Histopathology: what it is, how tissue samples are examined and when you get results

The word comes from Greek roots for tissue, disease and study. The Whittington Health NHS Trust explains that, in clinical medicine, histopathology refers to the examination of a biopsy or surgical specimen by a pathologist, after the specimen has been processed and thin sections have been placed onto glass slides.

The National School of Healthcare Science describes it as the diagnosis and study of diseases of the tissues by examining tissues and cells under a microscope, which enables clinicians to see the likely course and outcome of a disease so that they can manage care. Harrogate and District adds that histopathologists examine the microscopic architecture of tissues and the relationship between the cells and tissue types within organs.

Histopathology is the study of tissue (a piece of an organ or a lump). It is separate from cytopathology, which examines individual cells, and from blood tests, which are done in other laboratory departments.

Tissue reaches the laboratory from your clinical team in a labelled container. The healthcare science school says staff receive, dissect and prepare tissues for examination. Samples are processed and cut into very thin slices that are mounted onto glass slides, which the pathologist then studies under a microscope.

Histopathologists use chemical stains, immunological procedures and, increasingly, molecular techniques to help distinguish healthy tissue from abnormal tissue, cells and infective agents. This is why some reports include additional tests that arrive a few days after the first slides are read.

The Whittington says its department includes biomedical scientists, medical laboratory assistants, clerical and administrative staff and consultant pathologists, and that the hospital work involves a mix of biopsy and larger resection specimens including cancer and non-cancer specimens.

The Royal College of Pathologists, the professional body for pathologists in the UK, hosts public information about what pathology is and the work pathologists do. The report is written by a doctor, the pathologist, and not by the scientific staff who prepare the slides.

The NHS says a biopsy is where a small sample of skin, tissue or cells is taken from your body for testing, including to look for cancer. It may be used to find out what is causing symptoms, as a follow-up to a blood test or scan, or to monitor a long-term condition. You are usually referred by a GP or consultant, and sometimes it is done as part of an endoscopy or operation.

A biopsy is usually done in hospital, often under local anaesthetic so you are awake but feel no pain, sometimes with sedation or under general anaesthetic. It can be done by cutting out all or part of an area, by using a needle, or by using an endoscope. Some take less than 30 minutes, others longer, and you can usually go home the same day.

The NHS calls a biopsy a common and very safe procedure. You may have some pain or discomfort, and it is sometimes possible to get an infection. Contact your healthcare team or NHS 111 if pain is not helped by painkillers or is getting worse, you have a high temperature, blood or fluid is oozing from the site, or the area is swollen or red.

The NHS says it can take a few weeks or more to get results after a biopsy, and that you may get them in a letter. Waiting times vary between hospitals and depend on why you needed the biopsy. If you do not hear anything after a few weeks, contact your healthcare team or GP surgery.

A doctor or nurse should talk to you about your results and explain what happens next, and you may need a follow-up appointment. Sometimes you may need another biopsy or other tests. The laboratory cannot give results to you directly, so ask the clinician who arranged the biopsy how and when they will contact you.

The Whittington notes that the specimens received include cancer and non-cancer specimens, so a report does not always mean cancer. The Royal College of Pathologists describes pathologists as the people who diagnose cancers and other serious illnesses, but they also often find good news, such as that a lump or mole is benign.

Reports are written in technical language for clinicians. If you receive a copy, ask your clinician to explain the key terms, what the sample shows and what it means for your treatment. Other pages on this site explain common biopsy wording and timelines.

On the NHS the histopathology service is provided by hospital laboratories, many of which also process samples from GP practices in their area. You do not choose the laboratory, and the service is part of your hospital care.

Private hospitals use their own or contracted laboratories. If you want a second opinion on a slide or report, ask your consultant to arrange a review through the multidisciplinary team or a request to another pathologist, since the original tissue stays with the laboratory that processed it.