Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Time and Accuracy to Establish the Diagnosis of Soft Tissue Tumors: A Comparative Analysis from the Swiss Sarcoma Network

Time and Accuracy to Establish the Diagnosis of Soft Tissue Tumors: A Comparative Analysis from... Hindawi Sarcoma Volume 2022, Article ID 7949549, 6 pages https://doi.org/10.1155/2022/7949549 Research Article Time and Accuracy to Establish the Diagnosis of Soft Tissue Tumors: A Comparative Analysis from the Swiss Sarcoma Network 1,2 1,3 1,4 1,2,5,6 Hanna Wellauer , Gabriela Studer, Beata Bode-Lesniewska, and Bruno Fuchs Swiss Sarcoma Network, Luzern 6000, Switzerland Department of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur 8401, Switzerland Department of Radiation Oncology, Cantonal Hospital Lucerne, Lucerne 6004, Switzerland Institute of Pathology Enge, Zurich 8005, Switzerland Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich 8091, Switzerland Department of Orthopaedics and Traumatology, Cantonal Hospital Lucerne, Lucerne 6004, Switzerland Correspondence should be addressed to Hanna Wellauer; hanna.wellauer@ksw.ch Received 3 October 2021; Revised 28 March 2022; Accepted 19 April 2022; Published 30 April 2022 Academic Editor: Cyril Fisher Copyright © 2022 Hanna Wellauer et al. �is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Soft tissue tumors are rare tumors, and their histological examination remains a challenge. �e establishment of the correct initial histopathologic diagnosis is critical. However, due to the rarity of soft tissue and bone tumors and the inherent di‚culty of their classiƒcation and diagnostics, discrepancies may occur in up to one third of cases. For these reasons, several studies recommend the involvement of experienced pathologists frequently performing sarcoma diagnostics. Until now, there is only scarce information about how long it takes to establish a correct sarcoma diagnosis. We thus analyzed all consecutive patients presented to the Swiss Sarcoma Network Tumor Board (SSN-MDT/SB) with a primary diagnosis of a soft tissue tumor over a 2-year period (01/2019 to 12/ 2020) based on a tumor biopsy. We then compared the ƒnal histopathological diagnosis of two comparable institutions with similar case load, but di•erent work–ows: (i) institution A, with an initial diagnosis performed by a local pathologist, and reviewed by a reference pathologist, and (ii) institution B, with the ƒnal diagnosis performed directly by a reference pathologist. In addition, we analyzed the time from biopsy to establishment of the diagnosis. A total of 347 cases were analyzed, 196 from institution A, and 149 from institution B. In 77.6% of the cases, the diagnosis from the local pathologist was concordant with the expert review. Minor discrepancies were found in 10.2% of the cases without any consecutive changes in treatment strategy. In the remaining 12.2% of the cases, there were major discrepancies which in–uenced the treatment strategy directly. Establishing the ƒnal report took signiƒcantly longer in institution A (4.7 working days) than in institution B (3.3 working days; p < 0.01). Our results conƒrm the importance of a pathological second review by a reference pathologist. We recommend direct analysis by experts, as diagnoses can be made more accurately and quickly. Within the SSN, establishing the sarcoma diagnosis is overall accurate and quick but still can be improved. the patient. An incorrect histopathological diagnosis may lead 1. Introduction to the initiation of an incorrect therapy with potentially severe or even lethal consequences for the patient [3–8]. Soft tissue tumors are rare tumors and histological exami- nation remains a challenge [1]. �e recently published WHO Yet, due to the rarity of soft tissue and bone tumors and Classiƒcation of Soft Tissue and Bone Tumors [2] lists over the inherent di‚culty for a correct classiƒcation and diag- 100 tumor entities including variants, often characterized by nostic, discrepancies may occur in up to one third of cases speciƒc genetic aberrations, which can be detected by mo- [3–8]. For these reasons, several studies recommend the lecular diagnostic studies. Establishing the precise tissue di- involvement of experienced pathologists who are involved in agnosis of a soft tissue or bone tumor is of utmost importance sarcoma diagnostics on a daily basis and who have access to with respect to the choice of a correct treatment strategy for auxiliary studies [3, 4, 9]. 2 Sarcoma Various studies [4, 5, 7, 8] have shown that establishing *eaccuracyofthediagnosesofthelocalhistopathology the correct diagnosis for the treatment of soft tissue tumors instituteAandtheexpertanalysiswasexaminedinasecond step. Here, the diagnoses of institute A were compared with isindeedachallenge,with14%[10]to43%[4]ofallpatients receiving an incorrect diagnosis, which could lead to in- the expert opinion and divided into 3 groups according to correct treatment. *erefore, any multidisciplinary team the classification of *way et al. [6]: (MDT) must assess these numbers constantly to compare (i) Cases without diagnostic discrepancy between local with the reference benchmark for quality purposes. and reference institutions were classified into cat- Further, there is only scarce information on how long it egory A takes to establish an expert review. Besides the correct di- (ii) Category B includes cases with minor discrepancy agnosis,thetimefrombiopsytoestablishingthediagnosisis in diagnosis but without therapeutic consequences an important quality indicator for the work-up of sarcoma patients.Tothebestofourknowledge,thisfactorhasnotyet (iii) Category C contains all cases where the diagnosis been considered in published literature. from the reference pathologist changed the *epatientstreatedintheSwissSarcomaNetwork(SSN) treatment are either [1] referred directly to the member institutions In addition, all cases where the final report from insti- prior to biopsy or [2] following a diagnosis of a mesen- tution A did not establish a diagnosis were consequently chymaltumorinanearlieroutsidebiopsy.*ecurrentstudy classified under category C [6]. concentrates on the first group in order to study the con- *e data were collected using the Adjumed -Database dition to optimize the diagnostic paths within the network. ® (www.adjumed.ch; Zurich, Switzerland) and analyzed with As the expansion of the network progresses in the future, thestatisticalpackage“stats”oftheopensourcesoftware“R” thereishopethatthepercentageofthetissuestudiesoutside [12]. the network (including “whoops” unintended resections) *e cantonal ethic commission has approved the ap- will diminish. Herein, we report first on the quality of ac- plication of the Swiss Sarcoma Network under the agree- curacy in establishing the sarcoma diagnosis within the ment number BASEC-NR 2019-01107. *e study is also SwissSarcomaNetwork,andsecond,assesshowlongittakes registered on https://climincaltrials.gov with the number to establish the diagnosis including expert review analysis. NCT04300257 [13]. 2.Materials and Methods 3.Results All consecutive patients presented at the Swiss Sarcoma 3.1. Patient and Tumor Characteristics. A total of 347 cases Network Board with a primary diagnosis of a soft tissue were analyzed, 196 from Institution A and 149 from In- tumor from January 1, 2019, to December 31, 2020, were stitution B.179patientswerefemaleand168weremale,and includedinthisstudy.Patientswithincompleterecordswere the median age was 55 (range 12–90) years. 163 cases were excluded. A record was marked as incomplete when, for classified as benign (46.9%), 114 cases were malignant example, a case from institution A was missing an expert (32.8%), 66 cases were intermediate (19%), and 4 cases were review, or when a case from institution B was initially di- unclassifiable (see Table 1). agnosed locally. *e diagnoses were classified according to *e most common benign diagnosis was lipoma (69 the WHO into benign, intermediate and malignant [11]. cases,42.3%ofallbenigntumors),followedbySchwannoma *e biopsies of the two institutions were analyzed and (11 cases, 6.7%). Regarding the malignant diagnosis, un- compared. *e samples of institution A were initially ana- differentiated/unclassified sarcoma was the most common lyzed by the local pathology institute. *is is a general diagnosis (19 cases, 16.6% of all malignant tumors) followed pathology institute without specific subspecialization. Af- by the dedifferentiated liposarcoma (14 cases, 12.2%, see terwards, the samples being reviewed and assessed by a Table 2). reference institute pathologist specialized in soft tissue tu- mors. Conversely, institution B cases were assessed directly by the reference institute pathologist. *ese workflows are 3.2.Accuracy. Ofthe196tumorsspecimensfrominstitution illustrated in Figure 1. A (which underwent initial diagnosis by a local pathologist To determine the time from biopsy to the establishment followed by specimen being reviewed by a reference pa- of the diagnosis, the days between the arrival of the tissue thologist, see Figure 1), 152 tumors (77.6%) were diag- specimen at thepathology institute until the date of the final nostically concordant according to category A. Of the latter report were calculated. Weekend days or holidays were not 152 tumors, 46.7% were benign, 18.4% were intermediate, counted,unlessthereportwasissuedononeofthesedays.In 33.5% were malignant, and 1.4% unclassifiable. *ere were the analysis of the current study only cases which can be 20 cases (10.2%) with minor discrepancies, according to diagnosed by conventional histopathologic staining, im- category B (Table 3). Of these, 70% were malignant, 15% munohistochemistry, and FISH were included, as these intermediate, and 15% benign diagnoses. *ere were 24 studies have a short turn-around-time of one to two days. tumors (12.2%) with major diagnostic discrepancies (Ta- *e cases requiring PCR or NGS based analyses were ex- ble 3) according to category C. 50% of these were malignant cluded as they methodically require several days indepen- cases. From these major discrepancies, 12 cases were clas- dently of the performance of the pathologist. sified in this category because of a missing diagnosis in the Sarcoma 3 1. Accuracy of Diagnosis ? Institution reference Biopsy Specimen to local pathologist A pathologist Institution Biopsy Specimen DIRECTLY to Figure 1: Work–ow of the study. Table 1: Patient and tumor characteristics. Total 347 Institution A 198 (57%) Institution B 149 (43%) Male 168 (48.5%) Female 179 (51.5%) Median age 55 (range 12–90) years Benign diagnosis 163 (46.9%) Intermediate diagnosis 66 (19%) Malignant diagnosis 114 (32.8%) Unclassiƒed diagnosis 4 (1.2%) Table 2: Most common diagnoses. Benign Intermediate Malignant Atypical lipomatous tumor/well di•erentiated liposarcoma Unclassiƒed/undi•erentiated sarcoma (19 Lipoma (69 cases) (17 cases) cases) Schwannoma (11 cases) Aneurysmal bone cyst (11 cases) Dedi•erentiated liposarcoma (14 cases) Intramuscular myxoma (8 Desmoid-type ƒbromatosis (9 cases) Leiomyosarcoma (11 cases) cases) ƒnal report from institution A. In one case, there was a and 3.2 days, respectively, at institution B (p < 0.01). Ac- reclassiƒcation from benign to malignant and one case was cordingly, and with respect to undi•erentiated/unclassiƒed reclassiƒed from malignant to benign. A summary of all sarcoma, institution A required 5.2 days, and institution B original diagnoses, which were discordant from the expert 3.0 days (p < 0.01). review is shown in Table 3. 4. Discussion 3.3. Analysis of Time to Diagnosis. Establishing the ƒnal To the best of our knowledge, this is the ƒrst analysis report took on average 4.7 working days for institution A, comparing the duration of a histological review to establish a which is signiƒcantly longer than the 3.3 days required by sarcoma diagnosis. Our results conƒrm the importance of a institution B (Figure 2). 10 cases were excluded from the second pathological review by a reference pathologist. With analysis (7 from institution A and 3 from institution B) due an overall concordance of 77%, the results are comparable to to the necessity of NGS for the ƒnal diagnosis. We analyzed the already published literature. the data with a two-sided Wilcoxon t-test and found a p In 1986, Presant et al. [7] ƒrst reported on a histo- value of p < 0.01. pathologic peer review of specimens from 216 consecutive If only malignant diagnoses were considered for analysis, patients with soft-tissue or bone sarcomas by a panel of three establishing the diagnosis averaged 5.2 days in institution A, pathologists. Subtype of sarcoma, degree of conƒdence in and 3.4 days, respectively, for institution B (p < 0.01, see diagnosis, and grade were compared with agreement or Figure 2). disagreement in pathologic opinion from the primary According to the most commonly diagnosed lesion of all, member institution versus the pathology review panel. �ere the diagnosis of a lipoma averaged 4.6 days at institution A was a complete agreement between the primary pathologist 2. Time required for final diagnosis 4 Sarcoma Table 3: Minor/major discrepancies. Minor discrepancies Benign Institution A Institution B Fibroblastic/myofibroblastic proliferates in predominantly tight connective tissue L107 Collagen-rich myofibroblastic proliferation with partly regressive changes. L108 Chondrogenic neoplasm, highly differentiated Enchondroma L198 Fibrin and blood, intercalated with some lamellar bone tissue and connective tissue Intraosseous ganglion Intermediate Institution A Institution B L31 Spindle-cell, partly multinucleated giant-cell tumor with osteoid formation Aneurysmal bone cyst L34 Giant cell tumor of the soft tissue Plexiform fibrohistiocytic tumour L112 Chondroid neoplasia with cancellous bone Epiphyseal atypic chondrogenic tumor Malignant Institution A Institution B Spindle and pleomorphic high-grade malignant unclassified L4 Spindle-cell high-grade sarcoma sarcoma G3 Spindle-cell pleomorphic sarcoma, high grade, with evidence of myogenic L11 Leiomyosarcoma differentiation L19 Epithelioid sarcoma (proximal type) Epithelioid angiosarcoma Lymph node metastasis of a solid tumor (differential diagnosis: clear cell sarcoma or L29 Lymph node metastasis of malignant melanoma malignant melanoma) L35 Pleomorphic undifferentiated sarcoma with necrosis zones Pleomorphic liposarcoma (G3) L60 Spindle-cell pleomorphic neoplasia with striated muscles Sclerosing epithelioid fibrosarcoma Spindle and pleomorphic cell soft tissue sarcoma at least G2 L63 Sarcoma, spinel and partly pleomorphic cells with FNCLCC score of 4 Dedifferentiated liposarcoma with low-grade dedifferentiated L64 Highly differentiated liposarcoma portion, malignancy grade at least G2 L84 Myxofibrosarcoma Undifferentiated spindle cell sarcoma L110 Myxofibrosarcoma (high grade) High-grade, unclassifiable spindle cell sarcoma (G2) L140 Undifferenciated pleomorphic sarcoma High-grade, unclassifiable spindle cell sarcoma (G2) L157 Myxofibrosarcoma, high grade High-grade, unclassifiable spindle cell sarcoma (G2) L188 Pleomorphic highly proliferative tumor Giant cell-rich leiomyosarcoma at least G2 L201 Myxofibrosarcoma (high grade) Spindle cell sarcoma at least G2 Major discrepancies Benign Institution A Institution B PHAT (pleomorphic hyalinizing angiectatic tumor of soft L2 Fat necrosis parts) L37 Fibrin-rich connective tissue with low chronic inflammation and regressive changes Nodular fasciitis L52 Mature teratoma/dermoid Spinal dermoid cyst Spindle-cell mesenchymal myofibroblastic proliferation with low MIB-1 L57 Intramuscular myxoma proliferation rate along with skeletal muscles L66 Parts of a spindle-cell myxoid-chondroid impinging neoplasia Benign portion of a peripheral nerve sheath tumor Slightly atypical spindle cell tumor with myxoid background and increased L109 Myofibroblastic proliferation of the nodular fasciitis type proliferation (Ki67) of approx. 30%. L113 Low-grade fibromyxoid sarcoma Intramuscular myxoma Smooth-muscular proliferation with scaly calcifications as well as circumscribed L145 Leiomyoma of the deep somatic soft tissues ossification without necrosis or evidence of mitoses L195 Intramuscular lipoma Intramuscular haemangioma Intermediate Institution A Institution B Spindle cell mast cell-rich proliferation with low proliferation rate and L100 Solitary fibrous tumor (SFT) immunohistochemically S-100 positive with negativity for SOX-10 L101 Plump spindle-cell tumour with multiple multinucleated giant cells Periosteal aneurysmal bone cyst (ABC) Cell-rich neoplasia of oval, plump spindle mononuclear cells intermixed with giant L117 Tenosynovial giant cell tumor of the diffuse type cells and haemorrhage residues in connective tissue. Malignant Institution A Institution B L1 Epithelioid sarcoma Angiosarcoma L6 Osteosarcoma Chondrosarcoma L7 Highly differentiated/dedifferentiated or a myxoid liposarcoma Dedifferentiated liposarcoma (low grade) L51 Myxoid chondrosarcoma Myxoid liposarcoma (G1) L70 Chondroid and focal spindle cell neoplasia Mesenchymal chondrosarcoma L76 Slightly hypercellular chondrogenic tissue, connective tissue and skeletal muscle Conventional chondrosarcoma L94 Pleomorphic liposarcoma Round cell liposarcoma G3 L150 Small blue round cell tumor with low proliferation (Ki67) of approx. 10-15%. Granulosa cell tumor L164 Atypical lipomatous tumor/well-differentiated liposarcoma Dedifferentiated liposarcoma, at least G2 Neoplasia, predominantly spindle cell in cancellous bone with focal evidence of L171 Osteosarcoma, high grade irregular osteoid. Poorly differentiated neuroendocrine carcinoma (Merkel cell L191 Infiltrates of small, round and blue cell neoplasia carcinoma) Spindle and pleomorphic cell neoplasm with myxoid background of partial L204 High-grade myxofibrosarcoma (G2-3) expression of MDM2 Sarcoma 5 supplement in the classiƒcation without obvious conse- quences regarding the treatment modality, speciƒcally also for malignant diagnoses. Our study has several limitations: �e number of bi- opsies analyzed is still relatively small, and many diagnoses are benign, thereby not allowing further subgroup analysis. Also, considering the rarity of the disease and the 68 sarcoma entities included therein, further subtype analysis is not possible. �e deƒnition of diagnostic discordances is not always obvious and may skew the results. Arbitrarily, de- scriptive pathology reports without speciƒcation of dignity were classiƒed as major discrepancies because adequate treatment can only be initiated when the ƒnal diagnosis is made. Although there is a signiƒcant di•erence in the time to diagnosis, one may critically question to what extent this value has an in–uence on the time to diagnosis and further therapy. �e time it takes to establish the histological ex- Total cases Non-Benign Total cases Non-Benign amination is only one step on this path. It would therefore be Institution A Institution B interesting if a further study examines not only the duration Figure 2: Days until ƒnal report. of the biopsy, but the entire process from the suspected diagnosis to the initiation of the correct therapy. But from the point of view of the patient who must wait for a diag- and reviewer in 66% of cases. However, after the review, 12 nosis, every day that is gained with a faster diagnosis is worth a lot. In addition, a rapid histological diagnosis is essential cases (6%) were considered not to be sarcoma. In 27% of cases, the subtype of sarcoma was felt to be incorrect by for a timely discussion at the multidisciplinary sarcoma board. reviewers. In 2008, Lehnhardt et al. [5] reviewed 603 patients who Any additional examination, especially if not done in the were operated with the diagnosis of soft tissue sarcoma. �ey same institution, will lead to delays in the diagnostic process. found a concordance in primary diagnostics of 28.3% for Several studies conƒrmed that a centralized pathological pathologists in private clinics, 29.6% for hospital a‚liated review improved the quality of the diagnosis. Lurkin et al. [8] pathologists, 36.8% for academic medical centers, and 70.5% support the direct analysis by an expert pathologist because for the department of pathology at their institution. of the multitude and complexity of sarcoma tumors. Also, the access to molecular biology analysis can be provided. In 2010, Lurkin et al. [8] analyzed all histological data of all patients diagnosed with sarcoma in the Rhone-Alpes Compared to the recommendation of the ECCO Essential Requirements for Quality Cancer Care, the pathway of region between March 2005 and February 2006. Primary diagnoses were systematically compared with second Institution B is to be favored [14]. opinions from regional and national experts. �ey included In a small country like Switzerland, and with sarcoma 366 patients; of these, 199 (54%) had full concordance be- being a rare disease, establishing the correct pathological tween primary diagnosis and second opinion, 97 (27%) had diagnosis is very challenging. �e main reason is the small partial concordance (identical diagnosis), and 70 (19%) had amount of cases per individual hospital. Compared with the complete discordance. volume of international sarcoma reference centers, the data Ray-Coquard et al. [4] reviewed the histological data of of the entire country needs to be pooled and shared to reach patients diagnosed with sarcoma in Rhone-Alpes (France), high enough numbers for expert experience and teaching purposes. With the recently established Swiss Sarcoma Veneto (Italy) and Aquitaine (France) over a 2-year period. Initial diagnoses were systematically compared with the Network, allowing real-world outcome analytics, there is the possibility to improve the precision, timeliness, and accuracy second opinions from members of the group of pathologists of the GSF-GETO (French Unicancer Sarcoma Group). 1463 of sarcoma diagnosis in Switzerland in the near future. As of cases matched the inclusion criteria and were analyzed. Full now, 7 central referral institutions joined the Swiss Sarcoma concordance between primary and second diagnosis was Network so far and beneƒt from a second opinion by an observed in 824 (56%) cases, partial concordance in 518 expert pathologist. (35%) cases and complete discordance in 121 (8%) cases. �ere is no clear deƒnition in the literature on how a A summary of the studies can be found in Table 4. sarcoma expert is deƒned. As for the pathologists, the sarcoma experts within the Swiss Sarcoma Network are Interestingly, and speciƒcally contrasting the analysis between benign and malignant lesions, the uncertainty to deƒned by their speciƒc training, their speciƒc sarcoma interest, deƒned by dedication of >30–50% of their duty time establish the correct diagnosis was greater in malignant lesions. Considering the analysis of minor discrepancies in spent on treating sarcoma patients, their yearly scientiƒc contributions, their number of cases reviewed and/or treated the diagnosis comparing ƒrst line with expert review, the expert review delivers more diagnostic details or a per year, and their participation of the weekly Days until final report 6 Sarcoma Table 4: Overview of literature. Author (year) Interval No. of cases % concordance % minor deviations % major deviations Peasant (1986) May 1974 to May 1982 216 66% (137) Lehnhardt (2008) 1995 to 2001 603 28.3–70.5% Lurkin (2010) March 2005 to February 2006 366 54%(199) 27% (97) 19% (70) March 2005 to February 2007 resp. Ray-Coquard (2012) 2016 56% (824) 35% (518) 8% (121) January 2007 to December 2008 Our study January 2019 to December 2020 196 77.6% (152) 10.2% (20) 12.2% (24) [5] M. Lehnhardt, A. Daigeler, J. Hauser et al., “*e value of multidisciplinary tumor board including the number of expert second opinion in diagnosis of soft tissue sarcomas,” discussed cases and strategic decisions. Journal of Surgical Oncology, vol. 97, no. 1, pp. 40–43, 2008. [6] K. *way, J. Wang, T. Mubako, and C. Fisher, “Histopath- 5.Conclusions ological diagnostic discrepancies in soft tissue tumours re- ferredtoaspecialistcentre:reassessmentintheeraofancillary *ediagnosisofsarcomaremainschallenging.Accordingto molecular diagnosis,” Sarcoma, vol. 2014, Article ID 686902, our study and the current literature, an expert review by an 7 pages, 2014. experienced pathologist within a network such as the Swiss [7] C. A. Presant, W. O. Russell, R. W. Alexander, and Y. S. Fu, Sarcoma Network proves to be highly useful and beneficial “Soft-tissueandbonesarcomahistopathologypeerreview:the for the patient both regarding accuracy and timeliness to frequency of disagreement in diagnosis and the need for second pathology opinions. the southeastern cancer study establishthediagnosis.Establishingthesarcomadiagnosisas group experience,” Journal of Clinical Oncology, vol. 4, no.11, earlyas possibleafter biopsyis acritical qualityindicatorfor pp. 1658–1661, 1986. a multidisciplinary team. Considering the rapidly rising [8] A.Lurkin,F.Ducimetiere, ` D.R.Vinceetal.,“Epidemiological health care costs, the potential increase in cost efficiency of evaluation of concordance between initial diagnosis and such a process needs to be determined next. central pathology review in a comprehensive and prospective series of sarcoma patients in the rhone-alpes region,” BMC Cancer, vol. 10, no. 1, pp. 1–12, 2010. Data Availability [9] M. Lehnhardt, A. Daigeler, H. Homann et al., “Importance of specialized centers in diagnosis and treatment of extremity- *e data used to support the findings of this study may be soft tissue sarcomas. Review of 603 cases. Der Chirurg,” released from the Adjumed -Database upon request to the Chirurg, Der, vol. 80, no. 4, pp. 341–347, 2009. Swiss Sarcoma Network (office@sarcoma.surgery). [10] L. Perrier, P. Rascle, M. Morelle et al., “*e cost-saving effect of centralized histological reviews with soft tissue and visceral Conflicts of Interest sarcomas, GIST, and desmoid tumors: the experiences of the pathologists of the french sarcoma group,” PLoS One, vol.13, *e authors declare that they have no conflicts of interest. no. 4, Article ID e0193330, 2018. [11] V. Y. Jo and C. D. Fletcher, “WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition,” Pa- Acknowledgments thology, vol. 46, no. 2, pp. 95–104, 2014. [12] B.Fuchs,“Swisssarcomaboard,”2020,https://www.adjumed. *e authors thank Dr. Julien Gerard ´ Anet for his support ch. with the statistical analysis. [13] https://www.clinicaltrials.gov/ct2/show/NCT04300257? term�NCT04300257&draw�2&rank�1. References [14] E. Andritsch, M. Beishon, S. Bielack et al., “ECCO essential requirements for quality cancer care: soft tissue sarcoma in [1] M. A. Clark, C. Fisher, I. Judson, and J. M. *omas, “Soft- adults and bone sarcoma. A critical review,” Critical Reviews tissue sarcomas in adults,” New England Journal of Medicine, in Oncology/hematology, vol. 110, pp. 94–105, 2017. vol. 353, no. 7, pp. 701–711, 2005. [2] J. H. Choi and J. Y. Ro, “*e 2020 WHO classification of tumors of soft tissue: selected changes and new entities,” Advances in Anatomic Pathology, vol. 28, no. 1, pp. 44–58, [3] N. D. Jalaludin, N. Mohd Dusa, M. R. Hassan, and N. Abd Shukor, “Histopathological diagnoses in soft tissue tumours: an experience from a tertiary centre in Malaysia,” Malaysian Journal of Pathology, vol. 39, no. 3, pp. 209–216, 2017. [4] I. Ray-Coquard, M. Montesco, J. Coindre et al., “Sarcoma: concordance between initial diagnosis and centralized expert review in a population-based study within three European regions,” Annals of Oncology, vol. 23, no. 9, pp. 2442–2449, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Sarcoma Hindawi Publishing Corporation

Time and Accuracy to Establish the Diagnosis of Soft Tissue Tumors: A Comparative Analysis from the Swiss Sarcoma Network

Download PDF
6 pages

Loading next page...
 
/lp/hindawi-publishing-corporation/time-and-accuracy-to-establish-the-diagnosis-of-soft-tissue-tumors-a-U50j60HBq0

References (14)

Publisher
Hindawi Publishing Corporation
Copyright
Copyright © 2022 Hanna Wellauer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ISSN
1357-714X
eISSN
1369-1643
DOI
10.1155/2022/7949549
Publisher site
See Article on Publisher Site

Abstract

Hindawi Sarcoma Volume 2022, Article ID 7949549, 6 pages https://doi.org/10.1155/2022/7949549 Research Article Time and Accuracy to Establish the Diagnosis of Soft Tissue Tumors: A Comparative Analysis from the Swiss Sarcoma Network 1,2 1,3 1,4 1,2,5,6 Hanna Wellauer , Gabriela Studer, Beata Bode-Lesniewska, and Bruno Fuchs Swiss Sarcoma Network, Luzern 6000, Switzerland Department of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur 8401, Switzerland Department of Radiation Oncology, Cantonal Hospital Lucerne, Lucerne 6004, Switzerland Institute of Pathology Enge, Zurich 8005, Switzerland Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich 8091, Switzerland Department of Orthopaedics and Traumatology, Cantonal Hospital Lucerne, Lucerne 6004, Switzerland Correspondence should be addressed to Hanna Wellauer; hanna.wellauer@ksw.ch Received 3 October 2021; Revised 28 March 2022; Accepted 19 April 2022; Published 30 April 2022 Academic Editor: Cyril Fisher Copyright © 2022 Hanna Wellauer et al. �is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Soft tissue tumors are rare tumors, and their histological examination remains a challenge. �e establishment of the correct initial histopathologic diagnosis is critical. However, due to the rarity of soft tissue and bone tumors and the inherent di‚culty of their classiƒcation and diagnostics, discrepancies may occur in up to one third of cases. For these reasons, several studies recommend the involvement of experienced pathologists frequently performing sarcoma diagnostics. Until now, there is only scarce information about how long it takes to establish a correct sarcoma diagnosis. We thus analyzed all consecutive patients presented to the Swiss Sarcoma Network Tumor Board (SSN-MDT/SB) with a primary diagnosis of a soft tissue tumor over a 2-year period (01/2019 to 12/ 2020) based on a tumor biopsy. We then compared the ƒnal histopathological diagnosis of two comparable institutions with similar case load, but di•erent work–ows: (i) institution A, with an initial diagnosis performed by a local pathologist, and reviewed by a reference pathologist, and (ii) institution B, with the ƒnal diagnosis performed directly by a reference pathologist. In addition, we analyzed the time from biopsy to establishment of the diagnosis. A total of 347 cases were analyzed, 196 from institution A, and 149 from institution B. In 77.6% of the cases, the diagnosis from the local pathologist was concordant with the expert review. Minor discrepancies were found in 10.2% of the cases without any consecutive changes in treatment strategy. In the remaining 12.2% of the cases, there were major discrepancies which in–uenced the treatment strategy directly. Establishing the ƒnal report took signiƒcantly longer in institution A (4.7 working days) than in institution B (3.3 working days; p < 0.01). Our results conƒrm the importance of a pathological second review by a reference pathologist. We recommend direct analysis by experts, as diagnoses can be made more accurately and quickly. Within the SSN, establishing the sarcoma diagnosis is overall accurate and quick but still can be improved. the patient. An incorrect histopathological diagnosis may lead 1. Introduction to the initiation of an incorrect therapy with potentially severe or even lethal consequences for the patient [3–8]. Soft tissue tumors are rare tumors and histological exami- nation remains a challenge [1]. �e recently published WHO Yet, due to the rarity of soft tissue and bone tumors and Classiƒcation of Soft Tissue and Bone Tumors [2] lists over the inherent di‚culty for a correct classiƒcation and diag- 100 tumor entities including variants, often characterized by nostic, discrepancies may occur in up to one third of cases speciƒc genetic aberrations, which can be detected by mo- [3–8]. For these reasons, several studies recommend the lecular diagnostic studies. Establishing the precise tissue di- involvement of experienced pathologists who are involved in agnosis of a soft tissue or bone tumor is of utmost importance sarcoma diagnostics on a daily basis and who have access to with respect to the choice of a correct treatment strategy for auxiliary studies [3, 4, 9]. 2 Sarcoma Various studies [4, 5, 7, 8] have shown that establishing *eaccuracyofthediagnosesofthelocalhistopathology the correct diagnosis for the treatment of soft tissue tumors instituteAandtheexpertanalysiswasexaminedinasecond step. Here, the diagnoses of institute A were compared with isindeedachallenge,with14%[10]to43%[4]ofallpatients receiving an incorrect diagnosis, which could lead to in- the expert opinion and divided into 3 groups according to correct treatment. *erefore, any multidisciplinary team the classification of *way et al. [6]: (MDT) must assess these numbers constantly to compare (i) Cases without diagnostic discrepancy between local with the reference benchmark for quality purposes. and reference institutions were classified into cat- Further, there is only scarce information on how long it egory A takes to establish an expert review. Besides the correct di- (ii) Category B includes cases with minor discrepancy agnosis,thetimefrombiopsytoestablishingthediagnosisis in diagnosis but without therapeutic consequences an important quality indicator for the work-up of sarcoma patients.Tothebestofourknowledge,thisfactorhasnotyet (iii) Category C contains all cases where the diagnosis been considered in published literature. from the reference pathologist changed the *epatientstreatedintheSwissSarcomaNetwork(SSN) treatment are either [1] referred directly to the member institutions In addition, all cases where the final report from insti- prior to biopsy or [2] following a diagnosis of a mesen- tution A did not establish a diagnosis were consequently chymaltumorinanearlieroutsidebiopsy.*ecurrentstudy classified under category C [6]. concentrates on the first group in order to study the con- *e data were collected using the Adjumed -Database dition to optimize the diagnostic paths within the network. ® (www.adjumed.ch; Zurich, Switzerland) and analyzed with As the expansion of the network progresses in the future, thestatisticalpackage“stats”oftheopensourcesoftware“R” thereishopethatthepercentageofthetissuestudiesoutside [12]. the network (including “whoops” unintended resections) *e cantonal ethic commission has approved the ap- will diminish. Herein, we report first on the quality of ac- plication of the Swiss Sarcoma Network under the agree- curacy in establishing the sarcoma diagnosis within the ment number BASEC-NR 2019-01107. *e study is also SwissSarcomaNetwork,andsecond,assesshowlongittakes registered on https://climincaltrials.gov with the number to establish the diagnosis including expert review analysis. NCT04300257 [13]. 2.Materials and Methods 3.Results All consecutive patients presented at the Swiss Sarcoma 3.1. Patient and Tumor Characteristics. A total of 347 cases Network Board with a primary diagnosis of a soft tissue were analyzed, 196 from Institution A and 149 from In- tumor from January 1, 2019, to December 31, 2020, were stitution B.179patientswerefemaleand168weremale,and includedinthisstudy.Patientswithincompleterecordswere the median age was 55 (range 12–90) years. 163 cases were excluded. A record was marked as incomplete when, for classified as benign (46.9%), 114 cases were malignant example, a case from institution A was missing an expert (32.8%), 66 cases were intermediate (19%), and 4 cases were review, or when a case from institution B was initially di- unclassifiable (see Table 1). agnosed locally. *e diagnoses were classified according to *e most common benign diagnosis was lipoma (69 the WHO into benign, intermediate and malignant [11]. cases,42.3%ofallbenigntumors),followedbySchwannoma *e biopsies of the two institutions were analyzed and (11 cases, 6.7%). Regarding the malignant diagnosis, un- compared. *e samples of institution A were initially ana- differentiated/unclassified sarcoma was the most common lyzed by the local pathology institute. *is is a general diagnosis (19 cases, 16.6% of all malignant tumors) followed pathology institute without specific subspecialization. Af- by the dedifferentiated liposarcoma (14 cases, 12.2%, see terwards, the samples being reviewed and assessed by a Table 2). reference institute pathologist specialized in soft tissue tu- mors. Conversely, institution B cases were assessed directly by the reference institute pathologist. *ese workflows are 3.2.Accuracy. Ofthe196tumorsspecimensfrominstitution illustrated in Figure 1. A (which underwent initial diagnosis by a local pathologist To determine the time from biopsy to the establishment followed by specimen being reviewed by a reference pa- of the diagnosis, the days between the arrival of the tissue thologist, see Figure 1), 152 tumors (77.6%) were diag- specimen at thepathology institute until the date of the final nostically concordant according to category A. Of the latter report were calculated. Weekend days or holidays were not 152 tumors, 46.7% were benign, 18.4% were intermediate, counted,unlessthereportwasissuedononeofthesedays.In 33.5% were malignant, and 1.4% unclassifiable. *ere were the analysis of the current study only cases which can be 20 cases (10.2%) with minor discrepancies, according to diagnosed by conventional histopathologic staining, im- category B (Table 3). Of these, 70% were malignant, 15% munohistochemistry, and FISH were included, as these intermediate, and 15% benign diagnoses. *ere were 24 studies have a short turn-around-time of one to two days. tumors (12.2%) with major diagnostic discrepancies (Ta- *e cases requiring PCR or NGS based analyses were ex- ble 3) according to category C. 50% of these were malignant cluded as they methodically require several days indepen- cases. From these major discrepancies, 12 cases were clas- dently of the performance of the pathologist. sified in this category because of a missing diagnosis in the Sarcoma 3 1. Accuracy of Diagnosis ? Institution reference Biopsy Specimen to local pathologist A pathologist Institution Biopsy Specimen DIRECTLY to Figure 1: Work–ow of the study. Table 1: Patient and tumor characteristics. Total 347 Institution A 198 (57%) Institution B 149 (43%) Male 168 (48.5%) Female 179 (51.5%) Median age 55 (range 12–90) years Benign diagnosis 163 (46.9%) Intermediate diagnosis 66 (19%) Malignant diagnosis 114 (32.8%) Unclassiƒed diagnosis 4 (1.2%) Table 2: Most common diagnoses. Benign Intermediate Malignant Atypical lipomatous tumor/well di•erentiated liposarcoma Unclassiƒed/undi•erentiated sarcoma (19 Lipoma (69 cases) (17 cases) cases) Schwannoma (11 cases) Aneurysmal bone cyst (11 cases) Dedi•erentiated liposarcoma (14 cases) Intramuscular myxoma (8 Desmoid-type ƒbromatosis (9 cases) Leiomyosarcoma (11 cases) cases) ƒnal report from institution A. In one case, there was a and 3.2 days, respectively, at institution B (p < 0.01). Ac- reclassiƒcation from benign to malignant and one case was cordingly, and with respect to undi•erentiated/unclassiƒed reclassiƒed from malignant to benign. A summary of all sarcoma, institution A required 5.2 days, and institution B original diagnoses, which were discordant from the expert 3.0 days (p < 0.01). review is shown in Table 3. 4. Discussion 3.3. Analysis of Time to Diagnosis. Establishing the ƒnal To the best of our knowledge, this is the ƒrst analysis report took on average 4.7 working days for institution A, comparing the duration of a histological review to establish a which is signiƒcantly longer than the 3.3 days required by sarcoma diagnosis. Our results conƒrm the importance of a institution B (Figure 2). 10 cases were excluded from the second pathological review by a reference pathologist. With analysis (7 from institution A and 3 from institution B) due an overall concordance of 77%, the results are comparable to to the necessity of NGS for the ƒnal diagnosis. We analyzed the already published literature. the data with a two-sided Wilcoxon t-test and found a p In 1986, Presant et al. [7] ƒrst reported on a histo- value of p < 0.01. pathologic peer review of specimens from 216 consecutive If only malignant diagnoses were considered for analysis, patients with soft-tissue or bone sarcomas by a panel of three establishing the diagnosis averaged 5.2 days in institution A, pathologists. Subtype of sarcoma, degree of conƒdence in and 3.4 days, respectively, for institution B (p < 0.01, see diagnosis, and grade were compared with agreement or Figure 2). disagreement in pathologic opinion from the primary According to the most commonly diagnosed lesion of all, member institution versus the pathology review panel. �ere the diagnosis of a lipoma averaged 4.6 days at institution A was a complete agreement between the primary pathologist 2. Time required for final diagnosis 4 Sarcoma Table 3: Minor/major discrepancies. Minor discrepancies Benign Institution A Institution B Fibroblastic/myofibroblastic proliferates in predominantly tight connective tissue L107 Collagen-rich myofibroblastic proliferation with partly regressive changes. L108 Chondrogenic neoplasm, highly differentiated Enchondroma L198 Fibrin and blood, intercalated with some lamellar bone tissue and connective tissue Intraosseous ganglion Intermediate Institution A Institution B L31 Spindle-cell, partly multinucleated giant-cell tumor with osteoid formation Aneurysmal bone cyst L34 Giant cell tumor of the soft tissue Plexiform fibrohistiocytic tumour L112 Chondroid neoplasia with cancellous bone Epiphyseal atypic chondrogenic tumor Malignant Institution A Institution B Spindle and pleomorphic high-grade malignant unclassified L4 Spindle-cell high-grade sarcoma sarcoma G3 Spindle-cell pleomorphic sarcoma, high grade, with evidence of myogenic L11 Leiomyosarcoma differentiation L19 Epithelioid sarcoma (proximal type) Epithelioid angiosarcoma Lymph node metastasis of a solid tumor (differential diagnosis: clear cell sarcoma or L29 Lymph node metastasis of malignant melanoma malignant melanoma) L35 Pleomorphic undifferentiated sarcoma with necrosis zones Pleomorphic liposarcoma (G3) L60 Spindle-cell pleomorphic neoplasia with striated muscles Sclerosing epithelioid fibrosarcoma Spindle and pleomorphic cell soft tissue sarcoma at least G2 L63 Sarcoma, spinel and partly pleomorphic cells with FNCLCC score of 4 Dedifferentiated liposarcoma with low-grade dedifferentiated L64 Highly differentiated liposarcoma portion, malignancy grade at least G2 L84 Myxofibrosarcoma Undifferentiated spindle cell sarcoma L110 Myxofibrosarcoma (high grade) High-grade, unclassifiable spindle cell sarcoma (G2) L140 Undifferenciated pleomorphic sarcoma High-grade, unclassifiable spindle cell sarcoma (G2) L157 Myxofibrosarcoma, high grade High-grade, unclassifiable spindle cell sarcoma (G2) L188 Pleomorphic highly proliferative tumor Giant cell-rich leiomyosarcoma at least G2 L201 Myxofibrosarcoma (high grade) Spindle cell sarcoma at least G2 Major discrepancies Benign Institution A Institution B PHAT (pleomorphic hyalinizing angiectatic tumor of soft L2 Fat necrosis parts) L37 Fibrin-rich connective tissue with low chronic inflammation and regressive changes Nodular fasciitis L52 Mature teratoma/dermoid Spinal dermoid cyst Spindle-cell mesenchymal myofibroblastic proliferation with low MIB-1 L57 Intramuscular myxoma proliferation rate along with skeletal muscles L66 Parts of a spindle-cell myxoid-chondroid impinging neoplasia Benign portion of a peripheral nerve sheath tumor Slightly atypical spindle cell tumor with myxoid background and increased L109 Myofibroblastic proliferation of the nodular fasciitis type proliferation (Ki67) of approx. 30%. L113 Low-grade fibromyxoid sarcoma Intramuscular myxoma Smooth-muscular proliferation with scaly calcifications as well as circumscribed L145 Leiomyoma of the deep somatic soft tissues ossification without necrosis or evidence of mitoses L195 Intramuscular lipoma Intramuscular haemangioma Intermediate Institution A Institution B Spindle cell mast cell-rich proliferation with low proliferation rate and L100 Solitary fibrous tumor (SFT) immunohistochemically S-100 positive with negativity for SOX-10 L101 Plump spindle-cell tumour with multiple multinucleated giant cells Periosteal aneurysmal bone cyst (ABC) Cell-rich neoplasia of oval, plump spindle mononuclear cells intermixed with giant L117 Tenosynovial giant cell tumor of the diffuse type cells and haemorrhage residues in connective tissue. Malignant Institution A Institution B L1 Epithelioid sarcoma Angiosarcoma L6 Osteosarcoma Chondrosarcoma L7 Highly differentiated/dedifferentiated or a myxoid liposarcoma Dedifferentiated liposarcoma (low grade) L51 Myxoid chondrosarcoma Myxoid liposarcoma (G1) L70 Chondroid and focal spindle cell neoplasia Mesenchymal chondrosarcoma L76 Slightly hypercellular chondrogenic tissue, connective tissue and skeletal muscle Conventional chondrosarcoma L94 Pleomorphic liposarcoma Round cell liposarcoma G3 L150 Small blue round cell tumor with low proliferation (Ki67) of approx. 10-15%. Granulosa cell tumor L164 Atypical lipomatous tumor/well-differentiated liposarcoma Dedifferentiated liposarcoma, at least G2 Neoplasia, predominantly spindle cell in cancellous bone with focal evidence of L171 Osteosarcoma, high grade irregular osteoid. Poorly differentiated neuroendocrine carcinoma (Merkel cell L191 Infiltrates of small, round and blue cell neoplasia carcinoma) Spindle and pleomorphic cell neoplasm with myxoid background of partial L204 High-grade myxofibrosarcoma (G2-3) expression of MDM2 Sarcoma 5 supplement in the classiƒcation without obvious conse- quences regarding the treatment modality, speciƒcally also for malignant diagnoses. Our study has several limitations: �e number of bi- opsies analyzed is still relatively small, and many diagnoses are benign, thereby not allowing further subgroup analysis. Also, considering the rarity of the disease and the 68 sarcoma entities included therein, further subtype analysis is not possible. �e deƒnition of diagnostic discordances is not always obvious and may skew the results. Arbitrarily, de- scriptive pathology reports without speciƒcation of dignity were classiƒed as major discrepancies because adequate treatment can only be initiated when the ƒnal diagnosis is made. Although there is a signiƒcant di•erence in the time to diagnosis, one may critically question to what extent this value has an in–uence on the time to diagnosis and further therapy. �e time it takes to establish the histological ex- Total cases Non-Benign Total cases Non-Benign amination is only one step on this path. It would therefore be Institution A Institution B interesting if a further study examines not only the duration Figure 2: Days until ƒnal report. of the biopsy, but the entire process from the suspected diagnosis to the initiation of the correct therapy. But from the point of view of the patient who must wait for a diag- and reviewer in 66% of cases. However, after the review, 12 nosis, every day that is gained with a faster diagnosis is worth a lot. In addition, a rapid histological diagnosis is essential cases (6%) were considered not to be sarcoma. In 27% of cases, the subtype of sarcoma was felt to be incorrect by for a timely discussion at the multidisciplinary sarcoma board. reviewers. In 2008, Lehnhardt et al. [5] reviewed 603 patients who Any additional examination, especially if not done in the were operated with the diagnosis of soft tissue sarcoma. �ey same institution, will lead to delays in the diagnostic process. found a concordance in primary diagnostics of 28.3% for Several studies conƒrmed that a centralized pathological pathologists in private clinics, 29.6% for hospital a‚liated review improved the quality of the diagnosis. Lurkin et al. [8] pathologists, 36.8% for academic medical centers, and 70.5% support the direct analysis by an expert pathologist because for the department of pathology at their institution. of the multitude and complexity of sarcoma tumors. Also, the access to molecular biology analysis can be provided. In 2010, Lurkin et al. [8] analyzed all histological data of all patients diagnosed with sarcoma in the Rhone-Alpes Compared to the recommendation of the ECCO Essential Requirements for Quality Cancer Care, the pathway of region between March 2005 and February 2006. Primary diagnoses were systematically compared with second Institution B is to be favored [14]. opinions from regional and national experts. �ey included In a small country like Switzerland, and with sarcoma 366 patients; of these, 199 (54%) had full concordance be- being a rare disease, establishing the correct pathological tween primary diagnosis and second opinion, 97 (27%) had diagnosis is very challenging. �e main reason is the small partial concordance (identical diagnosis), and 70 (19%) had amount of cases per individual hospital. Compared with the complete discordance. volume of international sarcoma reference centers, the data Ray-Coquard et al. [4] reviewed the histological data of of the entire country needs to be pooled and shared to reach patients diagnosed with sarcoma in Rhone-Alpes (France), high enough numbers for expert experience and teaching purposes. With the recently established Swiss Sarcoma Veneto (Italy) and Aquitaine (France) over a 2-year period. Initial diagnoses were systematically compared with the Network, allowing real-world outcome analytics, there is the possibility to improve the precision, timeliness, and accuracy second opinions from members of the group of pathologists of the GSF-GETO (French Unicancer Sarcoma Group). 1463 of sarcoma diagnosis in Switzerland in the near future. As of cases matched the inclusion criteria and were analyzed. Full now, 7 central referral institutions joined the Swiss Sarcoma concordance between primary and second diagnosis was Network so far and beneƒt from a second opinion by an observed in 824 (56%) cases, partial concordance in 518 expert pathologist. (35%) cases and complete discordance in 121 (8%) cases. �ere is no clear deƒnition in the literature on how a A summary of the studies can be found in Table 4. sarcoma expert is deƒned. As for the pathologists, the sarcoma experts within the Swiss Sarcoma Network are Interestingly, and speciƒcally contrasting the analysis between benign and malignant lesions, the uncertainty to deƒned by their speciƒc training, their speciƒc sarcoma interest, deƒned by dedication of >30–50% of their duty time establish the correct diagnosis was greater in malignant lesions. Considering the analysis of minor discrepancies in spent on treating sarcoma patients, their yearly scientiƒc contributions, their number of cases reviewed and/or treated the diagnosis comparing ƒrst line with expert review, the expert review delivers more diagnostic details or a per year, and their participation of the weekly Days until final report 6 Sarcoma Table 4: Overview of literature. Author (year) Interval No. of cases % concordance % minor deviations % major deviations Peasant (1986) May 1974 to May 1982 216 66% (137) Lehnhardt (2008) 1995 to 2001 603 28.3–70.5% Lurkin (2010) March 2005 to February 2006 366 54%(199) 27% (97) 19% (70) March 2005 to February 2007 resp. Ray-Coquard (2012) 2016 56% (824) 35% (518) 8% (121) January 2007 to December 2008 Our study January 2019 to December 2020 196 77.6% (152) 10.2% (20) 12.2% (24) [5] M. Lehnhardt, A. Daigeler, J. Hauser et al., “*e value of multidisciplinary tumor board including the number of expert second opinion in diagnosis of soft tissue sarcomas,” discussed cases and strategic decisions. Journal of Surgical Oncology, vol. 97, no. 1, pp. 40–43, 2008. [6] K. *way, J. Wang, T. Mubako, and C. Fisher, “Histopath- 5.Conclusions ological diagnostic discrepancies in soft tissue tumours re- ferredtoaspecialistcentre:reassessmentintheeraofancillary *ediagnosisofsarcomaremainschallenging.Accordingto molecular diagnosis,” Sarcoma, vol. 2014, Article ID 686902, our study and the current literature, an expert review by an 7 pages, 2014. experienced pathologist within a network such as the Swiss [7] C. A. Presant, W. O. Russell, R. W. Alexander, and Y. S. Fu, Sarcoma Network proves to be highly useful and beneficial “Soft-tissueandbonesarcomahistopathologypeerreview:the for the patient both regarding accuracy and timeliness to frequency of disagreement in diagnosis and the need for second pathology opinions. the southeastern cancer study establishthediagnosis.Establishingthesarcomadiagnosisas group experience,” Journal of Clinical Oncology, vol. 4, no.11, earlyas possibleafter biopsyis acritical qualityindicatorfor pp. 1658–1661, 1986. a multidisciplinary team. Considering the rapidly rising [8] A.Lurkin,F.Ducimetiere, ` D.R.Vinceetal.,“Epidemiological health care costs, the potential increase in cost efficiency of evaluation of concordance between initial diagnosis and such a process needs to be determined next. central pathology review in a comprehensive and prospective series of sarcoma patients in the rhone-alpes region,” BMC Cancer, vol. 10, no. 1, pp. 1–12, 2010. Data Availability [9] M. Lehnhardt, A. Daigeler, H. Homann et al., “Importance of specialized centers in diagnosis and treatment of extremity- *e data used to support the findings of this study may be soft tissue sarcomas. Review of 603 cases. Der Chirurg,” released from the Adjumed -Database upon request to the Chirurg, Der, vol. 80, no. 4, pp. 341–347, 2009. Swiss Sarcoma Network (office@sarcoma.surgery). [10] L. Perrier, P. Rascle, M. Morelle et al., “*e cost-saving effect of centralized histological reviews with soft tissue and visceral Conflicts of Interest sarcomas, GIST, and desmoid tumors: the experiences of the pathologists of the french sarcoma group,” PLoS One, vol.13, *e authors declare that they have no conflicts of interest. no. 4, Article ID e0193330, 2018. [11] V. Y. Jo and C. D. Fletcher, “WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition,” Pa- Acknowledgments thology, vol. 46, no. 2, pp. 95–104, 2014. [12] B.Fuchs,“Swisssarcomaboard,”2020,https://www.adjumed. *e authors thank Dr. Julien Gerard ´ Anet for his support ch. with the statistical analysis. [13] https://www.clinicaltrials.gov/ct2/show/NCT04300257? term�NCT04300257&draw�2&rank�1. References [14] E. Andritsch, M. Beishon, S. Bielack et al., “ECCO essential requirements for quality cancer care: soft tissue sarcoma in [1] M. A. Clark, C. Fisher, I. Judson, and J. M. *omas, “Soft- adults and bone sarcoma. A critical review,” Critical Reviews tissue sarcomas in adults,” New England Journal of Medicine, in Oncology/hematology, vol. 110, pp. 94–105, 2017. vol. 353, no. 7, pp. 701–711, 2005. [2] J. H. Choi and J. Y. Ro, “*e 2020 WHO classification of tumors of soft tissue: selected changes and new entities,” Advances in Anatomic Pathology, vol. 28, no. 1, pp. 44–58, [3] N. D. Jalaludin, N. Mohd Dusa, M. R. Hassan, and N. Abd Shukor, “Histopathological diagnoses in soft tissue tumours: an experience from a tertiary centre in Malaysia,” Malaysian Journal of Pathology, vol. 39, no. 3, pp. 209–216, 2017. [4] I. Ray-Coquard, M. Montesco, J. Coindre et al., “Sarcoma: concordance between initial diagnosis and centralized expert review in a population-based study within three European regions,” Annals of Oncology, vol. 23, no. 9, pp. 2442–2449,

Journal

Sarcoma – Hindawi Publishing Corporation

Published: Apr 30, 2022

There are no references for this article.