At the just completed ASCP annual conference in Tampa, Dr. Liron Pantanowitz discussed how he and colleagues in the pathology department at the University of Pittsburgh School of Medicine have developed a new type of pathology report for solid tumors and FNAs. It's called the comprehensive theranostic summary (CTS). Theranostic is a blend of the words therapeutic and diagnostic and is applied here to a report that incorporates both diagnostic and therapeutic features. Pathology generates the CTS as an addendum to its solid tumors and FNA reports, creating a useful summary for clinicians of all of the ancillary prognostic/therapeutic findings for a patient based on IHC, FISH and molecular testing.
As I have commented in previous notes and lectures, we need to aggressively pursue integration of information from all of the diagnostic specialties, particularly pathology and radiology (see: Integrated Diagnostics: Innovations for a Leaner, Greener Healthcare System; Revisiting Integrated Diagnostics and the Integrated Diagnostic Report; Additional Discussion about Integrated Diagnostic Testing). However and in the short term, we should pay the most attention to the integration of test results from our own disciplines of surgical pathology, surgical pathology, and clinical pathology (see: Integrated Diagnostics and Its Relationship to Digital Pathology: A Strategic Analysis). Along these same lines, I have also previously proposed in Lab Soft News the development of integrated diagnostic centers (IDCs) staffed by both pathologists and radiologists and designed for the rapid analysis of undiagnosed tumor masses (see: A Call for the Development of Integrated Diagnostic Centers; More on Integrated Diagnostic Centers; Trend or Lukewarm Idea?). With the CTS, Pitt pathologists provide an integrated report to their test-ordering physicians for whom combing through the voluminous electronic record for a patient may lead to omissions and mistakes.
In my view, the CTS, as it stands now, is more of an integrated diagnostic report without much therapeutic information. However, this problem will soon be remedied as cancer genomics rapidly expands (see: IT Support for Cancer Genomics; Moving to Practical Clinical Solutions; Identifying Therapeutically Relevant Genetic Abnormalities in Cancer Patients). Pathologists will soon be able to supply therapeutic recommendations about optimal cancer treatment and the CTR will be able to "grow into its name."
In order to product the CTS for relevant cases, Pitt currently uses a customized manual process based on the synoptic reporting feature of CopathPlus by Cerner. In other words, the pathologists select the relevant ancillary test results for a patient and insert them into a synoptic template. To make this type of specialized report scalable in the future, Pitt intends to work with the CopathPlus developers to automate the process. I should note parenthetically that requiring pathologists to generate the CTS using a manual process has the salutary effect of raising to their highest level of consciousness all of the additional relevant information necessary to make a diagnosis including IHC, FISH, and molecular testing. A discussion of the concept and impact of the Pitt CTS reports has been published by Liron and colleagues in two abstracts:
Pantanowitz L, Yousem S, Piccoli A, Roy, Kelly S, Wiehagen L, Parwani AV. Evaluation of comprehensive theranostic reporting in Anatomic Pathology. Archives Pathology Laboratory Medicine 2013; 137(10): 1522.
Pantanowitz L, Wiehagen L, Monaco S, Yousem S, Piccoli A, Parwani A. Comprehensive Theranostic Summary (CTS) reports for thoracic cytopathology. Journal of the American Society of Cytopathology. 2014; 3(5):S83