Imaging and pathology results: questions for productive follow-up discussions

There’s a particular quiet that follows a new result in my patient portal. The page loads, a few unfamiliar terms appear, and my brain starts filling the gaps with guesses. I’ve learned that the quickest way to turn that anxious silence into clarity is to prepare good questions—practical, respectful, and focused on what to do next. This post is the list I wish I’d had sooner, shaped by many conversations and a lot of reading, and written in the spirit of a personal journal rather than a rulebook.

What I look for the moment a report appears

When imaging or pathology results land, I try not to jump to the scariest word. I start with three anchors: what question the test was meant to answer, how confident the result seems, and what the recommended next step is. That simple sequence pulls me out of the fog. It also makes follow-up visits less rushed because I’m already oriented to the report’s structure. For imaging, I look for the Impression section—it’s the radiologist’s bottom line. For pathology, I scan for the Diagnosis line and any comment about margins, grade, or biomarkers. If I can’t find those, I flag it for my follow-up list and plan to ask the clinician to walk me through it. See the patient-friendly overview of radiology reports from RSNA’s site here, and a clear explainer on pathology reports from the American Cancer Society here.

  • High-value takeaway I’ve learned: always connect the result to the original clinical question. A “negative” scan that didn’t target your symptoms isn’t fully reassuring, and an “abnormal” finding that’s unrelated to your concern may not be urgent.
  • Check for action verbs. Words like “recommend,” “correlate,” or “follow-up in X months” usually live in the impression or comments and point to the next chapter.
  • Remember individual differences. Reports are summaries of probabilities, not guarantees. What matters is how the finding fits you—your history, exam, and risks.

Questions that turn worry into a plan

I keep a short script in my notes app. It’s not fancy, just the questions that unlock the highest yield conversation in the shortest time. AHRQ has a great “Questions to Ask” toolkit that inspired parts of this list, which you can find here.

  • What question was this test designed to answer and did it clearly answer it?
  • How confident is this result in my situation? (Ask in plain terms: “highly likely,” “uncertain,” or “unlikely.”)
  • What are the recommended next steps and what’s the goal of each step—clarify, stage, treat, or watch?
  • What is the timeframe where acting (or waiting) changes outcomes?
  • Are there alternatives if I’d prefer fewer needles, less radiation, or lower cost?
  • What could make this result misleading—sample issues, motion on imaging, timing relative to symptoms?
  • How will we close the loop? Who will call about the next appointment or portal message, and when?

Imaging reports decoded without the jargon chase

Radiology reports often follow a rhythm: Clinical indication (why the test was ordered), Technique (how it was done, including whether contrast was used), Findings (objective observations), and Impression (the summary and recommendations). RSNA’s patient page breaks this down clearly here. I pay special attention to the Impression because it translates findings into a decision tree. If the report mentions a grading system—like BI-RADS for breast imaging, PI-RADS for prostate, or Lung-RADS for CT lung screening—that number is a shorthand for the likelihood of cancer and the advised next step.

  • Contrast matters. Ask why it was or wasn’t used and whether a contrast-enhanced study would change the answer.
  • Radiation dose context. CT scans use ionizing radiation; MRI and ultrasound do not. If a follow-up CT is advised, ask whether low-dose protocols or an alternative modality would be reasonable in your case.
  • Incidental findings are common. Many are benign and predictable—your clinician can help triage which ones need attention now versus routine monitoring.

One practical tip: request your images and the report on a digital file (DICOM) if you anticipate seeing a specialist. Bringing prior images can prevent repeat scans and make comparisons more reliable. Many radiology departments can provide a secure link upon request.

Pathology reports translated into next steps

Pathology is the discipline of turning tissue or cell samples into a diagnosis. The report usually names the specimen source (e.g., “left breast core biopsy”), the diagnosis (e.g., benign, atypia, carcinoma), and sometimes grade or stage-related features. It may also include biomarker testing—for example, ER/PR/HER2 in breast cancer, or PD-L1 and mutation panels in lung cancer. The American Cancer Society offers a plain-language series on reading pathology reports across many cancers here, and the National Cancer Institute explains tumor biomarker testing and when it guides treatment here.

  • Sample adequacy. Was there enough tissue? If the report says “limited sample” or “nondiagnostic,” that’s a cue to ask about repeat sampling or a different approach.
  • Margins and grade. For excisions, “negative margins” means no tumor seen at the edge of the removed tissue. Grade speaks to how aggressive cells look under the microscope.
  • Special stains and molecular testing. Sometimes the answer depends on immunohistochemistry or DNA/RNA testing. Ask if additional stains or tests are pending and how the result might change management.

If you’re staring at terms like “atypia,” “in situ,” or “indeterminate,” it helps to remember pathology has a careful vocabulary that avoids overpromising. “Atypia” can be a warning sign but isn’t synonymous with cancer; “in situ” often means very early, noninvasive disease. If a result is “suspicious for” a diagnosis, that usually means the features lean a certain way but more tissue or a different sampling technique is needed. MedlinePlus has a straightforward overview of what a biopsy is and how results are used here.

Simple frameworks that keep me from spinning out

I try to sort any result into these steps before I message or book a visit:

  • Step 1 Notice What problem were we trying to solve, and does the Impression or Diagnosis address it directly?
  • Step 2 Compare What are the reasonable alternate explanations, and how would they change the next step? (For example, infection versus tumor, scar tissue versus recurrence.)
  • Step 3 Confirm What verification would meaningfully change the plan—repeat imaging, a different modality, a second pathology review, or waiting and rechecking?

It helps to ask about probabilities in relatable terms. “If 100 people with this result were like me, how many would actually have the condition?” Clinicians often appreciate this because it aligns with how tests are validated—sensitivity, specificity, and predictive values, which depend on pretest probability.

Little habits that make follow-ups smoother

I used to show up with vague questions and leave overwhelmed. Now I keep small, repeatable habits:

  • A one-page summary with dates of tests, who ordered them, and the Impression or Diagnosis in a few words.
  • Portal housekeeping turning on notifications and starring messages with action items so nothing slips.
  • Shared vocabulary writing down the exact phrases from the report (“BIRADS 3,” “nondiagnostic,” “recommend MRI in 6 months”) so I can ask about that wording specifically.
  • Ask for a plain-language summary at the end of the visit and repeat it back to check I heard it right.
  • Use a trusted checklist like the AHRQ “Questions to Ask” cards to cover basics if my mind goes blank in the room. The resource is here.

Signals that tell me to slow down and double-check

Not every finding is urgent. But some patterns deserve prompt clarification—the goal is to be prudent, not alarmed:

  • Time-sensitive recommendations like “urgent” or “within two weeks.” I ask the clinic to help schedule those before I leave.
  • Mismatch between symptoms and imaging If pain, fever, or new deficits are escalating despite a “normal” scan, that’s a reason to reassess. Tests have blind spots.
  • Ambiguous pathology terms such as “nondiagnostic,” “atypia of undetermined significance,” or “suspicious for.” I ask whether a repeat sample, a different technique, or a second opinion would add clarity.
  • Incidental but concerning findings aneurysm, mass, or significant narrowing noted in passing. I confirm the plan and reasonable timeframe.
  • Communication gaps multiple specialists involved with no clear “captain.” I ask who is coordinating and how they’re sharing the report.

On the flip side, many results are designed for watchful waiting. Breast imaging BI-RADS 3, for example, often leads to short-interval follow-up because the chance of cancer is low. Understanding that these categories are built to balance safety and overtesting helps me accept planned monitoring without feeling neglected.

Cost, access, and comfort are part of medical quality

It took me a while to say this out loud in visits: cost and comfort matter. If I need follow-up imaging, I ask whether a different modality could answer the question (for example, ultrasound or MRI instead of CT when appropriate). If I’m claustrophobic, I ask about open MRI options, music, or mild anxiolytics. If contrast is recommended, I ask why it adds value and how kidney function and allergies are considered. These aren’t side issues—they shape whether I can actually complete the plan.

When to consider a second opinion without burning bridges

Second opinions are normal in complex diagnoses. For imaging, that might mean having a subspecialty radiologist re-read the study. For pathology, it can mean sending slides or blocks to a reference lab. I’ve found that framing it as “I want to be sure we’re seeing this clearly before I commit to a plan” keeps the conversation collaborative. The National Cancer Institute’s page on biomarker and molecular testing here also explains when specialized tests add meaningful information—sometimes the second opinion is not a new person, but a deeper test on the same sample.

A plain-English glossary I keep handy

  • Impression The radiologist’s summary and next steps; usually the most important section to read.
  • Indeterminate The features don’t clearly point one way; more information is needed (another test, time, or tissue).
  • Benign versus malignant Benign means noncancerous; malignant indicates cancer, but grade and stage still matter.
  • Margins Whether removed tissue has healthy edges; “negative” or “clear” margins are generally good news.
  • Grade How abnormal cells look; higher grade often behaves more aggressively.
  • Stage How far a cancer has spread; staging guides treatment and prognosis.
  • Biomarker A measurable feature (protein, gene, etc.) that can guide therapy choices; see NCI’s overview here.

What I’m keeping and what I’m letting go

I’m keeping the habit of starting with the clinical question, reading the Impression or Diagnosis out loud, and asking for the one-line plan. I’m keeping a respectful curiosity about why a follow-up test is the right next move and how it will change decisions. And I’m keeping a simple file of prior reports and images to avoid do-overs.

I’m letting go of the impulse to read every adjective as a verdict. I’m letting go of the idea that uncertainty means failure; often it means biology is subtle and we’re being careful. And I’m letting go of silent confusion during visits—if the plan isn’t clear to me, it won’t be clear at home either.

FAQ

1) My imaging report says “indeterminate.” Does that mean something was missed?
Answer: Not necessarily. “Indeterminate” means the features don’t strongly support one explanation yet. The next step might be a different imaging modality, a short-interval follow-up, or correlation with labs and exam. Ask how the suggested step will sharpen the picture.

2) The pathology report mentions “atypia.” Is that cancer?
Answer: Atypia means cells look unusual, but it is not the same as cancer. Depending on location and context, your team may recommend closer surveillance, additional sampling, or removal. The American Cancer Society’s guides for specific organs are helpful for context.

3) I’m worried about radiation from CT. Can I ask for MRI or ultrasound instead?
Answer: Absolutely ask. Some questions need CT because of speed or detail; others can be answered by MRI or ultrasound. Your clinician can weigh image quality, timing, cost, and your unique risks. RSNA’s patient resources explain modality trade-offs in plain language.

4) My report mentions biomarker testing. Do I need that now?
Answer: It depends on the diagnosis. Biomarker tests can guide targeted therapy but aren’t useful for every condition. The National Cancer Institute has a concise overview of when they matter and how results affect decisions. Clarify whether testing now would change your immediate plan.

5) Should I get a second opinion on the pathology?
Answer: It’s reasonable for complex or rare diagnoses, or when the plan is high-stakes. Many centers welcome outside reviews. Ask how slides can be shared and whether your insurance covers it.

Sources & References

This blog is a personal journal and for general information only. It is not a substitute for professional medical advice, diagnosis, or treatment, and it does not create a doctor–patient relationship. Always seek the advice of a licensed clinician for questions about your health. If you may be experiencing an emergency, call your local emergency number immediately (e.g., 911 [US], 119).