Absorbing information from a written report is a visual task; those who have studied this issue find that design layout matters [2]. Report layout can make comprehension seem effortless or turn it into an arduous slog. Valenstein [2]showed how four layout principles used by the newspaper industry could be adapted to the report context to aid communication: (1) use headlines to emphasize key points; (2) aim for report-format consistency, across one’s institution and over time; (3) optimize information density; and (4) reduce extraneous information (“clutter”). Renshaw [3] showed that applying some of these principles to cancer template formatting could increase synoptic-completion rates in a high-volume pathology practice.

On opposite sides of the surgical pathology report is the writer, a surgical pathologist (usually, just one) and the reader(s), most of them not pathologists: nonpathologist physicians (surgeons, oncologists, etc.), nonphysician health care providers and, increasingly, the patient. And, if things go wrong, an attorney may join the crowd. The College of American Pathologists (CAP), American Society of Clinical Oncology (ASCO), and the National Cancer Institute (NCI) have informational websites for patients that describe the pathology report and how to read it [4].

In addition to “know your audience,” pathologists can employ other linguistic strategies used by science and other technical writers to communicate complex information to nonscientists. Report-layout aside, the individual practitioner controls the actual content of the diagnostic report and can choose and order words to optimize error-free comprehension.

Narrative or synoptic—which format is better for a diagnostic report? In fact, both are useful, but for different tasks. Narrate derives from the Latin gnarus or knowing, akin to the Latin gnoscere, noscere—to know, meaning to recite the details of (a story); synoptic, derived from the Greek synoptikos, means affording a general view of a whole [5].

Narrative exposition tells a story; because humans are hard-wired to remember stories, diagnoses written as complete or partial sentences will be remembered more easily [6]. A synoptic format summarizes facts in outline-form; it is useful because humans are also hard-wired to forget details. Thus, in composing a surgical pathology report, narrative and synoptic formats are complementary; combining them, where appropriate (e.g., in reporting results of cancer resections), can facilitate both comprehension and completeness.

The meaning of “style” depends on context. Here, it is used to mean a manner of expressing information in words. Style is a tool set for articulating and disseminating complex information in an efficient manner [7, 8]. An effective style in writing surgical pathology reports can make content clear, easy to grasp, and more likely to be understood.

There are two prominent positions in a sentence or paragraph: the beginning and the end. An axiom of scientific writing is to go from what is known to what is new, stating the known at the sentence beginning and the new information at the end [9]. Because reading a surgical pathology report has a different goal and time frame than reading a scientific paper, it is more effective to use the front end of the sentence(s) for delivering critical, new information, i.e., the diagnosis. Context matters—in reports, the most important information should goes first.

Achieving completeness requires knowing what the clinician needs and expects to learn from the report . Earlier customer satisfaction studies showed lack of surgical pathology report completeness and other communication issues were high on the list of clinician’s complaints [10, 11]. Satisfaction with report completeness has improved in recent years, probably because of widespread adoption of cancer synoptics and other checklists [12, 13].

To ensure that complete staging information is recorded for all cancer patients, hospitals seeking American College of Surgeons accreditation must use CAP cancer case summaries or similar for patients receiving initial cancer treatment. The effective cancer summary ensures completeness by putting cancer staging elements for each anatomic site on “auto-pilot”; when optimized, it is a great communication and learning tool.

Completeness is vital, but reports can also have TMI . Nonpathologist clinicians read reports in a highly focused manner, searching for the “actionable” information. Although it can be tempting (especially for early career pathologists) to record every observation, an exhaustive litany of findings is difficult to sort through and may obscure the most important diagnoses. Avoid TMI in the narrative, so that the critical, need-to-know information stands out.

Checklists and cancer synoptics should also be monitored for TMI. Synoptic templates can be modified, as long as mandatory elements are covered [3]. Some “canned” templates that can be electronically downloaded via a laboratory information system are more comprehensive than is useful in daily practice and can be customized to better meet practice needs. Sticking to the shortest list of essentials will ease pathologist compliance and reader comprehension. Renshaw [3] showed that eliminating all optional items, sequentially numbering mandatory items, and a few other small format changes led to a durable 98 % increase in template completeness in their high-volume hospital practice.

In addition to eliminating nonmandatory elements, it is useful to order the essentials in a clinically logical fashion. Prioritize these so that the most clinically actionable information appears at the top-end (the beginning) of the synoptic, where it will be easy to find. Using breast cancer as an example, medical oncologists will focus on the pathologic stage elements—for most patients, invasive cancer size and node status—and predictive marker stain results, because these will dictate systemic treatment. Surgeons care most about margins and results of sentinel node biopsy. Radiation oncologists will focus on margin status, extratumoral lymphatic tumor emboli (LTE) and extracapsular extension of nodal metastasis. Thus, pathologic stage (and its components), predictive marker results, and margin status should lead the synoptic. Invasive carcinoma subtype and modified Bloom–Richardson grade follow, along with LTE. Clinician readers are far less interested in the specimen size and character, the color margins were inked, etc. Where a checklist summary is replacing conventional narrative gross description, these details belong toward the end. Key clinician groups can weigh-in on pruning and reorganizing synoptic templates to make them more useful; this may also ease acceptance of new reporting formats.