What impact has the introduction of a synoptic report for rectal cancer had on reporting outcomes for specialist gastrointestinal and nongastrointestinal pathologists?

  • Messenger D
  • McLeod R
  • Kirsch R
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CONTEXT: Synoptic pathology reports increase the completeness of reporting for colorectal cancer. Despite the perceived superiority of specialist reporting, service demands dictate that general pathologists report colorectal cancer specimens in many centers. OBJECTIVE: To determine differences in the completeness of rectal cancer reporting between specialist gastrointestinal and nongastrointestinal pathologists in both the narrative and synoptic formats. DESIGN: Pathology reports from rectal cancer resections performed between 1997 and 2008 were reviewed. A standardized, synoptic report was formally introduced in 2001. Reports were assessed for completeness according to 10 mandatory elements from the College of American Pathologists checklist. RESULTS: Overall, synoptic reports (n = 315) were more complete than narrative reports (n = 183) for TNM stage, distance to the circumferential radial margin, tumor grade, lymphovascular invasion, extramural venous invasion, perineural invasion, and regional deposits (all P < .01). Compared with those by nonspecialist pathologists, narrative reports by gastrointestinal pathologists were more complete for lymphovascular invasion (59.3% versus 35.9%, P = .02) and extramural venous invasion (70.4% versus 35.9%, P = .001), but there was no difference in completeness once a synoptic report was adopted. Gastrointestinal pathologists tended to report the presence of extramural venous invasion more frequently in both the narrative (18.5% versus 5.1%, P = .01) and synoptic formats (25.5% versus 14.6%, P = .02). CONCLUSIONS: Completeness of reporting, irrespective of subspecialist interest, was dramatically increased by the use of a synoptic report. Improvements in completeness were most pronounced among nongastrointestinal pathologists, enabling them to attain a level of report completeness comparable to that of gastrointestinal pathologists. Further studies are required to determine whether there are actual discrepancies in the detection of prognostic features between specialist gastrointestinal and nongastrointestinal pathologists.

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  • David E. Messenger

  • Robin S. McLeod

  • Richard Kirsch

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