The effects of implementing synoptic pathology reporting in cancer diagnosis: a systematic review

Abstract

Pathology reporting is evolving from a traditional narrative report to a more structured synoptic report. Narrative reporting can cause misinterpretation due to lack of information and structure. In this systematic review, we evaluate the impact of synoptic reporting on completeness of pathology reports and quality of pathology evaluation for solid tumours. Pubmed, Embase and Cochrane databases were systematically searched to identify studies describing the effect of synoptic reporting implementation on completeness of reporting and quality of pathology evaluation of solid malignant tumours. Thirty-three studies met the inclusion criteria. All studies, except one, reported an increased overall completeness of pathology reports after introduction of synoptic reporting (SR). Most frequently studied cancers were breast (n = 9) and colorectal cancer (n = 16). For breast cancer, narrative reports adequately described 'tumour type' and 'nodal status'. Synoptic reporting resulted in improved description of 'resection margins', 'DCIS size', 'location' and 'presence of calcifications'. For colorectal cancer, narrative reports adequately reported 'tumour type', 'invasion depth', 'lymph node counts' and 'nodal status'. Synoptic reporting resulted in increased reporting of 'circumferential margin', 'resection margin', 'perineural invasion' and 'lymphovascular invasion'. In addition, increased numbers of reported lymph nodes were found in synoptic reports. Narrative reports of other cancer types described the traditional parameters adequately, whereas for 'resection margins' and '(lympho)vascular/perineural invasion', implementation of synoptic reporting was necessary. Synoptic reporting results in improved reporting of clinical relevant data. Demonstration of clinical impact of this improved method of pathology reporting is required for successful introduction and implementation in daily pathology practice.

Keywords: Breast cancer; Checklist; Colorectal carcinoma; Completeness; Guideline; Narrative reporting; Pathology; Proforma; Quality; Synoptic reporting; Template.

Fig. 1

Flowchart of search strategy

Fig. 2

Impact of synoptic reporting on overall completeness of a pathology report. Fourteen studies [, –, , , , , , , , –47] reported the effect of synoptic reporting on the overall completeness of a Pathology report (definition 1). Thirteen studies showed an increased overall completeness, independent of cancer type or synoptic reporting level of the module. In contrast, only one article [33] described that the SR was less complete than the NR

Fig. 3

Impact of synoptic reporting on individual parameters in a colorectal specimen pathology report. a The effect of synoptic reporting on the proportion of pathology reports containing information on tumour type in colorectal cancers. b The effect of synoptic reporting on the proportion of pathology reports containing information on circumferential margin in rectal cancers. c The effect of synoptic reporting on the absolute mean number of lymph nodes resected per resection specimen. d The effect of synoptic reporting on the proportion of pathology reports reported 12 or more lymph nodes resected