Immunohistochemistry testing (IHC)
This guide explains immunohistochemistry — a laboratory test that uses special stains on a tissue sample to identify cells more precisely — and what it adds to a pathology report.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Immunohistochemistry uses special stains on a tissue sample to show which cell markers are present, helping identify cells more precisely.
- It is done on a sample already taken, and is read by a pathologist alongside the rest of the report — not as a stand-alone test.
- It can help classify a tumour, find where a cancer started, and identify features that guide treatment, such as hormone-receptor or HER2 status.
- Results can sometimes be borderline or need confirming with further tests, and complex cases may be reviewed by more than one specialist.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Makes a diagnosis more precise when the standard microscope view is not enough.
Immunohistochemistry cannot help if there is too little tissue for the markers needed.
The pathologist orders the stains on tissue already in the laboratory. Nothing further is needed from you.
A clear explanation of which markers were tested and what they mean for you.
The pathologist orders the stains on tissue already in the laboratory. Nothing further is needed from you.
The laboratory prepares and develops the stains, which usually adds a day or more to the report.
The marker results are interpreted alongside the rest of the sample and your clinical details to refine the...
The findings, including IHC, are usually discussed by a multidisciplinary team before the diagnosis and plan are...
What is immunohistochemistry testing?
Immunohistochemistry (IHC) is an extra laboratory test that a pathologist uses on a tissue sample to identify cells more precisely. It uses special antibodies that stick to particular proteins (markers) in the cells, with a colour added so the pathologist can see, under the microscope, which markers are present.
You do not have anything extra done to you for this. It is done on a sample that has already been taken — for example a biopsy, a removed lump or a piece of tissue from an operation. This guide is about what this test adds to your pathology report.
IHC helps answer questions the ordinary microscope view cannot fully settle: what type a cell or tumour is, where a cancer started if it has spread, and whether certain features are present that affect treatment (for example hormone-receptor or HER2 status in breast cancer). It is usually one important part of a fuller assessment, not a stand-alone test.
IHC is interpreted by a pathologist alongside the rest of the sample and your clinical picture. It often makes a diagnosis more precise, but results can sometimes be borderline or need confirming with further tests, and complex cases may be reviewed by more than one specialist.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Classifying a tumour
A panel of markers helps tell apart different cancer types, or cancer from non-cancer, when the microscope view alone is not enough — for example in lymphoma or...
Finding where a cancer started
When a cancer has spread and the primary site is unclear, IHC markers can point to the likely tissue of origin, which helps plan treatment.
Treatment-relevant markers
Some markers directly affect treatment choices, such as oestrogen and progesterone receptors and HER2 in breast cancer, which influence whether hormone or targeted treatments...
Prognostic and behaviour markers
Some markers, such as a measure of how fast cells are dividing, give a sense of how a tumour may behave. They are interpreted with caution and alongside other findings.
Preparing for your test
- There is nothing extra to prepare — IHC is done on a sample that has already been taken.
- Ask whether immunohistochemistry is being done on your sample and what it is looking for.
- Note that IHC can add time to your pathology report, as the stains take time to run.
- Find out who will explain the results and how they fit with the rest of the report.
- Bring any previous pathology results to your follow-up, as comparing markers can be useful.
- Write down your questions in advance so you can discuss what the markers mean for you.
What happens
When a pathologist needs more information than the standard stained slide gives, they request immunohistochemistry on the tissue that has already been collected.
In the laboratory, thin sections of the tissue are treated with specific antibodies. Each antibody sticks to its target marker if it is present, and a colour is developed so it shows up under the microscope. The pathologist then examines the stained sections to see which markers are present, how strongly, and in which cells.
These results are combined with the rest of the sample and your clinical details to give a more precise diagnosis. For cancer and complex cases, the findings are usually discussed by a multidisciplinary team, and the result is explained to you by your specialist.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Immunohistochemistry cannot help if there is too little tissue for the markers needed.
- It is not a stand-alone diagnosis; it must be interpreted with the rest of the sample and your clinical picture.
- It does not replace molecular or genetic tests when those are the right confirmatory test.
- It cannot answer questions about tissue that was not sampled.
Delay or rearrange if…
- The available tissue is insufficient and a further sample is needed.
- A marker result is borderline and a confirmatory test is pending.
- The case is awaiting discussion at a multidisciplinary team meeting.
- Key clinical details needed to interpret the markers are missing.
Alternatives to discuss
- The standard microscope examination alone, where it already gives a clear answer.
- Molecular or genetic tests when these are the more appropriate confirmatory test.
- A repeat or larger sample if there is not enough tissue for the markers needed.
- Specialist centre review when a case is complex.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Makes a diagnosis more precise when the standard microscope view is not enough.
- Helps tell apart different types of cancer, and cancer from non-cancer.
- Can point to where a cancer started when it has spread.
- Identifies markers that guide treatment, such as hormone-receptor or HER2 status.
- Adds objective information to the pathologist's assessment.
- Supports the team in choosing the most suitable treatment.
Risks & complications
- Running the stains adds time to the pathology report.
- Results are interpreted alongside everything else, so IHC alone rarely gives the whole answer.
- A marker result can be borderline and need careful interpretation.
- Waiting for a fuller report that includes IHC can be stressful.
- A result may need confirming with a separate test, such as a molecular test, before it changes treatment.
- The available tissue may be too small for all the markers the pathologist would like to test.
- A repeat or further sample may be needed if the markers do not give a clear answer.
- Staining can occasionally be difficult to interpret or give an unexpected pattern, which is why expert review and second opinions are used.
- Technical issues with a stain can mean it has to be repeated, extending the wait.
Immunohistochemistry is powerful but not infallible: results are interpreted by a pathologist and can sometimes be borderline, depend on the amount of tissue available, or need confirming with another test before they change treatment. Ask your specialist what the markers showed, how confident the result is, and whether any finding needs a confirmatory test or affects your treatment options.
Published figures to discuss
How useful immunohistochemistry is, and how often a result is borderline or needs a confirmatory test, depends on the marker, the amount and quality of tissue, and the question being asked. Some markers are clear-cut while others need careful, expert interpretation. Because comparable figures vary so much, we describe these realities in words rather than quoting precise percentages, and any figure should come from your own service.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| IHC result not diagnostic alone | Core limitation | Staining patterns must be interpreted with morphology, clinical history and other tests. | Guide sourcesClinical context |
| Insufficient tissue for all stains | Common with small biopsies | Pathologists may need to prioritise the most important stains or request more tissue. | Guide sourcesClinical context |
| False positive or false negative stain | Recognised technical limitation | Controls, staining quality and tumour heterogeneity affect interpretation. | Guide sourcesClinical context |
| Treatment biomarker result changes management | Cancer-dependent | ER, PR, HER2, MMR and PD-L1-style tests may influence treatment eligibility. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery, because immunohistochemistry is a laboratory test done on a sample that has already been taken. The main thing afterwards is waiting for the fuller report that includes the marker results and understanding what they mean.
- Waiting a little longer for the full report because the stains take time to run.
- Hearing about your diagnosis in stages as more results come together.
- Being told a marker result is borderline and needs careful interpretation.
- Being asked for a confirmatory test if a key marker affects treatment.
Aftercare
- Ask whether IHC was done and what the markers showed.
- Ask how the marker results affect your diagnosis and any treatment choices.
- If a result is borderline, ask whether a confirmatory test is needed.
- Keep a copy of the full report, including the marker results, for future appointments.
- Ask who your point of contact is if you have questions while you wait.
- If a serious diagnosis is given, ask about support and a named contact.
- Tell future clinicians about your marker results, as they can guide later treatment.
- Asked whether IHC is being done on your sample
- Noted what the markers are looking for
- Recorded who will explain the full report
- Gathered any previous pathology results
- Listed your questions in advance
- Saved a contact number for questions while you wait
⚠ Get urgent help if…
- Any urgent symptoms from the condition being investigated, as advised by your team
- Worsening of the symptoms that led to your biopsy
- Signs of infection or bleeding at a recent biopsy or operation site
- Feeling very unwell while waiting for results
- New or rapidly changing lumps or symptoms
- Feeling unable to cope while waiting for results — ask your team for support
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result clearly states which markers were present and how this refines the diagnosis — for example confirming a tumour type, suggesting where a cancer started, or reporting treatment-relevant markers such as hormone-receptor or HER2 status. These results are interpreted by the pathologist alongside the rest of the sample.
Immunohistochemistry on its own does not usually give a complete diagnosis or predict the future; it is one part of the picture, sometimes needing a confirmatory test, and is brought together with other findings by the team. Your specialist should explain what the markers mean for your diagnosis and treatment, and what any borderline result implies.
Marker results describe the tissue at the time it was tested and remain part of your medical record. Some markers, such as hormone-receptor or HER2 status, can guide treatment well beyond the time of the test. Occasionally markers are re-tested on a new sample if a cancer changes or returns, because they can sometimes differ over time.
Related tests, treatments or support
Immunohistochemistry is combined with the standard microscope examination and, where needed, molecular or genetic tests that confirm or extend its findings. It is read alongside your clinical details, blood tests and scans. For cancer and complex cases, the results are brought together by a multidisciplinary team to agree the diagnosis and plan.
Follow-up & long-term care
IHC results are reported as part of your pathology report and explained by your specialist, usually after any multidisciplinary team discussion. If a marker affects treatment, your specialist will explain the options. A named contact and support should be available if a serious diagnosis is made, and confirmatory tests are arranged where needed.
- Keep a copy of your marker results, as they can guide later treatment decisions.
- Tell new clinicians about previous marker results, especially for cancer.
- Attend any confirmatory or repeat tests arranged after a borderline result.
- Ask whether markers should be re-tested if a cancer returns or changes.
Repeat, follow-on and what comes next
- A borderline marker result may need a confirmatory test before it changes treatment.
- A stain may be repeated for technical reasons, or further markers added, extending the report.
- Markers are occasionally re-tested on a new sample if a cancer returns or changes over time.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear explanation of which markers were tested and what they mean for you.
- A plan for any confirmatory test when a result is borderline.
- Discussion of complex cases at an MDT, with specialist review where needed.
- A named contact and support if a serious diagnosis is made.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- How many markers (stains) the pathologist needs to run.
- Whether any findings need confirming with molecular or genetic tests.
- Whether specialist review or a second opinion is required.
- Whether the case is discussed at a multidisciplinary team meeting.
- Reporting speed, including any request for urgent reporting.
- The follow-up consultation to explain the markers and plan.
- The laboratory fee for the immunohistochemistry stains.
- Any extra charges for confirmatory molecular or genetic tests.
- Whether specialist review, a second opinion or MDT discussion is included if needed.
- The consultation fee to explain the results and agree a plan.
- What happens, and who pays, if a further sample or test is needed.
- How and when the full report will be shared with you and your GP.
On the NHS? Immunohistochemistry is a routine part of NHS diagnosis when clinically indicated; private pathways may be faster to access, but complex cases should still be discussed by a multidisciplinary team.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Treating a single marker result as the whole diagnosis rather than one part of it.
- Not being told that a borderline result may need a confirmatory test.
- Expecting an immediate answer when the stains and interpretation take time.
- Not knowing that expert review and second opinions are a normal part of careful practice.
Marketing red flags
- Promising that a panel of stains gives a complete, certain diagnosis on its own.
- Implying a private report avoids the need for confirmatory tests or an MDT.
- Offering large marker panels without a clear clinical reason.
- Suggesting markers can predict outcomes with certainty.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Was immunohistochemistry done on my sample, and what was it looking for?
- What did the markers show, and how does that change my diagnosis?
- Do any markers affect my treatment options?
- Is any result borderline, and does it need a confirmatory test?
- Was there enough tissue for all the markers you wanted to test?
- Will my case be discussed by a multidisciplinary team?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
What is immunohistochemistry for?
Do I need another biopsy for this test?
Why does it make my results take longer?
What does it mean if a marker is 'positive' or 'negative'?
Can a marker result change my treatment?
Is this available on the NHS or only privately?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Cancer Research UK — Biopsy NHS — Non-Hodgkin lymphoma: tests and next steps Royal College of Pathologists — What is pathology? Immunohistochemistry as a diagnostic tool in pathology (PMC) Cleveland Clinic — Immunohistochemistry (patient information)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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