Based on the implementation of structured surgical pathology reports (SSRs) for primary hepatocellular carcinoma (HCC), this study used traditional narrative pathology reports (TSRs) as a comparator to evaluate the values of SSRs in improving the quality and standardization of pathological information.

This retrospective study included 699 HCC pathology reports from April 2022 to April 2025 in the First Affiliated Hospital of Sun Yat-sen University, with expert pathologist review serving as the gold standard, and compared TSRs and SSRs in terms of key information completeness and concordance with the gold standard.

Implementation of SSRs led to significant reduction in overall underreporting rates, decreasing from 37.4%-82.4% before implementation to 0-38.3%. In comparison, TSRs exhibited underreporting rates of 0–97.5% for gross examination, 0.8%-97.7% for microscopic examination, and 45.6%-84.7% for surrounding and other organ invasion, whereas SSRs maintained underreporting rates below 12.6%. SSRs also significantly improved the concordance rates for growth pattern (38.6% vs 63.2%), capsule (19.0% vs 67.8%), capsule invasion (24.5% vs 74.1%), liver fibrosis stage (45.5% vs 56.1%), and hepatitis activity grade (5.7% vs 70.3%) (P<0.05).

SSRs can significantly improve the quality of pathology reports and better meet clinical diagnostic and therapeutic needs, providing real-world evidence for their standardized application in complex clinical settings for HCC.