To the Editor.–The College of American Pathologists (CAP) has helped develop synoptic reports for cancers in different organ systems. These reports have been created to provide uniform data for tumor characteristics and staging to assist our clinical colleagues in treating their patients. In the past few years we have seen the development of targeted therapy for mutations or structural abnormalities in solid tumors. The molecular assays for these therapies often require the choice of a block with the highest tumor percentage in a biopsy, resection, or metastasis specimen.

This task frequently requires going back to a case that may be several years old to choose a block, a process that takes time in a busy schedule making primary diagnoses. In the past, surgical pathology reports have not been written to accommodate this type of testing. The CAP held a companion symposium titled “Bridging the Divide Between Molecular and Surgical Pathology” at the United States and Canadian Association of Pathology meeting in Vancouver, British Columbia, Canada, in March 2012. At that symposium, I made the recommendation that it would be beneficial for synoptic reports to include an identification of the best block(s) with the highest percentage of tumor cells (recording the percentage). If the designation of 1 or more blocks is done in the synoptic report, it will save time for block selection by the surgical pathologist, the covering person when one is on vacation or has left the practice, or the molecular pathologist. The best time to record a good block is when all the sides of a case are evaluated the first time, along with any adjunctive immunohistochemical stains. Some pathologists may be concerned that such an action may obviate the Current Procedural Terminology code for archival selection of tissue material (88363). An informed decision still needs to be made, as the best choice of a block is dependent on the tumor type, the specific assay requirements, and the material available (biopsy, resection of primary tumor, or metastatic lesion). I think the synoptic report change will benefit everyone: surgical pathologists, molecular pathologists, and other laboratory professionals, and most of all, the patient; it will help get the best molecular answer in the shortest time possible.