Differential Diagnosis of a False Negative Biopsy of a Tumor

The biopsy was technically inadequate (no tissue, only blood, etc).

Repeat biopsy. Consider repeat biopsy from an alternative site.

The biopsy was adequate but mishandled (lost, poorly processed, poorly sectioned, specimens switched).

Evaluate specimen to see if tissue can be salvaged. Consider repeat biopsy. Consider testing to confirm patient as source.

Tumor is not present in the bopsy material taken.

Repeat biopsy. Consider repeat biopsy from an alternative site.

Tumor present in biopsy material but too small or distorted to be recognized (below the analytical limit of detection).

Cut serial sections to see if more tumor present. Consider special stains to highlight tumor cells. Consider rebiopsy.

Tumor present in biopsy material but sections taken not deep enough to show.

Cut serial sections.

Tumor in sections taken but tissue fragmented and the specific piece was not examined.

Carefully examine each and every piece in every level. Have second pathologist review case.

Tumor seen in section but misinterpreted as benign.

Training to recognize tumor histology. Have a second pathologist review case.