Standardized Structured Reporting (SSR) in Pathology: Part Two

In part one of Standardized Structured Reporting (SSR) in Pathology, Dr. Snehal Sonawane explained the importance of SSR and why it matters today and for the future of pathology. In part two, Dr. Sonawane discusses benefits and challenges of SSR and talks about the direction of SSR and pathology moving forward.

Pros and cons of SSR Depending on the stakeholder, synoptic reporting provides different benefits. From the perspective of practicing pathologists, the CAP cancer checklist provides discrete data elements in a specific format. It provides a consistent vocabulary and uniform language, which helps to reduce ambiguity and error rate. From an oncologist's perspective, standardized reporting provides a checklist that ensures completeness. For the researchers, it provides a means to populate a structured database. Structured reports use consistent vocabulary and terms used more consistently, thus allows data mining, research, and quality improvement. SSR provides an opportunity to create and analyze the benchmarks among various institutions. It increases intraobserver and interobserver agreement and interoperability. Various studies have shown that synoptic reporting is associated with a higher degree of satisfaction among its various users such as pathologists, surgeons, and oncologists due to improved completeness and easy decision-making (7). Structured reports provide a live guide for the recommendations and guidelines, leading to incremental adherence, which ultimately promotes evidence-based medicine, improves patient care quality, and improves clinical performance.

Finally, SSR facilitates information retrieval and data exchange: SSR allows data extraction and allows improved natural language search. Such data retrieval is key for various uses like research, clinical trials, cancer surveillance, education, public and population health and data analytics, quality assurance, and health system planning (8).

Although SSR has the above-listed benefits, there are various challenges associated with SSR. The limitations include resistance to change with pathologists possibly thinking that they lose their right to express their thoughts with the rigidity of the checklists. The pathologist may perceive it as additional work and increase the time needed to report a given case. Some of the applications are click-heavy and may not be user-friendly so users may have a time-consuming learning curve. The synoptic reporting tools come with additional cost and investment and do not make an attractive business case.

Barriers and facilitators of SSR The main facilitator of the SSR is improved communication during multidisciplinary team meetings (9). The barriers to implement SSR are related to lack of knowledge, incompatibility associated with SSR, lack of support from the multidisciplinary teams, and it is perceived as extra work. Various studies have reported that adoption of the SSR requires adjustment in LIS vendors, change in workflow, and unequal distribution of the related cost among lab, registry, hospital, and other stakeholders. The lack of uniform policies regarding SSR use is also a key barrier to the implantation of SSR. Implementation considerations and future directions Although there are various efforts to implement SSR in pathology, all the current efforts are directed towards standardization of the cancer reports. There is much less or virtually no such effort yet to standardize the non-malignant/benign reports, the clinical pathology reports and hematopathology or transfusion medicine reports. The standardization in the clinical pathology, hematopathology, and cytopathology areas is also in preliminary phases even though standardized guidelines are available, e.g., guidelines for reporting of cervical cytology (Bethesda System), urine cytology (Paris System). There are no guidelines about how these reports should be entered in the electronic format.

Pathology reports other than a synoptic cancer checklist has various other components which include special stains, various ancillary testing results, addendums, amendments, and molecular testing results. Currently, there are no guidelines or standards for reporting these components. There are a lot of opportunities to develop standards and guidelines for interoperable data elements in these areas. There are rare scenarios when the synoptic protocols may not be of service, for example, in cases with collision tumors (two different histologic tumor types). In these cases, a dilemma may arise regarding which templates should be utilized and how to incorporate findings of both tumors using the same template (10).

The length of the synoptic reports is increasing day by day, which is also a factor for decreasing completeness and leads to compromised accuracy of the reports. There are essential and non-required elements in the synoptic reports that add more confusion for pathologists while reporting out the data elements and appear problematic for oncologists and surgeons as they do not know how and where to use them. To address this issue, the pathologist associations should collaborate with the various vendors to implement user-friendly interfaces with essential data points, and the additional information should be made available when required. The software’s often struggle to keep up with updates and new versions of the CAP checklists.

Overall, a large amount of work needs to be done to take the SSR in pathology to level 6. If used wisely, the SSR in pathology has a tremendous potential to improve patient care, population and public health. SSR will allow to create data mining and bioinformatics tools which can play a crucial role in improving population and public health and has a potential to take the future of medicine to the next level.

We’d like to give our heartfelt thanks to Dr. Sonawane for sharing her thoughts on SSR. Is there a topic you are particularly knowledgeable about? We are looking for experts in all specialties to be guest bloggers. What will you write about? If it matters to you as a pathologist, then it matters to us and we want to share it with the larger pathology and medical community through our blog. Just email Kristin at and let’s chat.

Built on the vision of better patient outcomes, Instapath was founded in 2017 by engineers and scientists to enable patients to immediately know their cancer diagnosis. Our team made it our mission to develop fast and easy digital pathology technology so diagnosis can be made in minutes instead of days. To learn more about Instapath and our technology, visit www.instapathbio.comor contact us at





4. Ellis DW, Srigley J. Does standardized structured reporting contribute to quality in diagnostic pathology? The importance of evidence-based datasets. Virchows Arch. 2016 Jan;468(1):51–9.

5. Vanda F. Torous, Ross W. Simpson, Jyoti P. Balani, Alexander S. Baras, Michael A. Berman, George G. Birdsong, Giovanna A. Giannico, Gladwell P. Paner, Jason R. Pettus, Zack Sessions, S. Joseph Sirintrapun, John R. Srigley, and Samantha Spencer, College of American Pathologists Cancer Protocols: From Optimizing Cancer Patient Care to Facilitating Interoperable Reporting and Downstream Data Use; JCO Clinical Cancer Informatics 2021:5, 47-55


7. Lankshear S, Srigley J, McGowan T, Yurcan M, Sawka C. Standardized synoptic cancer pathology reports - so what and who cares? A population-based satisfaction survey of 970 pathologists, surgeons, and oncologists. Arch Pathol Lab Med. 2013 Nov;137(11):1599–602.

8. Torous VF, Simpson RW, Balani JP, Baras AS, Berman MA, Birdsong GG, Giannico GA, Paner GP, Pettus JR, Sessions Z, Sirintrapun SJ, Srigley JR, Spencer S. College of American Pathologists Cancer Protocols: From Optimizing Cancer Patient Care to Facilitating Interoperable Reporting and Downstream Data Use. JCO Clin Cancer Inform. 2021 Jan;5:47-55. DOI: 10.1200/CCI.20.00104. PMID: 33439728.

9. Swillens JEM, Sluijter CE, Overbeek LIH, Nagtegaal ID, Hermens RPMG. Identification of barriers and facilitators in nationwide implementation of standardized structured reporting in pathology: a mixed-method study. Virchows Arch. 2019 Nov;475(5):551-561. DOI: 10.1007/s00428-019-02609-6.

10. Hewer E. The Oncologist's Guide to Synoptic Reporting: A Primer. Oncology. 2020;98(6):396-402. DOI: 10.1159/000500884. Epub 2019 Jun 7. PMID: 3117726