Synoptic procedural reporting to improve quality indicators in systematic Staging Endobronchial Ultrasound (EBUS) in Non-small cell lung cancer (NSCLC): protocol for an ambispective multi-centre quality improvement study
This protocol outlines an ambispective, international, multicentre quality improvement study designed to evaluate whether implementing synoptic procedural reporting enhances the completeness, accuracy, and feasibility of systematic staging endobronchial ultrasound (EBUS) for non-small cell lung cancer (NSCLC) compared to traditional narrative reporting.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When a doctor suspects a patient has non-small cell lung cancer, the most critical step before deciding on a cure is to map the landscape of the chest. This process, known as staging, involves checking the lymph nodes in the center of the chest to see if the cancer has spread. If the nodes are clear, a surgeon might remove the tumor with the hope of a full cure. If the cancer has already traveled to these nodes, the treatment plan shifts entirely, often involving chemotherapy or radiation instead of immediate surgery. To check these hidden nodes, doctors use a specialized camera on a flexible tube called an endobronchial ultrasound, or EBUS. This tool allows them to see and sample lymph nodes that are too small to feel or too deep to reach otherwise. The accuracy of this map determines the entire future of the patient's care, yet for years, the way doctors recorded what they found during these procedures has been inconsistent.
For decades, medical reports have been written as free-flowing narratives, much like a doctor dictating a story of what they saw. While this allows for personal detail, it often leads to missing information. One doctor might mention the size of a lymph node, while another forgets to note whether they actually took a sample from it. This inconsistency makes it difficult to know if a procedure was truly thorough or if a cancer might have been missed simply because the report was incomplete. To solve this, a group of researchers from hospitals across the globe, including centers in Australia, the United States, the United Kingdom, and Asia, set out to test a different approach. They want to see if replacing the free-flowing story with a structured checklist, known as a synoptic report, will actually improve the quality of the medical care itself, not just the paperwork.
The study, described in a protocol published in late 2026, is designed as a large-scale experiment involving fifteen different lung cancer centers. The researchers plan to ask doctors at these sites to change how they write their reports for three months, then switch to a new, mandatory checklist format for the next three months. This checklist will force the doctor to answer specific questions for five key areas of the chest: Did they look at this spot? How big was the node? Did they take a sample? If they did, how many times did they pass the needle through? The goal is to see if this simple change in documentation will make the doctors more careful and thorough during the actual procedure.
The researchers will focus on two main things to measure success. First, they will look at whether the procedures become more complete, meaning every single required area of the chest is examined and sampled according to the rules. Second, and perhaps more importantly, they will look for a specific type of cancer spread that is notoriously hard to find: nodes that look perfectly normal on a standard CT scan and do not light up on a PET scan, yet still contain cancer cells. These are called PET-occult metastases. Finding these hidden cancers is vital because it can prevent a patient from undergoing a major surgery that would not cure them, redirecting them to a treatment that actually addresses the disease.
The study is built on the idea that when a doctor is forced to check a box for every single step, they are less likely to skip a step in the real world. The researchers calculated that they need data from about 590 patients to be sure of their results. They plan to compare the 295 patients treated before the checklist is introduced with the 295 patients treated after. By using advanced statistical methods to account for differences between the hospitals and the specific types of patients they treat, the team aims to isolate the effect of the new reporting style. They also plan to ask the doctors to fill out surveys to see if they find the new system annoying or helpful, ensuring that the solution is practical for the people doing the work.
The researchers hope that the findings from this international effort will show that the structured checklist does more than just organize the paperwork. They anticipate that when doctors use synoptic reporting, they will perform more thorough examinations of the chest. They expect doctors to be more likely to sample lymph nodes that look normal on scans, which could lead to finding more of those hidden, PET-occult cancers. This is a significant potential discovery because it would imply that the way a doctor documents a procedure can actually change how they perform it. The study aims to determine if the new system helps standardize care across different hospitals, reducing the gap between how one center performs compared to another.
This research aims to provide evidence on whether a simple change in how information is recorded can improve the quality of life-saving medical procedures. By moving away from variable, narrative descriptions to a consistent, checklist-based approach, the study seeks to determine if doctors can be guided to be more thorough in their work. This could lead to more accurate staging of lung cancer, ensuring that patients receive the right treatment for their specific condition. If successful, the results will support the idea that structured reporting should become a standard part of lung cancer care worldwide, helping to ensure that no hidden cancer is left undetected due to a missed note or an incomplete report.
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