From synoptic to structured reporting: real-world implementation and evaluation of a pathology reporting tool in lung cancer

Structured reporting in pathology can enhance data quality and interoperability through standardized terminologies; however, its integration into routine practice remains limited as structured reporting systems are frequently perceived as disruptive to established workflows. Although synoptic templates are widely implemented, they represent only an intermediate stage of digital maturity and do not ensure interoperable data. Evidence regarding real-world implementation and usability remains scarce. This study evaluates the impact of structured reporting on data completeness, reporting accuracy, and user adoption in routine lung cancer pathology reporting. A structured pathology reporting tool (SynReport, Celerato AG) was evaluated in two phases. In the validation phase, data from 123 conventional (synoptic) lung cancer resection reports were retrospectively re-entered into the tool. In the implementation phase, the tool was integrated into routine diagnostics with optional use over one year (n = 151). Report completeness was evaluated against ICCR core elements and adoption was measured by voluntary usage rates. Retrospective analysis identified 33 missing or inconsistent data elements (98.4% completeness) in the re-entered conventional reports, including six TNM classification errors, none of which occurred when using the tool. During routine implementation (n = 151), pathologists used the structured reporting tool in 90.1% of the cases (n = 136), achieving 99.9% completeness, whereas the remaining conventional reports contained multiple omissions (n = 11). Structured reporting achieved high voluntary adoption in routine practice while improving data completeness and reducing errors. This study demonstrates that structured reporting can be integrated into daily workflows and represents a practical step toward interoperable and data-driven pathology.