Cancer pathology reports contain information which is critical for patient management and for cancer surveillance, resource planning, and quality purposes. The College of American Pathologists (CAP) has defined scientifically validated content of checklists that form the basis for synoptic cancer pathology reporting. We outline how the CAP standards were implemented in a large Canadian province over a 3-year period resulting in improvements in rates of synoptic reporting and completeness of cancer pathology reporting.J. Surg. Oncol. 2009;99:517-524. ß 2009 Wiley-Liss, Inc. KEY WORDS: cancer pathology; standardization; synoptics; population study; outcomes INTRODUCTIONThe great majority of cancers are diagnosed through the combined efforts of surgeons and pathologists. A clear and thorough recording of the surgical and pathological findings allows assessment of diagnosis and prognosis, and thus facilitates treatment decisions for patients. In recent years, the complexity of cancer pathology reporting has significantly increased. The adequate surgical pathology report not only documents the presence and accurate typing of cancer but also contains information related to tumor grade, size, local extent, vessel involvement, marginal status along with other morphologic and sometimes ancillary results including tumor markers. In some tumor types, for instance breast cancer, the list of carcinoma descriptors can be quite daunting [1].There are four essential elements of quality in cancer pathology reporting: timeliness, accuracy, completeness, and usability. The timeliness or turnaround time of a cancer pathology report is clearly important as is the accuracy of the diagnostic and prognostic observations. The completeness of a cancer pathology report relative to an accepted standard is also an important reflection of overall quality. Cancer pathology reports should be timely, correct, and contain all the relevant information required for diagnosis, prognosis, and further treatment decisions. A fourth dimension of quality is the usability or accessibility of the data in the report.There is a spectrum of cancer pathology reporting which is shown in Table I. The range includes simple narrative reporting using a single text field of data without mandatory scientifically validated data elements as defined by the College of American Pathologists (CAP) (level 1 reporting) to sophisticated synoptic reporting with drop down menus, standardized language, discrete data fields, and automated ICD-O and/or SNOMED CT encoding (level 6). In practice most cancer pathology reports lie somewhere in the middle.Cancer pathology reports given in a synoptic format are intuitively easier to decipher than ones that are presented in a narrative or paragraphic style, minimizing the risk of misinterpretation and clinical error. Synoptic reporting can save time since all important diagnostic and prognostic factors are laid out in a list or table with headers and responses rather than being buried in paragraphic text fields. While cancer patholog...