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Bone Marrow Synoptic Reporting for Hematologic Neoplasms - Frequently Asked Questions

Bone marrow reporting is highly variable among different institutions. Data elements for clinical decision making can be difficult to find or may not even be included in the report. Ultimately, the guideline will improve the consistency, accuracy, and completeness of diagnostic information reported across care teams.

While the guideline restricts the synoptic section to a short list of evidence-based elements directly relevant to clinical outcomes, there are reasons to have a nonsynoptic section. The nonsynoptic section can include explanatory notes, such as interpretation of complex data, recommendations for further work-up, and relevant clinical history. In addition, it can documentthe working tools of the pathologist such as differential counts, a complete list of special stains, or immunohistochemistry used in the work-up.

Yes. However, there is no restriction on free text in the nonsynoptic section of the report.

No. The CAP Cancer Protocols are templates that can be used for reporting. They contain

additional useful elements based on expert opinion. Many of these elements are optional. The synoptic guideline is not a template; it is a framework that can be used to inform templates.

If your laboratory uses this cancer protocol, you may continue to use it. However, you should work toward including in your reports any diagnostically pertinent elements detailed in the synoptic guideline. When the protocol is updated, the guideline will be considered.

It is an element that has been shown to impact patient outcome and management.

The guideline recommendations do not call for the use of special characters in the synoptic section. However, there are no restrictions on the use of them in the nonsynoptic section as long as there is accurate, validated transmission across interfaces to all clients receiving the reports.

As with any clinical evidence-based guideline, following the recommendations is not mandatory. These recommendations may be incorporated into future versions of the CAP Laboratory Accreditation Program (LAP) checklist; however, they are not currently required by LAP or any regulatory or accrediting agency. It is only highly encouraged that laboratories adopt these recommendations. The hope is that over time, as laboratories select or develop their synoptic reporting templates for bone marrow specimens, they follow the guideline framework.


  1. Sever C, Abbott C, de Baca M, et al. Bone marrow synoptic reporting for hematologic neoplasms: guideline from the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med. 2016;140(9):932-949.
  2. Hussong JW, Arber DA, Bradley KT, et al. Protocol for the examination of specimens from patients with hematopoietic neoplasms involving the bone marrow. College of American Pathologists.
    http://www.cap.org/ShowPropertynodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/bone-13protocol-3111.pdf. Updated March 13, 2015. Accessed October 28, 2015.