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How do you understand your pathology report? What is tumor grade, differentiation, mitotic index, and ki67? How do you get a second opinion on your pathology? NET expert and pathologist Dr. Sue Chang of City of Hope answers ten common questions about pathology for neuroendocrine tumors. Dr. Chang defines important keywords to help you understand your pathology report which is instrumental in guiding treatment decisions.



Sue Chang, M.D., is an assistant clinical professor and interim chief of the Division of Anatomic Pathology in the Department of Pathology.

Dr. Chang graduated cum laude from Harvard University in Cambridge, Massachusetts, and went on to receive her medical doctorate from New York Medical College in Valhalla, New York. Later, she completed an anatomical/clinical pathology residency at UCLA Health, where she was a chief resident and a resident informaticist. She furthered her training with a cytopathology fellowship at UCLA Health and a surgical pathology fellowship at Brigham and Women's Hospital in Boston.

Board certified in anatomic pathology, clinical pathology, cytopathology and clinical informatics, Dr. Chang is the recipient of many honors and awards. She has published several articles in the peer reviewed literature, and has been invited to present her work nationally. Dr. Chang's professional interests include thyroid pathology and pathology informatics. She is active in the College of American Pathologists, currently serving as the chair for the Professional and Community Engagement Committee. She has written several blog posts and participates in patient-facing informational panels, with the goal of increasing public awareness and knowledge of pathology reports and laboratory testing. In her free time, she enjoys collecting rare and vintage medical books, reading historical fiction, karaoke and home gardening.



1. How do I find and understand my pathology report? What should I pay attention to in my pathology report?

2. What type of staining should be done for NET tumors?

3. How does the tumor location play a role in what testing a pathologist might do?

4. What is tumor grade, why is it important, and how is that determined? How is grade different from stage?

5. What is ki67? How reliable is this?

6. What is mitosis or mitotic index?

7. What is differentiation and how do you decide this? Is it ever ambiguous? How are poorly differentiated tumors different from other tumors?

8. What do typical and atypical mean and when might we see this?

9. Can there be different grades within the same tumor or between multiple tumors? How do I understand a pathology report that showed mixed neuroendocrine neoplasms?

10. Should I get a second opinion with my pathology? If so, how is that done? Also, how long are pathology specimens typically stored?



"Your Pathologist & Your Pathology Report" with Dr. Chang and Dr. Li

Click here for another helpful resource on how to read your pathology report.



LACNETS Podcasts are created for educational purposes only and do not substitute for medical advice. The views shared in this Podcast are the personal opinions of the experts and do not necessarily reflect the views of LACNETS. Please contact your medical team with questions or concerns about your individual care or treatment.



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