21.11 Dollar US$ Formatting NGS Results in Pathology Reports: A Modern Guide London

The introduction of Next-Generation Sequencing (NGS) into clinical pathology has revolutionized the way we diagnose and treat complex diseases, particularly in oncology. However, the sheer volume of data produced by genomic sequencing presents a significant challenge for the pathology department: how to distill thousands of data points into a concise, readable, and actionable report. The formatting of NGS results is not merely a matter of aesthetics; it is a critical component of patient safety. A poorly organized report can lead to the misinterpretation of variants or the oversight of a therapeutic target.

Effective NGS reporting relies on a structured hierarchy of information. Because clinicians often have limited time to review these documents, the most critical findings—such as Tier I and Tier II variants—must be placed prominently at the beginning of the report. This "Executive Summary" approach ensures that the oncologist can immediately see the clinical implications of the genomic findings. However, the complexity of transcribing genomic nomenclature, such as $c.123G>A$ or $p.Val600Glu$, requires an ear for detail and an understanding of specific formatting standards.

The Importance of the Clinical Summary Table

One of the most effective ways to format NGS results is through the use of a Clinical Summary Table. This table acts as the centerpiece of the pathology report, providing a bird's-eye view of the genomic landscape of the specimen. It should typically include columns for the gene symbol, the specific alteration, the variant allele frequency (VAF), and the clinical significance (e.g., pathogenic, likely pathogenic, or VUS). By using a tabular format, the pathologist can present complex data in a way that is easy to scan.

The table should also clearly distinguish between ****tic and germline findings if both are being reported. This distinction is vital for determining whether a finding has implications only for the patient’s current treatment or if it also necessitates genetic counseling for the patient’s family. The formatting must be clean, with bold headings and consistent use of symbols. Because genomic reporting often involves a mix of alphanumeric codes and specialized Greek letters, a high level of keyboard proficiency and "ear-to-hand" coordination is required.

Documenting Variants of Uncertain Significance (VUS)

A recurring challenge in NGS reporting is how to handle Variants of Uncertain Significance (VUS). These are alterations in the DNA where the clinical impact is currently unknown. While they are important for the scientific record, they can be confusing for clinicians if not formatted correctly. Best practice dictates that VUS should be separated from "actionable" mutations, often placed in a supplemental section or at the end of the report. This prevents the "cluttering" of the primary diagnostic results while still fulfilling the requirement for comprehensive reporting. Dictating these sections can be tedious, involving long lists of gene coordinates and protein changes. A transcriber who has mastered anaudio typing course will be familiar with the pacing required to accurately capture these lists, ensuring that every decimal point and gene letter is correctly placed.

The narrative section following the VUS list is equally important. This is where the pathologist provides context, explaining why certain variants were classified as VUS based on current databases like ClinVar or COSMIC. Formatting this text requires a clear use of paragraphs and bullet points to break up dense blocks of scientific evidence. For a medical secretary, the ability to quickly format these interpretations while listening to a pathologist's voice recording is a valuable asset.

Visual Aids and Graphical Representations in NGS

As pathology reports move into the digital age, the inclusion of visual aids like pie charts or bar graphs for variant allele frequency is becoming more common. These visuals provide an immediate sense of clonal hierarchy and tumor heterogeneity. While the transcriber may not be creating the graphs themselves, they are often responsible for transcribing the captions, legends, and data labels that accompany them. Mislabeling a graph can be just as detrimental as a typo in the main text. Therefore, understanding the relationship between the spoken word and the visual data is a key skill.

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