Pathology
Shared oncology pathology concepts, reporting logic and molecular context.
Specimen & disease context
Attach every pathological observation to the specimen, anatomical site, procedure and treatment timepoint that generated it.
- Capture
- Specimen type, site, collection date, procedure, pre/post-treatment context, source report.
- Why it matters
- The same patient can have discordant findings across biopsy, resection, node and recurrence specimens.
Common trap
Do not treat a biomarker from one specimen or timepoint as automatically representative of every tumour site.
Histological type
Record the tumour entity using the applicable authoritative classification, keeping the reported wording and mapped concept separate.
- Capture
- Reported diagnosis, mapped entity, source classification/version, uncertainty.
- Why it matters
- Histological type can determine staging applicability, prognosis and downstream treatment pathways.
Common trap
Do not silently convert an older diagnostic label into a newer entity without traceable mapping.
Grade
Store grade as a versioned, tumour-specific observation rather than a universal ordinal.
- Capture
- Grading system, grade, method/context, source version.
- Why it matters
- Different tumour families use different grading systems and thresholds.
Common trap
A numeric grade is meaningless without the grading system and tumour context.
Margins
Represent each relevant margin independently, with distance and involvement when reported.
- Capture
- Named margin, involved/not involved/indeterminate, distance, invasive vs in-situ component, specimen orientation.
- Why it matters
- Margin findings link pathology directly to surgery and postoperative treatment decisions.
Common trap
“Negative margins” can hide clinically important differences in which margin, tumour component and measured distance.
LVI / LVSI
Capture the observed lymphovascular invasion finding first; tumour-specific rules decide how it is categorized or used.
- Capture
- Present/absent/indeterminate, focality or extent when the source system requires it, specimen and method.
- Why it matters
- LVI/LVSI can influence staging, risk grouping and adjuvant pathways.
Common trap
Do not impose one tumour system’s “focal/substantial” thresholds on another tumour type.
Extranodal extension (ENE)
Record ENE as a nodal pathological observation with method and certainty; staging consequences remain system-specific.
- Capture
- Present/absent/indeterminate, microscopic/macroscopic descriptor when applicable, node/site, source report.
- Why it matters
- ENE is important in several tumour families but is not interpreted identically everywhere.
Common trap
Do not infer ENE from nodal size or imaging appearance when the classification requires pathology.
Nodal tumour deposit burden
Preserve measured deposit size and, where relevant, cell burden before assigning ITC/micro/macro categories.
- Capture
- Node basin, deposit size, cell count if reported, number of involved/examined nodes, method.
- Why it matters
- Thresholds are classification-system dependent and may change with corrigenda or new editions.
Common trap
Store the raw measurement; do not keep only the derived category.
ER / PR
Capture receptor assay result with scoring method, specimen and interpretation rather than a bare positive/negative flag.
- Capture
- Assay, percent/score, interpretation, controls/quality if relevant, specimen.
- Why it matters
- Receptor status is central to breast tumour characterization and treatment pathways.
Common trap
A derived positive/negative label should not erase the underlying measured result or assay context.
HER2
Represent HER2 protein and/or amplification testing as structured evidence with assay-specific interpretation.
- Capture
- IHC score, ISH result when performed, assay, specimen, interpretation, equivocal/indeterminate state.
- Why it matters
- HER2 reporting evolves and may differ by tumour context.
Common trap
Do not reuse breast-specific interpretation rules automatically for another tumour family.
Mismatch repair / MSI
Keep the component test results and the derived MMR/MSI interpretation separately.
- Capture
- MLH1/PMS2/MSH2/MSH6 pattern, MSI result if tested, methylation context when relevant, method, specimen.
- Why it matters
- MMR status may contribute to diagnosis, molecular classification, hereditary assessment and treatment pathways.
Common trap
Loss patterns can require additional interpretation; do not collapse every abnormal result into the same biological conclusion.
p53 pattern
Store the observed assay pattern and the derived molecular-class interpretation separately.
- Capture
- IHC pattern, method, specimen, interpretation, uncertainty.
- Why it matters
- p53-abnormal status is integrated into contemporary endometrial classification/staging frameworks.
Common trap
An equivocal or technically inadequate stain is not the same as a normal pattern.
POLE
Capture the exact variant and pathogenicity assessment before deriving POLE-mutated molecular class.
- Capture
- Variant, transcript/reference sequence if available, pathogenicity class, assay, specimen.
- Why it matters
- Only qualifying pathogenic POLE alterations should drive the molecular classification logic.
Common trap
A variant of uncertain significance must not be treated as POLE-mutated for staging.
p16 / HPV-associated context
Capture p16 staining and HPV-specific evidence distinctly, then let the applicable tumour rules define how they are used.
- Capture
- Staining pattern, assay, HPV test if performed, primary site, specimen.
- Why it matters
- p16 can define staging applicability in selected oropharyngeal cancers but is not a universal HPV surrogate.
Common trap
Do not apply an oropharyngeal p16 staging rule to another primary site.