Synoptic Reporting: Evidence-Based Review and Future Directions

Synoptic reporting is a process for reporting specific data elements in a specific format in surgical pathology reports. Previously, surgical pathology reports were free text, highly narrative, and prone to omission of necessary data and inconsistencies in formatting.1 Synoptic reporting not only ensures that all reports contain all necessary data elements, but also is amenable to scalable data capture, interoperability, and exchange. Efforts are ongoing to create national2 and international3-7 health care meaningful use standards by using cancer registries and health information exchanges for storing and accessing data. Ideally, data will be fed dynamically and seamlessly into and out of these data exchanges by using lean and streamlined automated processes. In practice, the College of American Pathologists (CAP) has been promoting synoptic reporting for > 20 years,8 has published protocols with both required and optional data elements for at least a decade, and has required reporting of these elements for the past 2 years as part of its Laboratory Accreditation Program (LAP) checklist.9 The contents of the CAP protocols along with the contents of the American Joint Commission on Cancer (AJCC) TMN staging system, which the protocols use, are both copyright protected. The AJCC copyright includes all computable representations of its TNM staging system, which raises issues to be discussed later. Internationally, the Royal College of Pathology (United Kingdom), the Royal College of Pathology Australasia, the European Task Force for Structured Reporting, the American Society of Clinical Pathologists, the Canadian Association of Pathologists, and CAP have worked with the International Collaboration on Cancer Reporting to produce a standard data set for the international community.3-7 A detailed road map was outlined by those involved in the CAP effort, which went from free-text narrative reports (level 1), to synoptic reporting (level 3), toward fully structured reporting. The final product includes discrete data embedded in laboratory information systems (LISs) and structured messaging/data exchange standards (level 6).10,11 Synoptic reporting has many different connotations, which depend on the stakeholder. For practicing pathologists, synoptic reporting refers to specific elements in the cancer protocols and a specific format required by the CAP LAP checklist.9 For clinicians, synoptic reporting provides a checklist that ensures completeness of reported data elements. For registrars, researchers, and data scientists, synoptic reporting denotes a means to populate structured databases. Although substantial overlap exists, the requirements for these various stakeholders can differ. This review details the components of synoptic reporting that affect its utility for these stakeholders and the components of synoptic reporting from the perspective that synoptic reporting actually exist as two layers. These layers comprise a front-end presentation layer and a back-end computational data layer. This understanding becomes sharper as components of synoptic reporting are discussed in context throughout this review.