Structured Pathology Reporting of Cancer

The goal of the National Structured Pathology Reporting of Cancer (SPRC) Project is to develop a suite of standardised cancer protocols that will, when implemented, provide more consistent and comprehensive pathology reporting of cancer.

In June 2007, a National Round Table was held to discuss the use of structured pathology reporting of cancer throughout Australia. All who were present at The Round Table agreed that structured reporting of cancer cases in anatomical pathology and haematology is likely to contribute to better cancer control through improvements in:

  • Clinical management and treatment planning
  • Cancer notification, registration and aggregated analyses
  • Research.

The Cancer Institute NSW secured funding in February 2008 from the Department of Health & Ageing (Quality Use of Pathology Programs) to work with the Royal College of Pathologists of Australasia (RCPA) and Cancer Australia to develop an initial 6 reporting protocols (lung, melanoma, breast, colorectal, lymphoma and prostate) and a framework to guide development of the protocols, in partnership with national clinician and pathologist organisations.

Subsequent rounds of funding from the Department of Health (Quality Use of Pathology Programs) have been awarded to promote and expand the use of structured reporting of cancer. This program of work is being overseen by the RCPA with clinical consultation with the Cancer Institute, and in conjunction with Cancer Australia.

To build on internationally standardised evidence-based consensus standards and guidelines in cancer reporting – reviewed by local experts - adapted to meet local needs.

To standardise evidence-based cancer reporting in Australasia for world-class patient care and to maintain highest-level patient outcomes.

Representative expert-panels of anatomical pathologists and clinical specialists develop open-access best-practice RCPA protocols for pathologists and trainees, for the purpose of encouraging standardised structured reporting in Australasia.

Nationwide implementation of structured pathology reporting of cancer improves patient survival outcomes. International1-15 and national16, 17 scientific evidence shows structured reporting protocols achieve this by:

  1. Acting as a mechanism to enhance national awareness of critical issues in pathology assessment, and
  2. Encourage standardisation of pathology information for highest-level communication.

Why have RCPA structured reporting protocols?

Local protocols to meet local needs

  • The purpose of the International Collaboration on Cancer Reporting (ICCR) (of which the RCPA is a founding member) is to only develop minimum datasets that can be used globally, including in countries with limited resources.
  • RCPA protocols broadly adopt all core ICCR content - but add bespoke detail for local routine pathology practice in Australasia (including best-practice guidance for pre-analytical, macroscopic, and ancillary studies; example reports; example request forms; and practice audits) at a level of detail that is not possible by the ICCR.
  • Local protocols are important for local implementation, to meet local demographic needs, and local policy directions, that is not possible by the ICCR (e.g., melanoma reporting needs, indigenous and Māori reporting needs, incorporating Australian and New Zealand molecular guidelines, registry awareness, details relevant to the Australian Medicare Benefit Schedule and National Cancer Screening Programs).
  • RCPA protocols provide guidance on new techniques and practices that may not yet be well-established globally (e.g., ancillary tests such as HPV-testing in cervical neoplasms as well as targeted and routine molecular testing, including Next Generation Sequencing).


Drive advances in best-practice pathology

  • Drive and lead advances in best-practice pathology guidelines that have a global impact for international reporting.
  • RCPA SPRC Project provides resources that are helpful for trainees and early career pathologists, and can more swiftly provide guidance on new techniques and practices that may not yet be established globally.
  • The RCPA SPRC Project has championed the development of best-practice guidelines for: fixation of tissues, HER2 testing, merkel cell carcinoma reports, endoscopic resection reports, and pathologist participation in multidisciplinary team meetings.
  • Strive for locally tailored best-practice quality standards, for safety, performance and accountability. Improve communication to prevent medical errors.

The RCPA SPRC Project has successfully published SPRC protocols covering over 89% of cancers and has been the catalyst for the formation of the ICCR.

The Project has proudly achieved the following:

  1. Grown significantly in popularity and use.
    • For example, the 2019 Survey of Australasian anatomical pathologists found that 91% use structured reporting.
  2. Is an official element of the Pathology Trainee Curriculum.
    • Structured reporting is a requisite anatomical pathology portfolio requirement which requires consultant verification.
  3. Facilitated major international collaborations.
    • The RCPA SPRC Project was instrumental for the first international meeting on structured reporting with the RCPA, RCPath UK, CAP and CPAC - which ultimately resulted in the initiation of the ICCR.
  4. Championed the standardisation cause for cancer reporting on the world stage.
    • RCPA SPRC project has strongly supported the ICCR and promoted the benefits of standardisation and best-practice cancer reporting in publications and scientific meetings around the world.
  5. Met the needs of Australian pathologists to conform to local best-practice pathology.
    • The RCPA has developed local protocols such as the Gastric cancer protocol, which includes bespoke detail useful for local implementation in Australia and New Zealand for ancillary studies such as HER2 testing.
    • Local demographic needs are met for example, in the Polypectomy protocol the type of endoscopic procedures, surgical practices and reporting of polyps is bespoke to Australasian practices.
    • Local policy directions are included, for example the Cervical pre-neoplasia and Cervical cervical cancer protocols included further detail for HPV-testing to assist epidemiological and clinical assessment of the utility of HPV vaccination.
  6. Provided invaluable resources for trainees and early career pathologists for cancer reporting.
    • RCPA protocols summarise the reporting requirements and evidence for trainees and early career pathologists.
  7. Providing guidance on contemporary techniques and advanced practices.
    • The RCPA SPRC Project coordinated webinars with expert pathologists who provided in depth guidance on advanced practices such as lung cancer molecular marker testing and HER2 testing in breast cancer.
  8. Supported the development of professional practice standards that meet the evolving needs of healthcare professionals and patients.
    • For example, the RCPA protocols have supported optimal fixation standards and reporting standards for evolving molecular testing needs.

1.            Baranov NS, Nagtegaal ID, van Grieken NCT, et al. Synoptic reporting increases quality of upper gastrointestinal cancer pathology reports. Virchows Arch 2019;475:255-259.
2.            Beattie GC, McAdam TK, Elliott S, et al. Improvement in quality of colorectal cancer pathology reporting with a standardized proforma--a comparative study. Colorectal Dis 2003;5:558-62.
3.            Buchwald P, Olofsson F, Lörinc E, et al. Standard protocol for assessment of colon cancer improves the quality of pathology. Colorectal Dis 2011;13:e33-6.
4.            Casati B, Bjugn R. Structured electronic template for histopathology reporting on colorectal carcinoma resections: five-year follow-up shows sustainable long-term quality improvement. Arch Pathol Lab Med 2012;136:652-6.
5.            Chan NG, Duggal A, Weir MM, et al. Pathological reporting of colorectal cancer specimens: a retrospective survey in an academic Canadian pathology department. Can J Surg 2008;51:284-8.
6.            Cross SS, Feeley KM, Angel CA. The effect of four interventions on the informational content of histopathology reports of resected colorectal carcinomas. J Clin Pathol 1998;51:481-2.
7.            Hammond EH, Flinner RL. Clinically relevant breast cancer reporting: using process measures to improve anatomic pathology reporting. Arch Pathol Lab Med 1997;121:1171-5.
8.            Ihnát P, Delongová P, Horáček J, et al. The impact of standard protocol implementation on the quality of colorectal cancer pathology reporting. World J Surg 2015;39:259-65.
9.            Messenger DE, McLeod RS, Kirsch R. What impact has the introduction of a synoptic report for rectal cancer had on reporting outcomes for specialist gastrointestinal and nongastrointestinal pathologists? Arch Pathol Lab Med 2011;135:1471-5.
10.         Porter GA, Urquhart RL, Rheaume D, et al. Clinical information available to oncologists in surgically treated rectal cancer: room to improve. Curr Oncol 2013;20:166-72.
11.         Renshaw AA, Gould EW. Comparison of Accuracy and Speed of Information Identification by Nonpathologists in Synoptic Reports With Different Formats. Arch Pathol Lab Med 2017;141:418-422.
12.         Siriwardana PN, Pathmeswaran A, Hewavisenthi J, et al. Histopathology reporting in colorectal cancer: a proforma improves quality. Colorectal Dis 2009;11:849-53.
13.         Sluijter CE, van Workum F, Wiggers T, et al. Improvement of Care in Patients With Colorectal Cancer: Influence of the Introduction of Standardized Structured Reporting for Pathology. JCO Clin Cancer Inform 2019;3:1-12.
14.         Srigley J, Lankshear S, Brierley J, et al. Closing the quality loop: facilitating improvement in oncology practice through timely access to clinical performance indicators. J Oncol Pract 2013;9:e255-61.
15.         Zarbo RJ. Interinstitutional assessment of colorectal carcinoma surgical pathology report adequacy. A College of American Pathologists Q-Probes study of practice patterns from 532 laboratories and 15,940 reports. Arch Pathol Lab Med 1992;116:1113-9.
16.         Gill AJ, Johns AL, Eckstein R, et al. Synoptic reporting improves histopathological assessment of pancreatic resection specimens. Pathology 2009;41:161-7.
17.         Karim RZ, van den Berg KS, Colman MH, et al. The advantage of using a synoptic pathology report format for cutaneous melanoma. Histopathology 2008;52:130-8.

Cancer Protocols

Cancer protocols for many major cancers and reporting guides and forms have been developed.

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Governance

A robust governance model supports the SPR project.

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Implementation

A number of documents are available to provide advice and guidance with implementation.

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International Cytology Guidelines

Endorsed International Cytopathology Standards for reporting

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Macroscopic Cut-Up Manual

A manual for the process of macroscopic dissection in Anatomical Pathology laboratories.

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Newsletters

Keep up with the latest news on the structured reporting project both nationally and internationally via the quarterly newsletters.

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Protocol Development

Each cancer protocol is developed under a quality framework which dictates both how the protocols look as well as what should be included.

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Structured Reporting Webinars

A list of Structured Reporting Webinars.

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06-Aug-2021
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