College of American Pathologists
Bone Marrow Synoptic Reporting for Hematologic Neoplasms
Improve diagnostic and treatment decision making

Bone marrow is a highly complex organ, making it difficult to develop a single reporting template for all bone marrow diseases without introducing an excessive amount of elements. Therefore, this guideline will provide an evidence-based framework for developing bone marrow synoptic reporting for hematologic neoplasms.

Open Comment/Feedback Period

Participate in the Open/Comment Period
The expert panel reviewed over 1,500 articles, examined evidence from more than 300 articles, and participated in a considered judgment process to formulate the draft recommendations presented in this open comment forum.

Participate in the open comment period to offer feedback on draft recommendations and ensure they are clinically sound, practical, and implementable.

The following items should be reviewed in context with the draft recommendations:

Step I: Review the draft recommendations (PDF, 140 KB)

Step II: Take the open comment survey

Step III: Review the following items in context with the draft recommendations:

Submit your feedback on these draft recommendations from April 21 through May 19, 2014.

Review of Comments
The expert panel will consider all comments received before completing the final recommendations which will be published in Archives of Pathology & Laboratory Medicine.

Posting of Comments
Please note, comments are not posted automatically. All comments are posted on a weekly basis beginning Wednesday, April 29 through Wednesday, May 21.

View Latest Survey Results
Download the current survey results and comments (PDF, 302 KB).


Initiatives to enhance the structure, uniformity, and consistency of pathology reports have been promulgated by the College of American Pathologists (CAP) and, in the case of Cancer Protocols, widely supported by important stakeholders such as the American College of Surgeons (ACS) and the American Society of Clinical Oncology (ASCO).

A key element to such enhancements has been the adoption of synoptic reporting principles. There is ample evidence that synoptic reporting has improved accuracy and completeness of relevant data as demonstrated for solid tumors such as colorectal cancer, breast cancer, and lung cancer.

In an era of genomic medicine, our ability to diagnose disease and predict biologic behavior of neoplasms has advanced at breathtaking speed. As a result, clear communication of all relevant positive as well as negative findings is of paramount importance to guide therapy.

In addition to improving communication between health care providers, such initiatives permit easier integration of diagnostic and ancillary testing results into electronic health care records, contingent health care databases and comparability across institutions.

A structured report holds the promise of more meaningful and effective data mining as complexity increases and treatment approaches become more and more tailored to the unique clinical and pathologic attributes of individual patients.

The elements of bone marrow synoptic reporting presented here were derived by assessing evidence levels to queries generated by the expert panel and fell into the following broad categories: specimen-level data elements to report, report format, and patient-level data elements to document.

It should be noted that the adoption of synoptic reporting guidelines does not exclude incorporation of additional information/sections in the report to document diagnostic issues or explanatory narratives. Rather, synoptic reporting assures that critical information is transmitted consistently and succinctly in every report.


The expert panel convened to address the following four domains:

  1. Identify and include bone marrow morphologic descriptors
  2. Identify and include possible tests (by category) to be performed on the primary sample
  3. Identify and include necessary components (regulatory, legal, financial, etc)
  4. Layout


The information, data, and draft recommendations provided by the CAP Pathology and Laboratory Quality Center (the Center) are presented for informational and public feedback purposes only.

The draft recommendations and supporting documents will be removed from the Web page May 28, 2014.

The draft recommendations along with the public comments received and completed evidence review will be reassessed by the expert panel in order to formulate the final recommendations. These draft materials should not be stored, adapted, or redistributed in any manner.