endometrioid adenocarcinoma. |
| Grade / differentiation | How closely the tissue still resembles normal lining. Grade 1 or “low grade” is the least aggressive; grade 3 or “high grade” the most. See how grade is determined. |
| Depth of myometrial invasion | How far into the muscle wall the tumour has grown, usually as a fraction — less than half or more than half the thickness. One of the strongest predictors of whether treatment after surgery is recommended. |
| Cervical stromal involvement | Whether the tumour has grown into the substance of the cervix. If present it raises the stage. Involvement of the surface lining of the cervix alone is a lesser finding than involvement of the stroma beneath it. |
| Lymphovascular space invasion (LVSI) | Tumour cells seen inside small lymphatic channels or blood vessels near the tumour. Reported as absent, focal or substantial. Substantial LVSI is associated with a higher risk of nodes being involved and of recurrence, and frequently influences the recommendation about radiotherapy. |
| Margins | Whether tumour reaches the cut edge of the tissue removed. “Negative”, “clear” or “free” margins are the good result. This is a different question from LVSI. |
| Lymph nodes | Usually written as a fraction — the number containing cancer over the number examined. “0/12” means twelve nodes were examined and none contained cancer. See lymph nodes. |
| Serosa, adnexa, parametrium | The outer surface of the uterus, the tubes and ovaries, and the tissue beside the uterus. Involvement of any of these raises the stage. |
| Mismatch repair proteins | Four names — MLH1, PMS2, MSH2, MSH6. “Retained” or “intact” for all four is proficient; “loss” of any is deficient, which affects treatment options and prompts assessment for Lynch syndrome. See MMR and MSI testing. |
| p53 | “Wild-type” is the normal pattern despite the odd name. “Aberrant”, “mutant pattern”, “overexpression” or “null” place the tumour in the p53-abnormal molecular group. See molecular classification. |
| FIGO stage | The conclusion assembled from all of the above — how far the cancer has spread. See FIGO staging. |
If your report does not mention mismatch repair or p53, ask. Since FIGO 2023 incorporates molecular class into staging, a report without them has not fully staged the tumour — and the testing can almost always be done afterwards on the stored tissue block.
Did You Know? The single most common misunderstanding we see is the word “positive”. In everyday use it means good. On a pathology report it simply means found — so “lymph nodes positive” means cancer was present in the nodes, and “margins negative” is the reassuring result rather than the worrying one. It is the reverse of the intuition most people bring to the page. The second most common confusion is between lymphovascular space invasion and margin involvement. LVSI means tumour cells were seen inside small vessels near the tumour; margin involvement means tumour reached the cut edge of what was removed. They are entirely different findings with different implications, and the similar-sounding language does no one any favours. Sources: WHO Classification of Tumours — Female Genital Tumours; International Collaboration on Cancer Reporting dataset for endometrial cancer; FIGO 2023 staging system for endometrial cancer.
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The Phrases Most Often Misread
Five that cause unnecessary distress, or occasionally unwarranted reassurance.
"Positive" does not mean good
It means present. "Lymph nodes positive" means cancer was found in the nodes; "margins negative" is the reassuring result. This is the reverse of ordinary usage and it is the single commonest misreading. If you are unsure which way round a line reads, that is a completely reasonable question to ask rather than a failure of understanding.
LVSI is not the same as an involved margin
Lymphovascular space invasion means tumour cells were seen inside small vessels within the tissue around the tumour — it says something about risk. Margin involvement means tumour reached the cut edge of what was removed — it says something about completeness of excision. They are different findings with different consequences, and they are constantly confused because both sound like the cancer has got out.
"Invasion" sounds worse than it often is
Almost every endometrial cancer invades the muscle to some degree — that is what distinguishes a cancer from a precancer. What matters is how far: less than half the thickness of the muscle wall is a substantially better position than more than half. The word alone tells you very little; the fraction is the information.
"0/14 nodes" is a good line
It means fourteen lymph nodes were examined and none contained cancer. Women sometimes read the larger number as the number affected. Where sentinel node biopsy was performed the total will be smaller — perhaps two or four — and that is by design rather than an incomplete operation. See sentinel node biopsy.
A biopsy report is not the final word
The report from your pre-operative biopsy is provisional. Type and grade can both be revised once the whole uterus is examined, and this is expected rather than an error. The definitive report follows surgery, typically two to three weeks afterwards, and it is that one on which treatment decisions rest.
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"Positive" Means Present, Not Good
The commonest misreading on any pathology report — and the one that causes the most unnecessary fear.
Questions to Take to the Appointment
Five that turn a report into a plan.
- “What is my stage, and what does it rest on?” The stage is a conclusion drawn from several findings. Knowing which findings drove it tells you far more than the numeral alone.
- “Which molecular group is my tumour?” A one-word answer. If it has not been determined, ask whether it can be done on the stored tissue — it can change the recommendation in either direction.
- “Do I need treatment after surgery, and why?” The decision weighs grade, depth, LVSI, stage and molecular class together. Ask which of these is driving the recommendation in your case. See treatment after surgery.
- “Was my case discussed at a tumour board?” The recommendation should come from surgeons, radiation oncologists and medical oncologists together rather than from one specialty. It is a fair question and the answer should be yes.
- “What does my mismatch repair result mean for my relatives?” If deficient, ask what further testing is planned and whether a genetics referral is indicated. See Lynch syndrome.
Take someone with you, and ask for a copy of the report if you were not given one. You are entitled to it, and having it makes every subsequent conversation — including any second opinion — considerably easier.
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Reading the Report Without It Reading You
A few things worth holding on to while you go through it.
- No single line is your prognosis. The report is a set of measurements that only mean something in combination. Reading one line in isolation — and it is almost always the most frightening line — gives a distorted picture.
- Most endometrial cancer is found early. Because it announces itself through bleeding, the majority of cases are diagnosed while still confined to the uterus, where outcomes are good. See survival by stage.
- The report describes what was removed. For most women, what it describes is a tumour that is no longer in the body. That is an important thing to hold on to while reading alarming language about it.
- Terminology varies between laboratories. Two reports describing the same findings can read very differently. Do not compare your wording with someone else’s on a forum and infer anything from the difference.
- Searching individual phrases at night is punishing. Nearly every phrase on the report will return frightening results out of context. Write the phrase down and ask about it instead. See coping with a diagnosis.
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It is the document that determines your treatment. Fifteen minutes is not enough to go through it.
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Common questions
Your Pathology Report — Frequently Asked Questions
What does "positive" mean on my pathology report?
It means present, not good — the reverse of ordinary usage, and the commonest misreading of these documents. "Lymph nodes positive" means cancer was found in the lymph nodes. "Margins negative" or "margins free" is the reassuring result, because it means tumour did not reach the cut edge of the tissue removed. "LVSI positive" means lymphovascular space invasion was seen. If you are unsure which way round a particular line reads, ask — it is an entirely reasonable question and misreading it in either direction causes real harm, whether that is unnecessary fear or false reassurance.
What is LVSI and how worried should I be?
Lymphovascular space invasion means tumour cells were seen inside small lymphatic channels or blood vessels in the tissue around the tumour. It indicates the tumour has reached routes by which cells could travel elsewhere, and it is associated with a higher risk of lymph node involvement and of recurrence. Reports usually describe it as absent, focal or substantial, and the distinction matters — substantial LVSI carries considerably more weight than focal. It frequently influences whether radiotherapy is recommended. Importantly, it is not the same as an involved margin, which means tumour reached the cut edge of what was removed; the two are constantly confused.
My report says "invasion of less than half the myometrium". Is that bad?
It is the better of the two categories. Almost every endometrial cancer invades the muscle wall to some degree — that is precisely what distinguishes a cancer from a precancerous change — so the presence of invasion is expected and the depth is the information. Invasion of less than half the thickness of the muscle wall is associated with a lower risk of lymph node involvement and of recurrence than invasion beyond half. It is one of the strongest single predictors on the report and a major input into whether treatment after surgery is recommended, weighed alongside grade, LVSI, stage and molecular class.
My report does not mention MMR or p53. Should it?
Yes, and this is worth raising. FIGO 2023 incorporates molecular class into how stage is assigned, so a report without mismatch repair and p53 results has not fully staged the tumour. Mismatch repair testing serves two purposes — it contributes to molecular classification and it screens for Lynch syndrome, an inherited condition with implications for your relatives. POLE sequencing is less widely available and is the component most often absent. In almost every case this testing can be performed afterwards on the stored tissue block, and it is worth doing, because the result can change the treatment recommendation in either direction.
Why is my report after surgery different from my biopsy report?
Because they examine different amounts of tissue, and this is expected rather than an error. A biopsy takes a small piece of the lining; the hysterectomy specimen contains the entire tumour, the full thickness of the uterine wall, and any lymph nodes removed. Tumours are frequently not uniform, so areas the biopsy never reached become visible — which is why grade sometimes rises, and occasionally why the histological type is revised. The final report also adds information a biopsy simply cannot provide: depth of invasion, margins, node status. It is the definitive report, and the decision about treatment after surgery deliberately waits for it.
Medical disclaimer: This page provides general information to help you understand an endometrial cancer pathology report, reviewed by a CION oncologist. It is not a substitute for individual medical advice. Terminology varies between laboratories and no single finding should be interpreted in isolation. Your report should be explained to you by your treating team in the context of your complete clinical picture.