Abstract
In keeping with the WHO 2016 revision of the classification of CNS tumors, we designed a new vehicle for reporting all tissue-based molecular tests within the body of a single surgical pathology report. This Integrated Report for CNS tumors required a novel clinical informatics pipeline to allow faculty members to edit and release component reports into the corresponding surgical pathology report. The Integrated Report is a collaborative document shared among pathology faculty, and final interpretation is issued by the surgical pathologist after consultation with co-authors. A new Integrated Diagnosis portion of the report is generated above the histologic diagnosis, at the top of the original surgical pathology report. Key informatics tools include safeguards against release of partial reports and creation of a digital workspace for collaborative editing. To date 23 integrated reports have been issued for CNS tumors at CHLA, with followup germline testing recommended for three patients. Common alterations identified include KIAA1549-BRAF fusion, TP53 mutation, CDKN2A/B deletion, and MYC amplification. A key component of the success of the Integrated Report was a molecular pathology/histopathology working conference, at which cases are discussed in a round-table format with neuro-oncologists. Inclusion of molecular findings in the report has allowed neuro-oncologists to more readily identify patients eligible for specific clinical trials. Implementation of an Integrated Reporting method requires collaboration within a pathology department and interdisciplinary cooperation from clinical stakeholders. At CHLA the Integrated Report has enhanced diagnostic accuracy and has had a positive impact on patient care.