Transcript THE DEVELOPMENT OF SYNOPTIC REPORTS FROM FREE …

THE DEVELOPMENT OF SYNOPTIC REPORTS
FROM FREE TEXT CONTENT OF ARCHIVAL
PATHOLOGY REPORTS GENERATED IN THE
ANATOMIC PATHOLOGY LABORATORY
INFORMATION SYSTEM
Purpose of Synoptic
Reports




Structure the information
Structured form facilitates research
queries
Structured form facilitates better
patient care
Structured form facilitates better
sharing of information between
institutions
Example Synoptic Page
Kidney – Genitorurinary
CAP Approved
Surgical Pathology Cancer Case Summary (Checklist)
Protocol revision date: January 2005
Applies to invasive carcinomas only
Based on AJCC/UICC TNM, 6th edition
KIDNEY: Nephrectomy, Partial or Radical
Patient name:
Surgical pathology number:
Note: Check 1 response nuless otherwise indicated.
MACROSCOPIC
Speciman Type
___Partial nephrectomy
___Radical nephrectomy
___Other (specifiy): ________________________________
___Not specified
Laterality
___Right
___Left
___Not specified
*Tumor Site (check all that apply)
*___Upper pole
*___Middle
*___Lower pole
*___Not specified
Focality
___Unifocal
___Multifocal
Tumor Size (largest tumor if multipled)
Greatest dimension:___cm
*Additional dimensions:___x___cm
___Cannot be determined (see comment)
Conversion of Archived
Systems


An institution that changes from free
formatted pathology reports to
synoptic reporting may wish to convert
all archived reports to synoptic form
Is it better to convert archived data by
hand or automatically with respect to:
• Accuracy
• Time
Computer Methods



Search for key words
Use auto-coding vocabularies so that
all (or most) variations of linguistically
equivalent phrases are placed in a
uniform phrase for proper pattern
matching in searches
Use negation algorithms
Special Challenges
(What is the Tumor Site for this case?)
Part A. RECTOSIGMOID COLON ULCER, BIOPSY:
--INFILTRATING MODERATELY DIFFERENTIATED
ADENOCARCINOMA, CONSISTENT WITH COLONIC
ORIGIN, SEE NOTE.
Part C. COLON, LEFT, HEMICOLECTOMY:
--INFILTRATING MODERATELY DIFFERENTIATED
ADENOCARCINOMA OF RECTOSIGMOID COLON,
SEE NOTE.
Which is “Whipple” and which is
“Whipple Pylorous Sparing”?


Received fresh for intraoperative consultation, labeled with
the patient's name, number and "Whipple," is a bloc section
of organs from a Whipple procedure. The specimen consists of
a 24.0 cm. in length duodenum and a 6.2 x 4.3 x 4.0 cm.
remnant of attached pancreas, and a portion of distal
stomach, 6.5 x 2.5 cm.
Received fresh for intraoperative consultation, post-fixed in
formalin, labeled with the patient's name and number, is an
en bloc resection of organs from a Whipple procedure. The
specimen consists of a 21.5 cm. length of duodenum, a 1.5
cm. length of distal common bile duct, and an 8.8 x 6.8 x 6.7
cm. remnant of attached pancreas.
Design of Experiment
To determine the feasibility of automated conversion of
archived reports, we collected all records for the year
2005 and converted them to synoptic form, both
manually and by computer text processing. We then
compared the results for accuracy and the time to
process. The organ sites we studied were:
•Pancreas
•Kidney
•Colon
•Prostate
•Breast
Estimated Accuracy for
Pancreas
Specimen
type
Tumor
Site
Tumor
size
Histologic Histologic
type
Grade
23/25
18/25
19/25
24/25
24/25
92%
72%
76%
96%
96%
Estimated Accuracy for
Kidney
Laterality
Tumor Site Tumor
Size
Histologic
Type
27/27
21/27
7/27
24/27
100%
78%
26%
89%
Estimated Accuracy for
Colon
Tumor Site
Tumor Size
Histologic
Type
40/75
42/75
74/75
53%
56%
99%
Estimated Accuracy for
Prostate
Histologic
Type
Gleason
Primary
Gleason
Gleason
Secondary Total
49/50
48/50
48/50
48/50
98%
96%
96%
96%
Estimated Accuracy for
Breast
BloomRichardson
grade
Mitotic Score
Angiolymphatic
Invasion
100%
100%
100%
Estimated Time for
Computer Conversion
The average time to develop the
text processing code was
approximately 4-6 hours per
organ. The first organ took the
longest time, the others were rewritten from the first.
Estimated Time for a Trained
Pathologist to convert archive
reports to synoptic reports
Pancreas
Total Time Number of Average
Cases
Time
N/A
N/A
N/A
Colon
9:27:48
72
7:53
Breast
4:46:46
48
5:58
Kidney
3:57:23
32
7:25
30
7:17
Prostate
3:38:30
Conclusion




Less than 40-60 cases, a trained pathologist
is quicker.
More than 40-60 cases, automated text
processing is quicker.
Attempts to improve the accuracy will
increase this time.
For archived systems with a very long
history and a large volume of patients,
automated processing may be preferred.
Acknowledgements
We wish to thank the following for
their participation in this project:
•Ashok Patel
•Doug Hartman
•John Gilbertson
•Robert Lanese
•Rajnish Gupta