Synoptic Pathology Reports for Standardized Reporting of Commonly Biopsied or Surgically Resected Neoplasms

Abstract

The explosion of information and technology in medicine is changing the role of pathology and pathologists in patient care. Clinical pathology has kept pace with the rapidly changing medical environment, offering reliable, standardized, and timely results in simplified formats, using the available instrumentation and computer technology to maximum advantage, aided by an excellent Quality Assurance Program developed by the American Society of Clinical Pathologists (ASCP) and the College of American Pathologists (CAP).Anatomic pathology has become the focus of attention, as there is an urgent need to simplify and standardize all the pertinent information in a timely manner for the following reasons:

• 1 Many morphologic parameters such as type, grade, and extent of tumor, involvement of margins and lymphatic/vascular invasion have been investigated by cooperative clinical trials involving large number of patients, confirming them to be of clinical significance in predicting outcome.

• 2 A host of biologic tumor markers are available for fluid and tissue specimen testing. Attempts to characterize their predictive value should be correlated with morphologic parameters. In addition, markers of established clinical significance will need to become a part of routine histopathologic evaluation.

• 3 Diagnostic techniques, such as cytogenetics, flow cytometry, and polymerase chain reaction are being used more frequently as aids to tissue diagnosis. This information must be incorporated in the surgical pathology report.

• 4 Surgeons have a difficult time interpreting surgical pathology reports. In a recent study by Powsner et al. [1], the authors showed that surgeons misunderstood pathology reports 30% of the time. The authors attributed this to a communication gap and lack of familiarity with reporting formats. Standardized reports clearly could contribute to reducing the misunderstandings that clinicians have concerning pathology reports and, it is hoped, reduce medical errors.

• 5 It is important to understand that all information, even that which at present is seemingly of limited significance, may be important in the future and should be recorded. This would facilitate meaningful clinical research in future, dealing with large patient populations.

• 6 All data should be available in a format easily adaptable to various current computer information systems. This is a particularly important aspect, as we have supported the goal of having a national pathology cancer database that every potential researcher can tap into. In fact, the National Cancer Institute (NCI) has now funded our institution along with Harvard, the University of California at Los Angeles, and Indianapolis to develop a “Shared Pathology Informatics Network” (SPIN) [2] with this goal at the core of the program. If successful, SPIN will allow researchers interested in anatomic pathology specimens to use a browser to anonymously search for case material from the participating institutions. This is now a reasonable (and laudable) goal with the widespread use and availability of the Internet.