“The Biopsy Was Clear”: When a Pathology Result Is Wrong or Not Followed Up
Missed and delayed diagnosis guides · 13 min read · Published 10 November 2026 · Reviewed 10 November 2026 · Next review May 2027
By Dr Rosemary Listing, PhD (Law) · Medical negligence lawyer since 2014 · Of Counsel, Peter Evans & Associates
Summary
A biopsy is often the test that decides whether you have cancer, and what treatment you need. Most results are accurate. But slides can be misread, samples mixed up, and abnormal results left sitting in an inbox. This guide is for people whose biopsy was reported as clear when it wasn’t, who had treatment they didn’t need, or whose result was never acted on. It explains how pathology works, where errors happen, and when they might point to care that fell short.
Quick answer · updated November 2026
Biopsy errors include a cancer being missed on the slide, a benign result being reported as cancer, mixed-up samples, and results that were correct but never followed up. The doctor who ordered the test is responsible for explaining it and recommending next steps. If you think something went wrong, ask for the pathology report, any review of the slides, and your doctor’s notes.
A biopsy result at a glance
- 1The biopsyTissue is taken and labelled.
- 2The labA pathologist examines it and writes a report.
- 3Your resultsThe doctor who ordered it should explain it and plan next steps.
- 4If it doesn’t fitA result that doesn’t match symptoms should be questioned.
- 5Second reviewSlides can be re-examined by another pathologist.
At any stage: new or worsening symptoms after a “clear” result should be checked again. Don’t let one result close the question.
I found a small mole on my calf that had changed. My GP took a biopsy, and a week later the clinic texted to say the result was normal, no follow-up needed.
I was relieved and forgot about it. It was summer. I was forty-five and busy.
Eighteen months later, a lump came up in my groin. The doctor who examined me went quiet, then very kind.
The lump was melanoma that had spread. The mole on my calf, the oncologist said, was where it had started.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If you trusted a biopsy result that turned out to be wrong, or learned that an abnormal result was never passed on, I want you to know that relying on it was entirely reasonable. That is what the test is for.
This guide covers how biopsies and pathology work, the different ways errors happen, what you can ask for, and how the law looks at a pathology error.
Why I can write this
I have been a medical negligence lawyer since 2014 and have worked on many hundreds of claims, including many involving missed and delayed diagnosis. My doctorate looked at patterns of failure in medical negligence. I am not medically qualified. The clinical facts in this article are checked against named sources, listed in the references, and I explain how I work in our editorial standards.
Start with your question
- What happens to a biopsy sample?
- What kinds of pathology errors happen?
- Who is responsible for following up a biopsy result?
- What if my result doesn’t match my symptoms?
- Can I get my biopsy slides reviewed?
- What if I had surgery I didn’t need?
- Could a pathology error be negligence?
How a biopsy is examined
A biopsy removes a small piece of tissue or some cells to be examined in a laboratory. A pathologist, a doctor trained in diagnosing disease from tissue, checks the sample. Results are usually ready within a few days.1
Definition
Histopathology is the examination of tissue under the microscope to diagnose disease.
In plain terms: a specialist doctor looking at thin slices of your tissue to see what it is.
In the laboratory
The tissue is processed into thin slices on glass slides, stained, and examined. The pathologist writes a report describing what they see and giving a diagnosis. For some cancers, the report also includes details that guide treatment, such as how deep the tumour goes or whether the edges are clear.
Where errors happen
- Before the lab: the wrong area is sampled, or the sample is mislabelled or lost. Many pathology errors occur before samples reach the lab.2
- In the lab: a cancer is missed on the slide (a false negative), something benign is called cancer (a false positive), or important details are wrong.
- After the lab: a correct, abnormal result is not seen, not acted on, or not passed on to you.
Australia has experience of large-scale pathology error. A 2012 study described a look-back in which independent pathologists reviewed more than 7,000 cases reported by one pathologist and found clinically significant errors in almost 3%.3
Getting your results
healthdirect says the doctor who ordered the test is the best person to interpret it, and that your doctor is responsible for explaining results and recommending next steps.2 A text message saying “normal” may be all you get, but you are entitled to the report itself.
Questions to ask about a biopsy result
- Can I have a copy of the pathology report?
- Was the whole lesion removed, and are the edges clear?
- Does this result fit with my symptoms and what you saw?
- Is any follow-up or repeat test needed?
When results aren’t followed up
Some of the most serious problems aren’t misread slides at all. They are correct reports showing something abnormal that sat in an inbox, were filed without being read, or were sent to a doctor who had moved on. Clinics are expected to have systems for tracking results and recalling patients.
When a result doesn’t fit
A biopsy result is one piece of evidence. If it says “benign” but the lump keeps growing, or symptoms continue, a doctor should question the result rather than rely on it. Our guide to getting a second opinion explains how.
Second review of slides
Slides and tissue blocks are kept by the laboratory, and they can be reviewed by another pathologist. If your diagnosis changes, or you are unsure about a result, your doctor can ask for a review. That review is often the clearest evidence of whether an error was made.
When the result was wrong the other way
A false positive can mean surgery, chemotherapy or radiotherapy that wasn’t needed, with its own lasting effects. If later testing shows you never had cancer, ask how the original diagnosis was made.
See also our guides to late bowel cancer diagnosis and failed diagnosis.
When the new pathologist reviewed the original slides from my calf, she found melanoma cells at one edge that had been missed. The original report said “benign naevus”.
I needed surgery on my groin and immunotherapy. It has worked so far. The scans are clear for now.
What I keep coming back to is the text: “normal, no follow-up needed”. Nobody gave me the report. If it had said anything about the edges, I would have asked.
My daughter sat beside me while I read the review report on the couch. She read it twice and said, “So it was there.” I said yes. It was there the whole time.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What to look for in the records
Your records are often where the story becomes clear. You have a right to access your own health information. In NSW the Health Records and Information Privacy Act 2002 covers both public and private providers, and the Information and Privacy Commission explains how to ask.4 Our step-by-step guide to getting your medical records in Australia walks you through it.
| Record | Why it matters |
|---|---|
| Biopsy request form | Shows what the doctor asked the lab to look for, and the clinical information given. |
| Pathology report | Shows the diagnosis and details reported. |
| Slide review report | Shows whether another pathologist agreed with the original. |
| Clinic results log | Shows when the result arrived, who saw it, and what action was taken. |
| Messages and letters to you | Show what you were told. |
| Later diagnosis records | Show what was found and the stage of disease. |
| Your own diary, photos and messages | Notes made at the time are evidence too. Keep them. |
How the law looks at it
A pathology result that turns out to be wrong is not automatically negligence. Some cancers are genuinely hard to see, and pathologists can reasonably disagree on borderline cases. The legal questions are whether the pathologist, the laboratory and the treating doctor met the standard expected, and whether any shortfall caused harm.
A claim usually turns on three questions: whether the care fell below what peers would widely accept as competent practice (section 5O of the Civil Liability Act 2002 (NSW))5, whether that shortfall probably caused harm you wouldn't otherwise have had (Tabet v Gett)6, and, where it matters, whether you were told the material risks first (Rogers v Whitaker)78. Our guide to how a medical negligence claim works explains each one in plain terms.
In a pathology case, the questions might be: was the sample taken from the right place and labelled correctly? Would a competent pathologist have seen the abnormality? Was clinical information given to the lab? Was the result received, read and acted on? Were you told the result and what it meant? Did anyone question a result that didn’t fit?
In plain terms, the question is whether an accurate, followed-up result would probably have led to earlier treatment and a better outcome, or avoided treatment you didn’t need.
For a biopsy, the relevant information is usually about what the result means and what follow-up is needed.
Who can claim, and when
The patient can claim. If they have died, their family may have a claim. In NSW, time usually runs from when you knew, or ought to have known, enough to claim, not from the treatment itself, and courts can sometimes extend it, so an old injury may still count. See time limits in NSW or other states, and ask early.
More: complaint or claim? · how a claim is paid for · what a claim can cover
In my practice
In pathology files, the slides are often the key. A review by an independent pathologist can show clearly whether something was there to be seen. Just as often, though, the report was right and the problem was what happened next: an abnormal result filed without action, or a “normal” text that left out the important detail. Following the result from lab to patient usually shows where it went wrong.
Both things can be true
The pathologist and your doctor may have been careful and competent, and an error may still have happened. You can trust the system in general and still want to know what went wrong in your case.
The bigger picture
Pathology laboratories in Australia are accredited, and large-scale errors have led to formal look-backs.3 Complaints about care in NSW can go to the Health Care Complaints Commission,9 and you can check a practitioner’s registration on the Ahpra public register.10 Our guide to getting your medical records explains how to ask for reports.
Our missed and delayed diagnosis page brings together related guides.
Support
You don't have to work through this alone. These services can help:
- Lifeline, 24-hour crisis support: 13 11 14 (listed on healthdirect's helplines page)11
- Beyond Blue, anxiety and depression support: 1300 22 4636
- Medicare Mental Health, help finding mental health support: 1800 595 212
- healthdirect, 24-hour nurse advice: 1800 022 222
- Health Care Complaints Commission (NSW): 1800 043 159
A woman who was told “normal, no follow-up needed” now knows what the slides really showed. You deserve that truth too.
With care,
Rosemary
Frequently asked questions
Can a biopsy miss cancer?
Yes. Cancer can be missed if the wrong area is sampled or an abnormality isn’t recognised on the slide.
Who is responsible for following up a biopsy result?
The doctor who ordered the test is responsible for explaining it and recommending next steps.
Can I get a copy of my pathology report?
Yes. Ask the doctor who ordered the test or the laboratory.
Can my biopsy slides be reviewed?
Yes. Laboratories keep slides and tissue, and another pathologist can review them.
What if I had surgery I didn’t need?
Ask how the original diagnosis was made, and whether the slides have been reviewed.
Can I claim for a pathology error?
You may well have a claim if the error fell below the accepted standard and caused harm.
Questions about a biopsy result?
When you're ready, and not before, I can look at what happened and help you understand your options.
Missed and delayed diagnosis guides
- “The biopsy was clear”: When a pathology result is wrong or not followed up (you are here)
- “They said it was a pulled muscle”: Missed blood clots (DVT and PE)
- Failed diagnosis: when a missed diagnosis causes harm
- Cauda equina misdiagnosis: when back pain red flags are missed
- Misdiagnosed UTI: when a delayed diagnosis leads to kidney damage
- Sepsis and leg removal: when is that medical negligence?
Part of our guide to missed and delayed diagnosis. Not sure where you stand? Try the free claim checker.
References
- healthdirect. Biopsy.
- healthdirect. Understanding pathology tests.
- Aldrich R, Finlayson P, Hill K, Sullivan M, et al. Look back and talk openly: responding to and communicating about the risk of large-scale error in pathology diagnoses. International Journal for Quality in Health Care. 2012;24(2):135–43. Summary via AHRQ PSNet.
- Information and Privacy Commission NSW. Fact sheet: Accessing your health information in NSW.
- Civil Liability Act 2002 (NSW) s 5O, Standard of care for professionals.
- Tabet v Gett [2010] HCA 12.
- Rogers v Whitaker [1992] HCA 58; (1992) 175 CLR 479.
- Australian Commission on Safety and Quality in Health Care. Informed consent.
- Health Care Complaints Commission NSW. Home page.
- Australian Health Practitioner Regulation Agency. Register of practitioners.
- healthdirect Australia. Mental health helplines.
Stories in this article are composites, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. They do not describe any individual client.
Dr Rosemary Listing, PhD (Law), Medical negligence lawyer since 2014 · Of Counsel, Peter Evans & Associates. Rosemary's doctorate examined patterns of failure in medical negligence, and she teaches health law at the University of Newcastle. She is not medically qualified. About Rosemary.
Last updated: 10 November 2026 · First published: 10 November 2026 · Next review: May 2027
Cite this article: Listing R. “The biopsy was clear”: When a pathology result is wrong or not followed up. Reframe Legal. Published 10 November 2026. https://reframelegal.com/biopsy-pathology-error/
This article is general information, not legal or medical advice. It does not create a lawyer–client relationship. Speak to your treating clinicians about your health, and get legal advice about your own situation.
If you are in danger or need urgent medical help, call 000. For crisis support, call Lifeline on 13 11 14.
Legal services are provided by Peter Evans & Associates.