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Template reporting matters-a nationwide study on histopathology reporting on colorectal carcinoma resections
Abstract
Complete and accurate histopathology reports are fundamental in providing quality cancer care. The Cancer Registry of Norway and the Norwegian Society of Pathology have previously developed a national electronic template for histopathology reporting on colorectal carcinoma resection specimens. The present study was undertaken to investigate (1) whether quality routines in Norwegian pathology laboratories might affect completeness of such histopathology reports and (2) whether the national electronic template improves completeness of histopathology reports compared with other modes of reporting. A questionnaire on quality routines was sent to the 21 pathology laboratories in Norway. All histopathology reports on colorectal cancer submitted to the Cancer Registry for a 3-month period in the autumn of 2007 were then evaluated on the mode of reporting and the presence of 11 key parameters. Of the 20 laboratories that handled resection specimens, 16 had written guidelines on histopathology reporting. Of these, 4 used the national electronic template, 5 used checklists, 3 used locally developed electronic templates, whereas the remaining 4 had neither obligatory checklists nor templates. Of the 650 histopathology reports submitted to the Cancer Registry in the 3-month period, the national template had been used in 170 cases (26.2%), checklists/locally developed templates in 112 cases (17.2%), and free text in 368 cases (56.6%). Quality routines in the pathology laboratories clearly governed reporting practice and the completeness of the histopathology reports. Use of the national electronic template significantly improved (P < .05) the presence of the 11 key parameters compared with reporting by checklists, locally developed electronic templates, or free text.
... Branston et al. 26 ...
... There are published guidelines for reporting formats and styles. 18,24 There are indications that electronic reports are better than free-text reports, due to ease of formatting and a more uniform and consistent layout, as well as easier access for clinicians, pathologists, and anyone else involved in a patient's care 5,25,26 . Branston et al. 25 suggest that guidelines and computerized report forms/templates improve the quality of histopathological reporting. ...
Objectives
Good communication between clinicians and pathologists is a vital element in the diagnostic process, and poor communication can adversely affect patient care. There is a lack of research about communication in diagnostic oral and maxillofacial pathology. This narrative review explores different aspects of the quality of communication between clinicians and oral pathologists, with a focus on the diagnosis of oral and maxillofacial diseases.
Study design
An electronic search was carried out in MEDLINE/PubMed, Scopus, and Embase databases up to April 2021.
Results
No studies reporting communication, its adequacy, or the required skills between clinicians and pathologists in oral diagnosis were found. According to studies published in medicine, strategies for improving communication skills include clinician-pathologist collaboration; a well-formatted, clear, and thorough report; training in communication skills; and patient-centered care.
Conclusions
Further studies evaluating the current practices and quality in oral and maxillofacial pathology are required to identify barriers and encourage optimal communication to facilitate diagnosis and patient safety.
... Branston et al. 26 ...
... There are published guidelines for reporting formats and styles. 18,24 There are indications that electronic reports are better than free-text reports, due to ease of formatting and a more uniform and consistent layout, as well as easier access for clinicians, pathologists, and anyone else involved in a patient's care 5,25,26 . Branston et al. 25 suggest that guidelines and computerized report forms/templates improve the quality of histopathological reporting. ...
Abstract Good communication between clinicians and pathologists is a vital element in the diagnostic process, and poor communication can adversely affect patient care. There is a lack of research about communication in diagnostic oral and maxillofacial pathology. This narrative review explores different aspects of the quality of communication between clinicians and oral pathologists, with a focus on the diagnosis of oral and maxillofacial diseases. An electronic search was carried out in MEDLINE through the PubMed, Scopus, and Embase databases up to April 2021. No studies reporting communication, its adequacy or the required skills between clinicians and pathologists in oral diagnosis were found. According to studies published in medicine, strategies for improving communication skills include clinician-pathologist collaboration; a well-formatted, clear and thorough report; training in communication skills; and patient-centered care. Further studies evaluating the current practices and quality in oral and maxillofacial pathology are required to identify barriers and encourage optimal communication to facilitate diagnosis, as well as patient safety.
... The highest data entry of clinical dimension was related to the pathological dataset in screening program of RIGLD. According to studies, pathology sample is obtained in 30-50% of colonoscopy interventions (42). Accurate histopathological data is a requirement for providing high-quality care services to patients with colorectal cancer (42). ...
... According to studies, pathology sample is obtained in 30-50% of colonoscopy interventions (42). Accurate histopathological data is a requirement for providing high-quality care services to patients with colorectal cancer (42). Precise pathology reports can enhance screening recommendations for follow-up. ...
Background A data-driven colorectal cancer screening strategy based on personalized approach can improve health outcomes, facilitate early stratification of at-risk patients and reduce health care costs. This study aims to develop an information road map for personalized colorectal cancer screening in Iran.
Methods This study is a Mix-Method Research (MMR) which consisted of three phases: phase I, development of a checklist with 275-items for assessing required data elements of personalized colorectal cancer screening; phase II, situational analysis of colorectal cancer screening dataset according to the checklist; phase III, development of national information road map for personalized colorectal cancer screening with in-depth interview and focus groups.
Results Personalized datasets of colorectal cancer screening were defined in four dimensions, including clinical dataset (5 sub-dimensions, 162 items), genetic dataset (2 sub-dimensions, 67 items), demographic dataset (1 sub-dimension, 6 items) and a social determinant dataset (3 sub-dimensions, 40 items). The next step data elements of colorectal cancer screening based on personalized datasets were analyzed. Of the 275-items, only 96 items are recorded. Only 17.8% of clinical dataset of screening program were entered. The highest data elements of clinical dimension were related to pathological datasets (53.6%) in the present screening program. The lowest data elements of the clinical dimensions were related to the clinical history dataset (3.4%). 73% of pedigree data elements and 15.33% of social determinant datasets were entered. In the final step, a national information road map of personalized CRC screening with 6 layers (information leadership, personalized datasets, data integration, data architecture, data descriptor, and screening program layers) was developed.
Conclusion Personalized screening based on integration dataset play a key role for the successful implementation of the screening program. Eliminating data deficiencies can improve the quality of documentation and may lead to improved screening performance. Therefore, standard datasets and indicators can help to identify information gaps and facilitate precise decision-making. Entering data was inadequate and poor in this study. Implementation of national road map can assist to improve the quality of data in personalized screening.
... Just one structured electronic synoptic histopathology reporting template was developed before the project had to close down due to lack of funding. However, several follow-up studies on the implementation and use of the colorectal form have shown quality improvement by using it, 24,25 that the compliance rate is generally high in departments having implemented the form, 24,26 and that both individual pathologists and departments have a positive attitude toward electronic synoptic reporting. 26 the Netherlands ...
... With respect to completeness of the histopathology reports on cancer, a number of studies have been undertaken. 22,24,25,[28][29][30][31][32][33][34][35][36] The main conclusion from these studies is that the use of a checklist or template improves upon the completeness of histopathology reports as evaluated against guidelines published by pathology associations. One early intervention study is of particular interest. ...
Christopher L Williams,1 Roger Bjugn,2 Lewis A Hassell1 1Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; 2Department of Pathology, Oslo University Hospital, Oslo, Norway Abstract: The current status of synoptic pathology reporting is presented with its historical context. The awareness of additional audiences and users has made the presentation and capture of pathology data, particularly cancer data of broad importance. Current models of adoption in the US, Canada, Norway, and the Netherlands are noted. Significant terms, benefits, and stakeholders key to implementation and advancement of capabilities particularly with regard to capture of discrete data elements are presented. Important barriers to be overcome include fiscal constraints, technologic barriers such as interconnectivity and legacy systems, as well as social and organizational obstacles. Keywords: quality assurance, integrated disease reporting, clarity, completeness, pathology report, cancer registry, biorepository
... 4 Despite the apparent benefits of electronic synoptic histopathology reporting, and the successful regional implementation of such a reporting system in Ontario, Canada, 5 others have reported that the implementation and use of electronic histopathology reporting is no easy organisational task. 6,7 Similar challenges have also been reported regarding the implementation and use of a web-based synoptic reporting tool for cancer surgery. 8,9 From a management and organisational perspective, the list of possible causes for project failure with respect to information technology development, implementation and use is long. ...
... Some laboratories had a user rate above 90%, while other laboratories had not implemented the synoptic tool at all. 7 Issues related to individual behaviour Even after the successful development and implementation of a new IT tool, successful long-term usage is not guaranteed. Health care professionals may not adhere to new guidelines and practices, 14 and each individual's adoption and use of new IT solutions is affected by a number of interacting factors (Fig. 3). ...
... Over the past years, the SSR use has increased and the number of countries adopting the International Collaboration of Cancer Reporting templates is increasing as well [13,14]. However, differences in SSR usage are still present between countries and within countries between the reporting of tumor types, retrieval techniques, and (types of ) laboratories, resulting in variation in treatment choices and therefore, patient outcomes [13,[15][16][17][18]. From our previously conducted context analyses, we retrieved barriers and facilitators for SSR implementation [19,20]. ...
Background
Implementation strategies are aimed at improving guideline adherence. Both effect and process evaluations are conducted to provide insights into the success or failure of these strategies. In our study, we evaluate the nationwide implementation of standardized structured reporting (SSR) in pathology.
Methods
An interrupted time series analysis was conducted to evaluate the effect of a previously developed implementation strategy, which consisted of various digitally available elements, on SSR in pathology laboratories. A segmented regression analysis was performed to analyze the change in mean SSR percentages directly after the strategy introduction for pathology reporting and specific subcategories. In addition, we analyzed the change in trend in the weekly percentages after strategy introduction, also for subgroups of tumor groups, retrieval methods, and type of laboratory. The change in SSR use after the strategy introduction was determined for all pathology laboratories. We further conducted a process evaluation in which the exposure to the strategy elements was determined. Experiences of the users with all strategy elements and the remaining barriers and potential strategy elements were evaluated through an eSurvey. We also tested whether exposure to a specific element and a combination of elements resulted in a higher uptake of SSR after strategy introduction.
Results
There was a significant increase in an average use of SSR after the strategy introduction for reporting of gastrointestinal ( p =.018) and urological ( p =.003) oncological diagnoses. A significant increase was present for all oncological resections as a group ( p =.007). Thirty-three out of 42 pathology laboratories increased SSR use after the strategy introduction. The “Feedback button”, an option within the templates for SSR to provide feedback to the provider and one of the elements of the implementation strategy, was most frequently used by the SSR users, and effectiveness results showed that it increased average SSR use after the strategy introduction. Barriers were still present for SSR implementation.
Conclusions
Nationwide SSR implementation improved for specific tumor groups and retrieval methods. The next step will be to further improve the use of SSR and, simultaneously, to further develop potential benefits of high SSR use, focusing on re-using discrete pathology data. In this way, we can facilitate proper treatment decisions in oncology.
... 19 Therefore, the use of SSR in pathology is recommended in several international and national oncologic guidelines, and standard datasets are developed to enable SSR in pathology. [21][22][23] Despite the obvious benefits of SSR and guideline recommendations, SSR is currently underused. Frequency of SSR usage varies widely, depending on tumor type and infrastructure. ...
Context.—
Standardized structured reporting (SSR) among pathologists results in more complete diagnoses and, subsequently, improved treatment decisions and patient outcomes. Therefore, SSR templates' usage is advocated in oncology guidelines. However, actual SSR usage varies widely. Previous studies have shown multiple impeding and facilitating factors regarding SSR implementation.
Objective.—
To select, develop, and test an evidence-based multifaceted strategy, tailored to the impeding and facilitating factors to improve SSR implementation in oncologic pathology.
Design.—
Six strategy elements to increase the use of SSR were selected on the basis of a barrier and facilitator analysis, literature review, and consecutive discussions with a nationwide expert panel and project team. In collaboration with a professional organization for developing SSR templates (PALGA), we developed elements and combined them in 1 multifaceted strategy and subsequently tested effectiveness and feasibility.
Results.—
The 6 strategy elements were as follows: (1) renewed Web site including SSR information; (2) e-learning including SSR instructions; (3) communication manual describing communication about SSR; (4) improved feedback process, including use of the “Feedback Button” within SSR templates and “Frequently Asked Questions” on the Web site; (5) information sheet on SSR updates within SSR templates; and (6) monthly telephone conversations to discuss audit and feedback information regarding local SSR usage. A significant change (12.4%) in SSR usage among test laboratories was noticed. After the first test, e-learning and the “Feedback Button” were deemed most feasible and effective. However, awareness of all elements could be increased.
Conclusions.—
Next step will be to optimize the tailored strategy, to distribute it to all Dutch pathology laboratories, and to evaluate effectiveness and feasibility in a nationwide setting.
... The actual use of the SSR-templates varied from 8 to 86% (median 54%) in 2017 [24]. The wide range of actual SSR use in the Netherlands is comparable to other countries [19][20][21][22][23]. Therefore, despite some success with passive implementation, there is considerable room for improvement to the extent and speed of implementing SSR in pathology. ...
Standardized structured reporting (SSR) enables high-quality pathology reporting, but implementing SSR is slow. The objective of this study is to identify both barriers and facilitators that pathologists encounter in SSR, in order to develop tailored implementation tools to increase SSR usage. We used a mixed method design: a focus group interview helped to identify barriers and facilitators in SSR. The findings were classified into the following domains: innovation, individual professional, social setting, organization, and economic and political context. We used a web-based survey among Dutch pathologists to quantify the findings. Ten pathologists participated in the focus group interview, and 97 pathologists completed the survey. The results of both showed that pathologists perceive barriers related to SSR itself. Particularly its incompatibility caused lack of nuance (73%, n = 97) in the standardized structured pathology report. Regarding the individual professional, knowledge about available SSR-templates was lacking (28%, n = 97), and only 44% (n = 94) of the respondents agreed that using SSR facilitates the most accurate diagnosis. Related to social setting, support from the multidisciplinary team members was lacking (45%, n = 94). At organization level, SSR leads to extra work (52%, n = 94) because of its incompatibility with other information systems (38%, n = 93). Main facilitators of SSR were incorporation of speech recognition (54%, n = 94) and improvement in communication during multidisciplinary team meetings (69%, n = 94). Both barriers and facilitators existed in various domains. These factors can be used to develop implementation tools to encourage SSR usage.
... A number of CRC pathology reporting audits have been conducted in the past. Most of them were performed at either local [5][6][7][8][9], regional [10][11][12][13][14][15][16][17], or national level [18,19] and assessed the adherence to national pathology guidelines by reviewing pathology reports. ...
Different guidelines for colorectal cancer (CRC) pathology reporting have been published. We aimed to identify differences between publicly available CRC reporting guidelines and to survey pathologists from different countries to establish the degree of guideline implementation in local routine practice. We compared all core and non-core items of CRC reporting guidelines to identify discrepancies. We then created a survey, which was sent out to 782 pathologists practicing in 30 different countries. It included questions on the demographics of the reporting pathologist as well as resection specimen handling and microscopic evaluation, grading, staging, and additional techniques, such as immunohistochemistry or molecular pathology. First, core and non-core items of five national CRC reporting guidelines were compared and 12 items were found to differ. Different items are considered core or non-core by different guidelines and more than one TNM staging edition was applied across guidelines. The survey was completed by 143 pathologists from 30 countries. We identified differences between local practice and guidelines with potential clinical impact, e.g., tumor budding was never reported by 28.7% of responders, although it has prognostic value for survival in stage II CRC. This is the first international study comparing CRC pathology reporting guidelines with real-world local practices. There are differences in CRC pathology reporting guidelines and in guideline implementation into local practice, both with potential impact on patient care. Harmonization of datasets, use of templates, and audits of local pathology practice are needed to ensure best possible quality of CRC pathology reporting.
... 81, level I National electronic template reporting improves the inclusion of important key parameters for CRC resection specimen compared with reporting by checklists, locally developed electronic templates or free text (p<0.05). 82,level III In view of the importance of high quality reporting of CRC resection specimen, Pathology Service of MoH has developed a standardised histopathology reporting proforma for this purpose (refer to Appendix 5). ...
Colorectal carcinoma (CRC) is the second most common cancer in Malaysia (13.2%) as reported in Malaysian National Cancer Registry Report 2007-2011. According to National Cancer Patient Registry on Colorectal Cancer 2008-2013, the overall incidence rate for CRC was 21.3 cases per 100,000 population. Overall mortality rate was 9.8 cases per 100,000 population and age-adjusted mortality rate was 1.42 times higher in male than female.The estimated societal cost of CRC management in government hospitals in Malaysia using conventional chemotherapy ranges between RM13,622 to RM27,163 based on different stages, with an average of RM21,377 per patient. The cost of treatment is higher when combined conventional chemotherapy and monoclonal antibody is used. With increasing number of new cases detected every year, the economic burden of CRC management is escalating especially if the patients present in advanced stage.
Management of patients with CRC consists of a comprehensive strategy of screening, diagnosis, staging, appropriate treatment and follow-up. Hence, this first national CPG on CRC is developed to assist healthcare providers in the management of CRC.
... Patients were registered as being LN-positive (N?) or LN-negative (N0); the N? group included both N1 (67 patients) and N2 (35 patients) [ Table 1]. According to the Norwegian guidelines at the time, 23 immunohistochemistry or polymerase chain reaction (PCR) analyses were not routinely performed. ...
Objective
The aim of this study was to analyse the survival impact of primary tumor nodal status (N0/N+) in patients with resectable colorectal liver metastases (CLM), and to determine the value of circulating and disseminated tumor cells (CTCs/DTCs) in this setting. Methods
In this prospective study of patients undergoing resection of CLM from 2008 to 2011, peripheral blood was analyzed for CTCs using the CellSearch System®, and bone marrow was sampled for DTC analyses just prior to hepatic resection. The presence of one or more tumor cells was scored as CTC/DTC-positive. Following resection of the primary tumor, the lymph nodes (LNs) were examined by routine histopathological examination. ResultsA total of 140 patients were included in this study; 38 patients (27.1%) were negative at the primary colorectal LN examination (N0). CTCs were detected in 12.1% of all patients; 5.3% of patients in the N0 group and 14.7% of patients in the LN-positive (N+) group (p = 0.156), with the LN-positive group (N+) consisting of both N1 and N2 patients. There was a significant difference in recurrence-free survival (RFS) when analysing the N0 group versus the N+ group (p = 0.007) and CTC-positive versus CTC-negative patients (p = 0.029). In multivariate analysis, CTC positivity was also significantly associated with impaired overall survival (OS) [p = 0.05], whereas DTC positivity was not associated with survival. Conclusion
In this cohort of resectable CLM patients, 27% had primary N0 colorectal cancer. Assessment of CTC in addition to nodal status may contribute to improved classification of patients into high- and low-risk groups, which has the potential to guide and improve treatment strategies.
... The mean number of Fig. 3c), and 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 Article Appleton [23] Austin[19] M a t h e r s a [40] McEvoy [41] Level SR Buchwald [29] Cross [31] Idowu [36] Ihnat b [37] Porter [43] Rigby [46] Siriwardana [21] Woods b [51] Chan [18] C a s a t i[ 30] Haugland [34] Messenger [42] Level SR Reporting format NR SR NR SR NR SR NR SR NR SR NR SR NR SR NR SR NR SR NR SR SR3 NR SR NR SR4 SR5 NR SR RCP Royal College of Pathologists, CAP College of American Pathologists, CRC colorectal carcinoma, NR narrative report, SR synoptic report, SR3 synoptic reporting 15 months after implementation, SR4 local synoptic report, SR5 national synoptic report, CRM circumferential margin (only on rectum tumours) *Significant improvement in completeness according to the article a more frequently, the minimum number of 12 lymph nodes was achieved. Three studies also showed an improvement of the proportion of pathology reports with a minimum of 12 lymph nodes reported after implementation of SR (Fig. 3d). ...
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.
... Nowadays, many web-based reporting system based on synoptic checklists are available. The Cancer Registry of Norway and the Norwegian Society of Pathology implanted a national electronic checklist for surgical pathology reporting of colorectal carcinoma (Haugland et al., 2011). Casati and Bjugn showed that after implantation of the mentioned electronic checklist, the presence of essential elements in reports was significantly improved (Casati and Bjugn, 2012). ...
Cancer pathology reports play an important role in choice of patient care. They provide crucial information concerning diagnosis, therapy options, and prognosis. Professional pathology institutions, such as the College of American Pathologists (CAP), have developed checklists to ensure the presence of all the required elements in reports. In this study, 438 surgical pathology reports of patients with breast (148), colon (147), and stomach cancer (143) were evaluated with respect to the presence of mandated elements according to CAP checklists. The most common missing element in all the three types of cancer was 'staging' (73.6, 53.1, and 56.6% in breast, colon, and stomach cancer reports missed 'staging', respectively). The second most missing element was 'tumor site' in breast (64.2%) and stomach cancer (30.1%), and 'procedure' in colon cancer (29.3%). 'Perineural invasion' was the third most missing element in the three types of cancer (25.7, 17.0, and 22.4% in breast, colon, and stomach cancer, respectively). Only 11.4% of reports included all key elements required by CAP. The use of checklists was associated with higher rate of completeness. This study demonstrates that the key elements requiring the information on the requisition forms from the clinicians are commonly missed, leading to ambiguity.
... By establishing synoptic reports created semi-automatically based on a checklist template, a nearly complete data acquisition was reached, again with a statistically highly significant increase of median EDS to 9 (Fig. 2). These data are totally consistent with publications of other authors [1,9,11,12] and already published findings of our group [7,8] concerning breast and colorectal as well as lung and prostate tumors, respectively, all of which with the recommendation to use template-based reports because in reports with this format both data content and, accordingly, quality are higher compared with other format types. Statistically significant differences between the format types regarding the content of essential data could be measured for tumor site, tumor size, specific grading (according to Elston and Ellis for invasive carcinoma or Silverstein for in situ carcinoma), angioinvasion, additional findings, and hormone receptor status. ...
There is increasing evidence that not only the way of data acquisition but also the design of data visualization (i.e., the format) has impact on the quality of pathology reports. Therefore, we investigated the correlation between the format of pathology reports and the amount as well as the detection time of transmitted data. All reports of oncological breast resection specimens referred to the Institute for Surgical Pathology, University Medical Center Freiburg, between 2003 and 2011 (n = 4181) were classified into descriptive reports (DR, n = 856), structured reports (SR, n = 2455), or template-based synoptic reports (TBSR, n = 870). The reports were screened regarding the content of nine organ-specific essential data. The amount of recorded essential data per report was summarized in an essential data score (EDS) and the format types were statistically compared regarding their EDS. Additionally, we measured the time a gynecologist needed to detect all nine essential data within a subset of reports and compared the format types regarding the detection times statistically. A full-score EDS of 9 was seen in 28.4 % of all reports, in 4 % of DRs, in 21.4 % of SRs, and in 72.3 % of TBSRs (p < 0.0001). Median EDS of DRs was 7, of SRs 8, and of TBSRs 9 (p < 0.0001). Data regarding tumor localization, tumor size, specific grading, angioinvasion, hormone receptor status, and additional findings were mentioned more frequently in TBSRs compared to other format type reports with a statistically highly significant difference (p < 0.0001). Mean data detection time decreased significantly from 26 to 20 and 14 s in DRs, SRs, and TBSRs, respectively. Our results clearly show that due to the use of TBSRs reporting of oncological breast resection specimens are improved regarding the content of essential data and the clarity of the data layout resulting in a rapid detection of essential data by clinicians.
... [4,5] It is well recognized that standardization in cancer reporting improves the completeness and quality of the reports. [6][7][8] With respect to similar audits from our country, we came across an audit of rectal carcinoma reports by Nambiar et al. from India. [9] Comment about the lymphovascular emboli, perineural invasion, involvement of the cervix was mentioned in 100% of the cases. ...
The aim was to see, compliance to minimum data information in carcinoma endometrium reports, in a team of 13 pathologists, and also to analyze these parameters e.g. tumor size, type, grade, depth of myometrial invasion, lymph node yield, pTNM stage etc.
During the period of 2008-2010, from the files of Pathology department of our hospital, reports of 114 cases of carcinoma endometrium, who were operated in house, were analyzed.
The median age was 58.04 years and median tumor size was 4 cm. Endometrioid adenocarcinoma was the most common type (82.5%), followed by malignant mixed Mullerian tumor (MMMT) (6.1%) and Serous carcinoma (3.5%). Grade 2 was the commonest tumor grade (42.1%). Less than half of myometrial invasion was seen in 50% of the cases and more than half of the myometrial invasion was seen in 46.5% of cases. (Information was not available in four cases). Parametrial involvement was seen in 5.3% cases. The pTNM stage was not mentioned in 71.9% reports. The median lymph node yield was 15.
The compliance to adhere to and to provide minimum data information in carcinoma endometrium reports is generally good. Lymph node yield is reasonable. Mentioning of pTNM staging is to be done more meticulously. Use of proformas/checklists is recommended.
... Seven of the then 19 public pathology laboratories participated in the project. A national survey undertaken in 2008 showed that usage of the template varied greatly between pathology departments [6]. Some laboratories had a compliance rate above 90%, while others had not implemented the template at all. ...
Background
The information contained in histopathology reports on surgical resections of cancer is fundamental for both patient treatment and cancer registries. Electronic synoptic histopathology reporting is considered superior to traditional narrative reporting with respect to both completeness and feasibility of data use. An electronic template for colorectal cancer reporting was introduced in Norway in 2005, but implementation has varied greatly between different pathology departments. In 2012, four pathology departments and the Norwegian Cancer Registry started a new initiative on electronic cancer reporting. As part of this initiative, this study was undertaken to learn more about factors influencing implementation and use.Methods
Qualitative and quantitative data were obtained from six of the 17 public pathology departments in Norway using explorative case study methodology. Methods included document studies, semi-structured interviews with key informants, and audits on actual template use. A systematic analysis of data was conducted based on theoretical models for project management, stakeholder engagement, and individual acceptance of new information technology.ResultsMost key informants had a positive view on synoptic reporting, and five departments had tested the electronic template. Of these, four had implemented the template while one department had decided not to implement it due to layout concerns. Of the four departments using the template in daily routine, one had compulsory use, two consensus based use, while the fourth had voluntary use. Annual average usage of the electronic template in the three departments with compulsory or consensus based use was 92% compared to 53% in the department with voluntary use.Conclusions
There was a general positive attitude towards electronic synoptic reporting. Reasons for not implementing the colorectal template were specific technical and quality issues not adequately addressed by the project organization having developed the template. A formal assessment of project outcomes with a task force handling such technical issues should accordingly have been established as part of the project. After an organizational decision on implementation, perceived job relevance and practical benefits are factors important for individual template use. Consistent high long-term usage was related to a departmental environment with a consensus based decision on use.
... En nasjonal undersøkelse høsten 2007 viste at bruk av den strukturerte elektroniske malen ga bedre rapportering av patologifunn enn tradisjonell fritekstrapportering, men at bruken av malen varierte betydelig mellom ulike patologiavdelinger (8). Patologiavdelingene ved Akershus universitetssykehus, Haukeland universitetssykehus og Stavanger universitetssjukehus er blant dem som har brukt malen for rutinerapportering. ...
In order to succeed in realising general health-policy goals for cancer care, they must be formulated as specific and realistic objectives. An administrative organ must be provided with the authority and funding needed to establish the technical solutions required. Reporting to national registries must take place automatically in electronic form, on the basis of ongoing structured reporting in the patient records. In our opinion the Directorate of Health should enter into cooperation with the College of American Pathologists, with a view to integrating a Norwegian version of their electronic checklists for pathology reporting of cancer into the hospitals' record systems.
Background:
Standardized structured reporting (SSR) improves quality of diagnostic cancer reporting and interdisciplinary communication in multidisciplinary team (MDT) meetings, resulting in more adequate treatment decisions and better health outcomes. However, use of SSR varies widely among pathologists, but might be encouraged by MDT members (MDTMs). Our objectives were to identify barriers and facilitators (influencing factors) for SSR implementation in oncologic pathology from the perspective of MDTMs and their determinants.
Methods:
In a multimethod design, we identified influencing factors for SSR implementation related to MDT meetings, using 5 domains: (1) innovation factors, (2) individual professional factors, (3) social setting factors, (4) organizational factors, and (5) political and legal factors. Four focus groups with MDTMs in urologic, gynecologic, and gastroenterologic oncology were conducted. We used an eSurvey among MDTMs to quantify the qualitative findings and to analyze determinants affecting these influencing factors.
Results:
Twenty-three MDTMs practicing in 9 oncology-related disciplines participated in the focus groups and yielded 28 barriers and 28 facilitators in all domains. The eSurvey yielded 211 responses. Main barriers related to lack of readability of SSR: difficulties with capturing nuances (66%) and formulation of the conclusion (43%); lack of transparency in the development (50%) and feedback processes of SSR templates (38%); and lack of information exchange about SSR between pathologists and other MDTMs (45%). Main facilitators were encouragement of pathologists' SSR use by MDTMs (90%) and expanding the recommendation of SSR use in national guidelines (80%). Oncology-related medical discipline and MDT type were the most relevant determinants for SSR implementation barriers.
Conclusions:
Although SSR makes diagnostic reports more complete, this study shows important barriers in implementing SSR in oncologic pathology. The next step is to use these factors for developing and testing implementation tools to improve SSR implementation.
Context:
-There is ample evidence from the solid tumor literature that synoptic reporting improves accuracy and completeness of relevant data. No evidence-based guidelines currently exist for synoptic reporting for bone marrow samples.
Objective:
-To develop evidence-based recommendations to standardize the basic components of a synoptic report template for bone marrow samples.
Design:
-The College of American Pathologists Pathology and Laboratory Quality Center convened a panel of experts in hematopathology to develop recommendations. A systematic evidence review was conducted to address 5 key questions. Recommendations were derived from strength of evidence, open comment feedback, and expert panel consensus.
Results:
-Nine guideline statements were established to provide pathology laboratories with a framework by which to develop synoptic reporting templates for bone marrow samples. The guideline calls for specific data groups in the synoptic section of the pathology report; provides a list of evidence-based parameters for key, pertinent elements; and addresses ancillary testing.
Conclusion:
-A framework for bone marrow synoptic reporting will improve completeness of the final report in a manner that is clear, succinct, and consistent among institutions.
Background:
We hypothesized that mandatory multidisciplinary team (MDT) participation improves process evaluation, outcomes, and technical aspects of surgery for rectal cancer in a stable practice of colorectal surgery.
Methods:
A retrospective review of MDT data was conducted of all patients with colorectal cancer since 2010. Demographic, clinical stage, process evaluation, quality of surgery, and outcome data were collected. Total mesorectal excision and MDT required participation started 2013.
Results:
One hundred thirty patients were included in this study: 47 patients in 2014; 41 patients in 2013; and 42 patients pre-MDT. Improvements were seen in 12 of the 14 preoperative process variables, 6 significantly. Improvement in the completeness of total mesorectal excision (0% to 76%) was significant. Local recurrence occurred in 10% of the pre-MDT group, and follow-up is ongoing in the MDT groups.
Conclusions:
MDT participation improves care of patients with rectal cancer. Preoperative clinical staging, multimodality treatment, pathologic staging, and technical aspects of surgery have improved.
Evaluation of ≥ 12 lymph nodes (LNs) is recommended after surgery for colon cancer. A harvest of ≤ 8 is considered poor, but few reports have evaluated risk factors associated with a poor harvest. This aims of this study were to analyse the clinical, surgical and pathological factors associated with poor LN harvest (LNH), the total number of examined nodes and the effect of LN number on stage.
All patients reported to the Norwegian Colorectal Cancer Registry during 2007 and 2008 who underwent curative resection for Stage I–III colon cancer were studied. Risk factors for poor LNH and the proportion of Stage III disease were analysed by univariate and multivariate analyses.
A total of 2879 patients were included in the study. The median LNH was 14. Overall, 69.9% had ≥ 12 lymph nodes and 14.4% had ≤ 8 LN (poor harvest). Multivariate analysis showed that male sex, age > 75 years, sigmoid tumours, pT category 1–2, failure to use the pathology report template and distance of ≤ 5 cm from the bowel resection margin were all independent factors for poor LNH. Age < 65 years, pT category 3–4, and poor tumour differentiation were independent predictors of Stage III disease. An increased LNH did not increase the proportion of patients identified as being LN positive at the ≤ 8, 9–11 and ≥ 12 LN levels.
Adequate LNH was achieved in the majority of curative colon cancer resections in this national cohort. Elderly, male patients with sigmoid cancers, and a short distal margin were at increased risk of a poor LNH.
The main purpose of the study was to present a baseline audit of reporting of colorectal cancers resection specimens in Scotland, audited against the Royal College of Pathologists (RCPath) standards (2007) and NHS Quality Improvement Scotland (NHS QIS) standards.
50 consecutive rectal and 50 consecutive colonic cancer cases from 2011 were audited from 10 Scottish health boards involved in colorectal cancer reporting (n=953). The rates of reporting of serosal involvement, extramural venous invasion (EMVI) and the mean numbers of lymph nodes found were audited against RCPath standards and compared between units that routinely used a reporting proforma versus those that did not.
The performance in reporting of rectal cancer was generally worse than for colonic cancer, with only three units meeting the RCPath standards for reporting of rectal cancer. There were significant differences between units that routinely used a proforma, with the non-proforma group failing to meet the minimum standards for both serosal involvement (6%) and EMVI (24%). In the non-proforma group, 56% of rectal cases had a mean lymph node count of 12 or more compared with 81% in the proforma group.
Significant differences exist in the frequencies with which important adverse prognostic features are reported by pathologists across 10 Scottish health boards. This has potential implications for patient care. Health boards that make routine use of reporting proformas are more likely to meet RCPath guidelines for reporting of these important pathological parameters.
For patients undergoing curative resections for colon cancer, the nodal status represents the strongest prognostic factor, yet at the same time the most disputed issue as well. Consequently, the qualitative and quantitative aspects of lymph node evaluation are thus being scrutinized beyond the blunt distinction between 'node positive' (pN+) and 'node negative' (pN0) disease. Controversy ranges from a minimal or 'least-unit' strategy as exemplified by the 'sentinel node' to a maximally invasive or 'all inclusive' approach by extensive surgery. Ranging between these two extremes of node sampling strategies are factors of quantitative and qualitative value, which may be subject to modification. Qualitative issues may include aspects of lymph node harvest reflected by surgeon, pathologist and even hospital performance, which all may be subject to modification. However, patient's age, gender and genotype may be non-modifiable, yet influence node sample. Quantitative issues may reflect the balance between absolute numbers and models investigating the relationships of positive to negative nodes (lymph node ratio; log odds of positive lymph nodes). This review provides an updated overview of the current controversies and a state-of-the-art perspective on the qualitative and quantitative aspects of using lymph nodes as a prognostic marker in colon cancer.
To improve quality, pathology organizations have published guidelines with key parameters for histopathology reporting on cancer resections. Checklists or structured templates improve upon the presence of key parameters in histopathology reports, but data are lacking on long-term sustainability of such reporting. From 2003 to 2006, the Cancer Registry of Norway and the Norwegian Society of Pathology collaborated on the development of a structured electronic template for histopathology reporting on colorectal carcinoma resections.
To investigate use and long-term effect of this structured template in one of the first laboratories implementing the template for routine diagnostic work.
All histopathology reports (n =123) in the 1-year period prior to implementation were evaluated with respect to presence of key parameters. Likewise, all histopathology reports (n =1186) in the 5-year period after implementation were evaluated with respect to template use and presence of key parameters.
The electronic template had been used in 1089 (91.8%) of the 1186 cases. Template use was stable in the entire 5-year period, and had significantly improved upon the presence of data on 7 of 11 key parameters valid for both the pre-implementation and the post-implementation period. Eight hundred and twenty-two (75.5%) of the 1089 template reports contained information on all key parameters, compared to just 20 (16.3%) of the 123 free text reports in the 1-year pre-implementation period.
Electronic template reporting has a significant and sustainable long-term, positive effect upon the quality of histopathology reports.
The prognostic impact of the number of lymph nodes and ratio in colon cancer is still debated.
The aim of this study was to evaluate lymph node harvest in patients with colon cancer over time, and to test the hypotheses that investigation of more lymph nodes, and low lymph node ratio in stage III patients, has positive prognostic impact.
This is a prospective, observational study.
This study was conducted in a single institution treating all patients with colon cancer in a defined catchment area.
All patients admitted in the period 1993 to 2009 (n = 1481) were included.
The primary outcomes measured were the number of examined regional lymph nodes according to treatment period, 5-year overall survival and time to recurrence, and univariate (Kaplan-Meier) and multivariate (Cox regression) analyses of prognostic factors.
Nine hundred fifty (65%) patients underwent curative resection. Median number of examined lymph nodes increased from 7 to 15 (p < 0.001), and the proportion of patients with stage III disease increased from 25% to 33% (p = 0.02) during the study period. In patients with stage I to III disease, time to recurrence (proportion of patients without recurrence or death of colon cancer) improved from 65% to 82% during the period (p < 0.001). An association between lymph node count (<8 compared with ≥ 12) and overall survival was found for patients with stage II disease (57% vs 71%, p = 0.004). Hazard ratio for death within 5 years was 0.7 (p = 0.043) when 8 to 11 nodes were examined and 0.6 (p = 0.001) when ≥ 12 nodes were examined (<8 reference). In patients with stage III disease, increasing lymph node ratio was associated with reduced overall survival and time to recurrence in uni- and multivariate analyses.
This study was limited by the small number of patients in each stage.
The number of examined lymph nodes increased in the study period. A stage migration was observed, and time to recurrence improved in patients with stage I to III disease. In patients with stage III disease, lymph node ratio was a stronger prognostic factor than the total number of lymph nodes examined.
The aim of this study was to determine whether reporting guidelines and computerised form-based reports improve the completeness of histopathological cancer data available for patient management and population cancer registration and to evaluate the acceptability of the intervention. The study was a randomised controlled trial with a split unit design and stratified cluster randomisation. All 16 hospital pathology laboratories in Wales were randomly allocated to report either breast or colorectal resection specimens by computerised form or conventional free text. 1044 reports were analysed in the study arm, 998 in the control arm. Use of pre-defined forms led to a 28.4% (95% confidence interval (CI): 15.7–41.2%) increase in complete reporting of a minimum dataset required for cancer registration and a 24.5% (95% CI: 11.0–38.0%) increase in complete reporting of minimum data required for patient management. Form-based reporting was acceptable to pathologists and preferred by clinicians. In conclusion, guidelines and computerised forms significantly improve the quality of histopathology reporting.
Background:
The National Health Service (NHS) bowel cancer screening programme (BCSP) was initiated across England in April 2006. To determine the feasibility of using national cancer registration data to assess the impact of the BCSP on stage-specific incidence, we studied trends in the incidence rates of colon (ICD10 C18) and rectosigmoid junction and rectum (ICD10 C19–C20) cancers and the completeness of data on Dukes stage in England.
Methods:
Data were obtained from all nine cancer registries for the period 1996–2004, before the introduction of the BCSP, in men and women aged 50–79 years.
Results:
Overall, incidence rates declined by 1% per year in the 9 years before the introduction of the BCSP (P<0.001). Dukes stage was recorded for 60% of all registrations but this varied between regions and over time. Only four registries had completeness of 74% or more. Registrations with unknown Dukes stage decreased from 1996 to 2000, and then increased during 2001–2004 affecting trends in stage-specific incidence.
Conclusion:
To study the impact of the BCSP on stage-specific incidence, regional variations in data completeness need to be addressed.
To audit the information content of pathology reports of oesophageal and gastric cancer resection specimens in Wales.
All such reports from the 16 NHS histopathology laboratories in Wales in a one year period were evaluated for their information content. Two standards were used: (1) best practice reporting, and (2) a minimum dataset required for informed patient management that included clear statements on histological tumour type, depth of tumour invasion, lymph node involvement, and completeness of excision.
282 reports were audited. Minimum standards were achieved in 77% of gastric resections (156/203) and 53% of oesophageal resections (42/79). All laboratories achieved minimum standards in some gastric cancer reports (range 50-100%); three laboratories did not achieve minimum standards in any oesophageal cancer reports (range 0-100%). Best practice reporting was achieved in only 20% of gastric and 18% of oesophageal cancer reports. Failure to include an explicit statement on completeness of excision or involvement of the oesophageal circumferential resection margin were the most frequent causes of inadequate reporting. Most other data items were generally well reported, but apparent inadvertent omission of just one item was noted in many of the substandard reports.
This audit shows the need to improve the information content of pathology reports in gastric and oesophageal cancer. The widespread implementation of template proforma reporting is proposed as the most effective way of achieving this. Multidisciplinary meetings of clinicians involved in cancer management should provide a forum for greater communication between pathologists and surgeons, and help to maintain standards of pathological practice.
Pathology informatics involves management and analysis of large complex data sets derived from various tests performed in clinical and anatomic pathology laboratories, annotated biorepositories, image analysis, telepathology, and large scale experiments, including gene expression analysis, proteomics, and tissue array studies. It facilitates intelligent use of computing technologies to improve patient care and understand the natural history of disease. Herein, we describe the various bioinformatics tools used to support translational research at the University of Pittsburgh Medical Center.
Quality of colorectal cancer pathology reports is related to individual patient prognosis and future treatment options. This study sought to validate the prognostic utility of the Royal College of Pathologists minimum pathology dataset (MPD), regarded as the 'gold standard', within a population. Retrospective study of the survival of 5947 surgically resected colorectal cancer patients for whom an MPD had been collected. Variables were related to survival. The study population was representative of the Yorkshire colorectal cancer population. Survival was poorer in older patients and colonic tumours and improved over the study period. Local invasion, total number of lymph nodes retrieved, nodal stage, extramural vascular invasion, peritoneal involvement, distance of invasion beyond the muscularis propria, and in rectal cancers, circumferential resection margin involvement and distance to this margin were all validated as of prognostic significance within a population. Failure to report extramural vascular invasion, peritoneal involvement or circumferential resection margin status was associated with a worse survival than absence of the factor. All variables within the Royal College of Pathologists MPD are of prognostic significance. High-quality pathology reports are essential in providing accurate prognostic information and guiding optimal patient management.
Aim The histopathology report is vital to determine the need for adjuvant therapy and prognosis in colorectal cancer (CRC). Completeness of those in text format is inadequate. This study evaluated the improvement of quality of histopathology reports following the introduction of a template proforma, based on standards set by the Royal College of Pathologists (RCP), UK.
Method Sixty-eight consecutive histopathology reports based on 19 items for rectal cancer (RC) and 15 items for colon cancer (CC) using the proforma were prospectively analysed and compared with results of a previous audit of 82 consecutive histopathology reports in text format. The percentage of reports containing a statement for each data item for both series was compared using the Normal test for difference between two proportions. Completeness of each report was assessed and a percentage score (percentage completeness) was given. Mean percentage completeness was calculated for each format and compared using the two sample t-test.
Results Except for comments on the presence of ‘histologically confirmed liver metastases’ in CC and RC, ‘distance from dentate line’ and ‘distance to circumferential margin’ in RC, all other items were commented in more than 90% of reports, where 71% of the items based on the minimum data set were present in all reports. Compared to prose format, the mean percentage completeness (SD) improved from 74% (8) to 91% (4) (P < 0.0001) and from 81% (5) to 99% (1) (P < 0.0001) for RC and CC respectively in template proforma format.
Conclusion A template proforma and surgeon’s contribution in relation to operative findings improves the quality of the histopathology report in CRC.
Cancer pathology reports contain information which is critical for patient management and for cancer surveillance, resource planning, and quality purposes. The College of American Pathologists (CAP) has defined scientifically validated content of checklists that form the basis for synoptic cancer pathology reporting. We outline how the CAP standards were implemented in a large Canadian province over a 3-year period resulting in improvements in rates of synoptic reporting and completeness of cancer pathology reporting.
To investigate the effect of different interventions on the inclusion of data items in the histopathology reports of resected colorectal carcinomas.
272 routine histopathology reports on colorectal carcinomas from the department of histopathology, Royal Hallamshire Hospital, Sheffield.
The presence or absence of 10 specific data items was recorded for each report. The reports were divided into five audit periods. In the initial period reports were generated using free text with no agreed guidelines. In period 2, text guidelines had been issued; in period 3, flow diagram guidelines had been issued; and in periods 4 and 5, template proformas were attached to each specimen request form.
All interventions produced some increase in inclusion rate for some features, but only with the introduction of template proformas did these rates approach 100% for all data items. Inclusion rates were 100% for all items in all cases reported using a proforma. In the final audit period 96% of specimens were reported using proformas.
Template proformas produce a high rate of inclusion of data items in reports of colorectal carcinoma resection specimens.
The aim of this study was to determine whether reporting guidelines and computerised form-based reports improve the completeness of histopathological cancer data available for patient management and population cancer registration and to evaluate the acceptability of the intervention. The study was a randomised controlled trial with a split unit design and stratified cluster randomisation. All 16 hospital pathology laboratories in Wales were randomly allocated to report either breast or colorectal resection specimens by computerised form or conventional free text. 1044 reports were analysed in the study arm, 998 in the control arm. Use of pre-defined forms led to a 28.4% (95% confidence interval (CI): 15.7-41.2%) increase in complete reporting of a minimum dataset required for cancer registration and a 24.5% (95% CI: 11.0-38.0%) increase in complete reporting of minimum data required for patient management. Form-based reporting was acceptable to pathologists and preferred by clinicians. In conclusion, guidelines and computerised forms significantly improve the quality of histopathology reporting.
Histopathological evaluation is a critical component in the management of patients with colorectal cancer (CRC). It is the single most powerful prognostic indicator in CRC and determines if adjuvant chemotherapy is indicated. The aim of this study was to assess if the introduction of a comprehensive standardized pathology proforma improved the quality of histopathology reporting.
A standardized pathology proforma, based on the 1996 minimum dataset for colorectal histopathology reporting, was introduced in our pathology department in 1998. Pathology reports for all colonic resection specimens for 1996 (n = 85) and 2000 (n = 86) were identified, retrieved and entered on to database. Comparison was made with the minimum dataset published in the 1996 guidelines for the management of colorectal cancer.
Demographic details were complete in all cases. Clinical data was incomplete in 57 (67%) patients in 1996 and 63 (73%) in 2000 (ns; chi2). There were 24 (28%) (7 Abdomino-perineal resections (APER)) and 40 (47%) (17 APER's) rectal specimens for 1996 and 2000, respectively. The presence or absence of pathological background abnormalities were commented on in 18 (21%) reports in 1996 and 80 (93%) reports in 2000 (P < 0.01; Fishers exact test (Fisher)). Histological differentiation was commented on in 73 (86%) and 86 (100%) in 1996 and 2000, respectively (P < 0.01; Fisher). Dukes' stage was stated in 33 (39%) reports in 1996 and 86 (100%) in 2000 (P < 0.01; Fisher) but Dukes' stage was calculable in 84 (99%) in 1996 and 86 reports (100%) for 2000 (ns; Fisher). The apical node was commented on in 34 (40%) reports in 1996 and 85 (99%) reports in 2000 (P < 0.01; Fisher). The median (IQR) number of nodes assessed in 1996 was 8 (5-12) compared to 12 (8-17) in 2000 (P < 0.001; Mann-Whitney (MW)). Complete resection was mentioned in 74 (87%) reports in 1996 and 86 (100%) in 2000 (P < 0.01; Fisher). Regarding rectal specimens, the circumferential resection margin (CRM) was commented on in 19 of 24 specimens in 1996 and 38 of 40 specimens in 2000 (ns; Fisher). Relationship to the peritoneal reflection was commented on in 1 (1%) rectal specimen in 1996 and 30 (35%) in 2000 (P < 0.001; Fisher).
The introduction of a standardized proforma for reporting CRC resection specimens improves the quality of histopathological reporting. This aids decision-making regarding adjuvant chemotherapy or radiotherapy and further surveillance.
Advances in information technology have made electronic systems productive tools for pathology report generation. Structured data formats are recommended for better understanding of pathology reports by clinicians and for retrieval of pathology reports. Suitable formats need to be developed to include structured data elements for report generation in electronic systems.
To conform to the requirement of protocol-based reporting and to provide uniform and standardized data entry and retrieval, we developed a synoptic reporting system for generation of bone marrow cytology and histology reports for incorporation into our hospital information system.
A combination of macro text, short preformatted templates of tabular data entry sheets, and canned files was developed using a text editor enabling protocol-based input. The system is flexible and has facility for appending free text entry. It also incorporates SNOMED coding and codes for teaching, research, and internal auditing.
This synoptic reporting system is easy to use and adaptable. Features and advantages include pick-up text with defined choices, flexibility for appending free text, facility for data entry for protocol-based reports for research use, standardized and uniform format of reporting, comparable follow-up reports, minimized typographical and transcription errors, and saving on reporting time, thus helping shorten the turnaround time.
Simple structured pathology report templates are a powerful means for supporting uniformity in reporting as well as subsequent data viewing and extraction, particularly suitable to computerized reporting.
Although the synoptic format is being increasingly used for primary cutaneous melanoma pathology reporting, no study assessing its value has yet been reported in the literature. The aim was to determine whether the use of synoptic reports increases the frequency with which pathological features that may influence prognosis and guide management are documented.
Melanoma pathology reports (n = 1692) were evaluated; 904 were in a synoptic format [671 Sydney Melanoma Unit (SMU) reports and 233 non-SMU reports] and 788 were non-synoptic (184 SMU reports and 604 non-SMU reports). Reports (n = 1354) from 677 patients who had both a SMU report and a non-SMU report were compared. Almost all features were reported more frequently in synoptic than in non-synoptic reports (P < 0.001). No significant differences were found in the frequency of reporting the main pathological features between SMU and non-SMU synoptic reports. Synoptic reports were more frequently used by SMU (78%) than by non-SMU pathologists (28%).
This is the first study to provide objective evidence that synoptic pathology reports for melanoma are more complete than non-synoptic reports (regardless of whether the reports are generated within or outside a specialist melanoma centre). All synoptic reports should include the facility for free text, be tailored to individual institutional requirements and be updated regularly to be of maximal value.
Both individual patient treatment and cancer registries depend on adequate histopathology reports. To ensure the quality of these reports, professional organizations have published guidelines on minimum data sets for various cancer types. Norway has a population of 4.6 million, and all individuals have a unique identification number. As required by law, relevant information on cancer is submitted to the Cancer Registry of Norway. A closed, national health data network has been established facilitating electronic transferal between various institutions. The Cancer Registry and the Norwegian Society for Pathology have jointly established a nationwide project to (i) develop standardized templates in database format for histopathology reports on cancer resection specimens and (ii) develop an Extensible Markup Language (XML) standard to facilitate future electronic transfer of cancer reports from hospitals to the Cancer Registry. A minimum data set template for reporting colorectal carcinoma resection specimens and the Extensible Markup Language standard have been established. The template is based on international guidelines and classification systems. For most key parameters, pull-down menus with predefined alternatives have been constructed. The template is fully integrated into software being used by all pathology laboratories in Norway. Since the introduction of the template in April 2005, the template had been used for reporting 430 (93%) of 462 colorectal resections at 2 pilot laboratories (Akershus University Hospital [Lørenskog, Norway] and Stavanger, University Hospital [Stavanger, Norway]), demonstrating that high and consistent quality can be ascertained. Pathologists have found the template both time saving and user friendly. The template is now gradually implemented nationwide.
Guidelines for reporting malignant tumours (Norwegian; Veileder i biopsibesvarelse av maligne svulster)
- V Isaksen
- H Aarset
- V Abeler
Isaksen V, Aarset H, Abeler V, et al. Guidelines for reporting malignant tumours (Norwegian; Veileder i biopsibesvarelse av maligne svulster). 2001;1:1-82.