Implementing a structured pathology reporting tool during routine lung cancer diagnostics could be associated with more complete pathology reports, fewer classification errors, and high voluntary adoption by pathologists, suggesting it may support more consistent and interoperable pathology reporting.
In a study, researchers evaluated the reporting tool in a two-phase study, first retrospectively re-entering 123 conventional synoptic pathology reports for primary lung cancer resections completed in 2023 into the structured reporting platform to assess completeness and identify discrepancies. They then prospectively integrated the tool into routine diagnostics for a period of 1 year, during which its use remained optional for 151 consecutive lung cancer resection cases.
The outcomes included report completeness based on International Collaboration on Cancer Reporting core data elements, reporting accuracy, and physician adoption of the structured reporting tool. The researchers also assessed the identification of missing or inconsistent report elements and assessment of workflow integration through user feedback.
Among the retrospective reports, the researchers identified 33 missing or inconsistent data elements, corresponding to about 98% completeness. Frequently omitted lung-specific elements included spread through air spaces, pleura invasion, extranodal extension, lymphovascular invasion, lymph node counts, and tumor-to-margin distance. Automated tumor-node-metastasis staging within the structured reporting tool also detected six classification errors in the conventional reports. Four had already been corrected during multidisciplinary review, whereas two were newly identified. However, neither of them changed the overall staging.
During the prospective implementation phase, pathologists used the structured reporting tool in 136 of 151 cases, representing 90% adoption. Structured reporting achieved 99.9% completeness, with only one missing required data element. By comparison, the 15 reports completed using conventional templates during the same period contained 11 missing or inconsistent data elements, including omissions involving spread through air spaces, pleura invasion, grading, and tumor-to-margin distance.
The structured reporting system automatically derived tumor-node-metastasis classifications from entered data and demonstrated complete internal consistency without requiring manual correction. The researchers observed broad uptake among both thoracic specialists and general pathologists, indicating that the tool could be incorporated into routine diagnostic workflows beyond subspecialty practice. Informal feedback suggested that pathologists valued the automated completeness checks, dynamic display of relevant data fields, and automated staging, although some reported additional steps were needed to finalize reports within existing laboratory information systems.
The researchers noted several limitations. The study was conducted at a single institution and was limited to lung cancer resection specimens, which may limit generalizability to other practice settings or disease sites. Workflow efficiency and user satisfaction were not quantitatively evaluated, and integration with electronic health records and external registries remained in progress.
Overall, the findings suggested that structured reporting may improve the completeness and consistency of lung cancer pathology reports while supporting the adoption of interoperable reporting standards.
"Structured reporting substantially improves completeness and consistency in lung cancer pathology compared with template-based approaches," wrote lead study author Martina Haberecker, of the Department of Pathology and Molecular Pathology at the University Hospital Zurich in Switzerland, and colleagues.
The study was supported by the Promedica Stiftung. Full disclosures of the study authors can be found in the study.
Source: Virchows Archiv
