Complete Pathology Reports and Clinical Decision Making

Pathology reports provide care teams with crucial diagnostic and prognostic data. For population-level research and quality assurance initiatives, it’s important that reports are consistently complete. But report consistency can also be important for the medical outcomes of a single person.

Today, I’ll discuss the unique experience of a friend of mine, and I’ll explain how his isolated incident is connected to large-scale initiatives in pathology reporting quality assurance.

Incomplete Pathology Reports


A friend of mine has particularly fair skin and is at thus at increased risk for skin cancers. His family physician has recommended he have various moles removed to prevent the development of possible skin cancers.

Over time, my friend and his family physician became troubled by the inconsistencies they found in comparing the pathology reports from his five different biopsies.

Five out of five reports identified that the moles were dysplastic—irregular and potentially cancerous. Yet only three reports identified that this dysplasia was in his skin’s basal cells as opposed to squamous cells or melanocytes.

The the type of skin cells exhibiting dysplasia is important to clinical decision making: dysplasia affecting melanocytes is the basis for melanomas, the most serious forms of skin cancer. Lacking this information makes it more difficult for care teams to develop the comprehensive understanding of an individual’s medical history that guides clinical decision making.

In response to the incompleteness of the pathology reports, the family physician remarked, “I rarely have to query a pathologist about what’s in a report. It’s usually about what’s left out.”

And it’s not just one physician who’s seeking better reports.

Synoptic Reporting for Complete Consistency in Pathology

For over 20 years, the College of American Pathologists (CAP) has been developing clinical templates to standardize pathology reporting, substantially improving the completeness and consistency of pathology reports through the use of the synoptic—i.e. structured—format.

Synoptic reporting uses coded data templates to produce standardized electronic medical documentation that is more complete and consistent than reports generated using narrative methods.

Cancer Care Ontario introduced synoptic reporting for pathologist across the province—the largest jurisdiction to do so. Clinicians have shown over-whelming support for this initiative, finding that synoptic reports have facilitated consistent intepretation of diagnostic and prognostic data.

The Canadian Partnership Against Cancer is building on Ontario’s success to help implement synoptic pathology reporting across Canada, strengthening provincial cancer registries and fostering cross-jurisdictional research and quality assurance initiatives.

Clinical research has continually found that the use of synoptic reporting improves the completeness of pathology reports [123, 4]. These conclusions have been upheld in research on synoptic reporting for surgery as well [5, 6].

An important goal of synoptic reporting implementation initiatives is equipping pathologists and surgeons with clinical documentation software that enables them to provide each other with specific, reliable and actionable data—through complete and consistent reports.

  1. McLeod RS, Kirsh R. What impact has the introduction of synoptic reporting for rectal cancer had on reporting outcomes for specialist gastrointestinal and nongastrointestinal pathologists? Archives of Pathology & Lab Medicine. 2011;135(11):1471-5.
  2. Pignol JP, et al. Accuracy and completeness of pathology reporting–impact on partial breast irradiation eligibility. Clinical Oncology. (Royal College of Radiology) 2012 Apr;24(3):177-82.
  3. Branston LK, Greening S, Newcombe RG et al. The implementation of guidelines and computerised forms improves the completeness of cancer pathology reporting. The CROPS project: a randomised controlled trial in pathology. European Journal of Cancer. 2002;38(6):764-72.
  4. Karim RZ et al. The advantage of using synoptic pathology report format for cutaneous melanoma. Histopathology. 2008 Jan;52(2);130-8.
  5. Edhemovic I, Temple WJ, de Gara CJ, Stuart GC. The computer synoptic operative report–a leap forward in the science of surgery. Annals of Surgical Oncology. 2004;11(10):941-7. 
  6. Donahoe L, Bennett S, et al. Completeness of dictated operative reports in breast cancer–the case for synoptic reportingJournal of Surgical Oncology. 2012;106(1):79-83.