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Synoptic Pathology Reporting

Synoptic pathology reporting uses an electronic report in discrete data field format. That means each type of information has a specific place and format in the report. Synoptic reports standardize the way data is collected, transmitted, stored, retrieved and shared between clinical information systems.

For a list of specific features that define synoptic reporting format, please visit The College of American Pathologists.

Levels of Standardized Pathology Reporting

In Ontario, since 2004, pathology reporting has evolved from the traditional narrative structure to Level 6 pathology reporting based on the CAP content standard and NAACCR Volume V messaging and format standard. These are outlined in Cancer Care Ontario’s Data Book.


Proportion of Ontario Hospitals Reporting Cancer Pathology to Cancer Care Ontario, by Level of Standardization, from Narrative to Synoptic Format

Reporting level

Level 1 Level 2 level 3 level 4 level 5 level 6


No CAP content

Single text field data


No CAP content

Single text field data

Level 2+

Synoptic-like structured format

Level 3+

Electronic reporting tools using drop-down menus

Level 4+

Standardized reporting language

Data elements stored in discrete data fields

Level 5+

Common data and messaging standards with ckeys, SNOMED CT or other encoding

% Ontario Hospitals
2004 - 05

5%  40%  50% 5%  0%  0% 

% Ontario Hospitals 
2006 - 07

0%  5%  70% 25%  0%  0% 

% Ontario Hospitals
2008 - 09

0%  0% 65%  17%  18%  0%

% Ontario Hospitals
2009 -10

0%  0%  20%  2%  78%  0%

% Ontario Hospitals
January 2012

0%  0%  8%  0%  0%  92%

% Ontario Hospitals
may 2012

0%  0%  3%  0%  0%  97%

% Ontario Hospitals
October 2015

0% 0% 0%  0%  0%  100%

Data Source: CCO ePath
Notes: Ontario hospitals includes 119 acute care facilities – primary and secondary. Primary sites submit cancer pathology reports directly to CCO Ontario Cancer Registry via CCO ePath system. Primary sites may also report cancer pathology for secondary hospitals. Private labs and Paediatric facilities are not included.

College of American Pathologists Cancer Checklist Standards

Ontario has endorsed the College of American Pathologists (CAP) cancer checklists as the content standard for pathology reporting based on these benefits:

  • The checklists were derived by the CAP Cancer Committee, with extensive input from leading interdisciplinary disease site experts across North America, using the most currently available research and evidence.
  • The checklists comprise evidence-based protocols and lists of criteria.
  • The Canadian Association of Pathologists has endorsed the CAP checklists as the pan-Canadian standard for synoptic pathology reporting, as of July 2009.

Mandated Checklists

All data for this table was last updated on: August 17, 2017

Body SystemMandated electronic Cancer Checklist (eCC)Accepted eCC Release VersionsCAP Original Release DateEffective Date
Bone and Soft TissueBONE: Resection3.000.001Jun-17Apr-18
Bone and Soft TissueSOFT TISSUE: Resection3.000.001Jun-17Apr-18
BreastDCIS OF THE BREAST2.000.001Jun-17Apr-18
Central Nervous SystemBRAIN/SPINAL CORD: Biopsy/Resection2.006.001Jan-15Apr-18
GastrointestinalAMPULLA OF VATER: Ampullectomy, Pancreaticoduodenectomy (Whipple Resection)3.000.002Jul-17Apr-18
GastrointestinalANUS: Abdominoperineal Resection3.001.002Jul-17Apr-18
GastrointestinalAPPENDIX, NEUROENDOCRINE TUMOR (CARCINOID TUMORS): Excision (Appendectomy) or Resection2.000.002Jul-17Apr-18
GastrointestinalAPPENDIX: Resection (Appendectomy with or without right hemicolectomy)3.000.001Jun-17Apr-18
GastrointestinalCOLON AND RECTUM NEUROENDOCRINE TUMORS (Carcinoid Tumors): Resection, Including Transanal Disk Excision of Rectal Neoplasms2.000.002Jun-17Apr-18
GastrointestinalCOLON AND RECTUM: Excisional Biopsy (Polypectomy)2.007.001n/an/a
GastrointestinalCOLON AND RECTUM: Resection, Including Transanal Disk Excision of Rectal Neoplasms3.000.002Jul-17Apr-18
GastrointestinalDISTAL EXTRAHEPATIC BILE DUCTS: Local or Segmental Resection, Pancreaticoduodenectomy3.001.002Aug-17Apr-18
GastrointestinalNew - DUODENUM AND AMPULLA NEUROENDOCRINE TUMOR1.000.001Jun-17Apr-18
GastrointestinalESOPHAGUS: Endoscopic Resection, Esophagectomy, or Esophagogastrectomy3.000.002Jul-17Apr-18
GastrointestinalGALLBLADDER: Resection/Cholecystectomy3.000.001Jun-17Apr-18
GastrointestinalGASTROINTESTINAL STROMAL TUMOR (GIST): Resection3.000.001Jun-17Apr-18
GastrointestinalHEPATOCELLULAR CARCINOMA: Hepatic Resection3.000.001Jun-17Apr-18
GastrointestinalINTRAHEPATIC BILE DUCTS: Resection2.000.001Jun-17Apr-18
GastrointestinalNew - JEJUNUM AND ILEUM NEUROENDOCRINE TUMOR1.000.001Jul-17Apr-18
GastrointestinalPANCREAS (ENDOCRINE): Resection3.000.002Jul-17Apr-18
GastrointestinalPANCREAS (EXOCRINE): Resection3.000.002Jul-17Apr-18
GastrointestinalPERIHILAR BILE DUCTS: Local or Segmental Resection, Hilar Resection with or without Hepatic Resection2.000.002Jul-17Apr-18
GastrointestinalSMALL INTESTINE: Segmental Resection, Pancreaticoduodenectomy (Whipple Resection)3.000.002Jul-17Apr-18
GastrointestinalSTOMACH, NEUROENDOCRINE TUMORS: Endoscopic Resection, Gastrectomy2.000.002Jul-17Apr-18
GastrointestinalSTOMACH: Local Resection, Gastrectomy3.000.002Jul-17Apr-18
GenitourinaryADRENAL GLAND: Needle biopsy (Core, Incisional, Excisional); Resection3.001.001Jul-17Apr-18
GenitourinaryKIDNEY: Nephrectomy, Partial or Radical3.000.001Jun-17Apr-18
GenitourinaryPENIS: Incisional Biopsy, Excisional Biopsy, Partial Penectomy, Total Penectomy, Circumcision3.000.001Jun-17Apr-18
GenitourinaryPROSTATE GLAND: Radical Prostatectomy3.000.001Jun-17Apr-18
GenitourinaryRENAL PELVIS AND URETER: Resection3.000.001Jun-17Apr-18
GenitourinaryTESTIS: Radical Orchiectomy3.001.001Jul-17Apr-18
GenitourinaryTESTIS: Retroperitoneal Lymphadenectomy3.000.001Jun-17Apr-18
GenitourinaryURETHRA: Partial or Total Urethrectomy; Cystectomy, Cystoprostatectomy; Anterior Exenteration3.000.001Jun-17Apr-18
GenitourinaryURINARY BLADDER: Biopsy and Transurethral Resection of Bladder Tumor (TURBT)1.003.011Oct-13Apr-15
GenitourinaryURINARY BLADDER: Cystectomy, Partial, Total, or Radical; Anterior Exenteration3.000.001Jun-17Apr-18
GynecologicENDOMETRIUM: Hysterectomy, With or Without Other Organs or Tissues3.000.011Jul-17Apr-18
GynecologicOVARY or FALLOPIAN TUBE or PRIMARY PERITONEUM1.000.000Jun-17Apr-18
GynecologicTROPHOBLAST: Dilation and Curettage, Resection3.000.001Jun-17Apr-18
GynecologicUTERUS (SARCOMA): Hysterectomy & Myomectomy, with or without other organs or Tissues2.000.001Jun-17Apr-18
GynecologicUTERINE CERVIX: Trachelectomy, Hysterectomy, Pelvic Exenteration3.000.001Jun-17Apr-18
GynecologicVAGINA: Excisional Biopsy, Resection (Vaginectomy, Radical Vaginectomy)3.000.001Jun-17Apr-18
GynecologicVULVA: Excisional Biopsy, Resection3.000.001Jun-17Apr-18
Head and NeckLARYNX (SUPRAGLOTTIS, GLOTTIS, SUBGLOTTIS): Incisional Biopsy, Excisional Biopsy, Resection3.001.001Jul-17Apr-18
Head and NeckLIP AND ORAL CAVITY: Incisional Biopsy, Excisional Biopsy, Resection3.001.001Jul-17Apr-18
Head and NeckMAJOR SALIVARY GLANDS: Incisional biopsy, Excisional Biopsy, Resection3.000.001Jun-17Apr-18
Head and NeckNASAL CAVITY AND PARANASAL SINUSES: Incisional Biopsy, Excisional Biopsy, Resection3.000.001Jun-17Apr-18
Head and NeckPHARYNX (OROPHARYNX, HYPOPHARYNX, NASOPHARYNX): Incisional Biopsy , Excisional Biopsy, Resection3.000.001Jun-17Apr-18
Head and NeckTHYROID GLAND: Resection4.000.001Jun-17Apr-18
HematologicBONE MARROW: Aspiration, Core (Trephine) Biopsy2.002.001Oct-13Apr-15
HematologicHODGKIN LYMPHOMA: Biopsy, Resection2.001.001Oct-13Apr-15
HematologicNON-HODGKIN LYMPHOMA/LYMPHOID NEOPLASMS: Biopsy, Resection2.003.001Oct-13Apr-15
HematologicOCULAR ADNEXA: Biopsy, Resection1.001.021Apr-15Apr-13
HematologicPLASMA CELL NEOPLASM: Targeted Biopsy, Resection, or Bone Marrow Sampling1.001.001Jul-17Apr-18
SkinMELANOMA OF THE SKIN: Excision, Re-Excision2.000.002Jul-17Apr-18
SkinMELANOMA OF THE SKIN: Biopsy1.000.000Jun-17Apr-18
SkinMERKEL CELL CARCINOMA OF THE SKIN: Incisional Biopsy, Excision, Re-Excision, Lymphadenectomy2.000.001Jun-17Apr-18
ThoraxLUNG: Resection3.000.002Jul-17Apr-18
ThoraxTHYMUS: Resection3.000.001Jun-17Apr-18
BiomarkersBREAST: Biomarker Reporting Template1.001.000Jan-15Apr-18
BiomarkersCOLON AND RECTUM: Biomarker Reporting Template1.001.001Jan-15Apr-18
BiomarkersLUNG: Biomarker Reporting Template1.001.001Jul-16Apr-18
BiomarkersSTOMACH: Gastric HER2 Biomarker Reporting Template1.001.001TBDApr-18
BiomarkersMelanoma: Biomarker Reporting Template2.000.001TBDApr-18

Optional Checklists

All data for this table was last updated on: August 17, 2017

Body SystemExcluded electronic Cancer Checklists (eCC)
Bone and Soft TissueBONE: Biopsy
Bone and Soft TissueSOFT TISSUE: Biopsy
GastrointestinalANUS: Excisional Biopsy or Local Excision (Transanal Disk Excision)
GenitourinaryKIDNEY: Biopsy
GenitourinaryPROSTATE GLAND: Transurethral Prostatic Resection (TUR), Enucleation Specimen (Subtotal Prostatectomy)
GenitourinaryPROSTATE GLAND: Needle Biopsy
GenitourinaryURETER, RENAL PELVIS: Biopsy
GenitourinaryURETHRA: Biopsy
GynecologicUTERINE CERVIX: Excision (Cone/LEEP)
GynecologicVAGINA: Biopsy
OphthalmicRETINOBLASTOMA: Enucleation, Partial or Complete Exenteration
OphthalmicUVEAL MELANOMA: Resection (Local Resection, Enucleation, Limited or Complete Exenteration)
PediatricKIDNEY: Resection for Pediatric Renal Tumor
PediatricNEUROBLASTOMA: Resection, Biopsy
BiomarkerGIST: Biomarker Reporting Template
BiomarkerCNS: Biomarker Reporting Template
BiomarkerChronic Myelogenous Leukemia (CML): Biomarker Reporting Template
BiomarkerMyeloproliferative Neoplasms (MPN): Biomarker Reporting Template
BiomarkerChronic Lymphocytic Leukemia (CLL): Biomarker Reporting Template
BiomarkerDiffuse Large B-Cell Lymphoma (DLBCL): Biomarker Reporting Template
BiomarkerEndometrium: Biomarker Reporting Template
BiomarkerThyroid: Biomarker Reporting Template


Measurement of Quality and Performance in Pathology Reporting

Synoptic pathology data is used by Cancer Care Ontario to report on 5 routine indicators:

  • Pathology data quality indicators:
    •  synoptic reporting rate for mandated eCC templates
    • pathology report completeness
  • Surgical pathology indicators:
    • radical prostatectomy with involved margin
    • colorectal resection lymph node retrieval count
  • Pathology performance indicator:
    • cancer resection turnaround time

Want to earn CME credits? See the Synoptic Pathology Reporting Education section for details.

For more information on synoptic pathology data, please email