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Crenn V, Lataste F, Galmiche L, Le Nail LR, Ropars M, Blay JY, de Pinieux G, Gouin F. Enhanced accuracy and reduced delay in diagnosing bone tumors within an expert sarcoma network: A nationwide study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108271. [PMID: 38522331 DOI: 10.1016/j.ejso.2024.108271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Primary bone tumors encompass a range of rare and diverse lesions. Pathological diagnosis poses significant challenges, with histological discrepancies extensively studied in soft tissue sarcomas but lacking specific investigation in bone lesions. This study aimed to determine the rate of major diagnostic discrepancies in primary bone tumors, assessing whether initial histological analysis within an expert referral center network reduces this rate and final diagnostic delay. Additionally, we examined the impact of mandatory systematic re-reading by expert pathologists on diagnostic variation and readjustment. METHODS Our study cohort comprised patients with primary bone tumors, drawn from the national prospective French sarcoma network database. A total of 1075 patients were included from 2018 to 2019. RESULTS The cohort exhibited a major discrepancy rate of 24%. Within the expert referral centers network, 49 cases (7%) showed major diagnostic discrepancies in the initial analysis, compared to 207 cases (57%) outside the network (p < 0.001). Regarding the final diagnostic delay, a mean of 2.8 weeks (±4.9) was observed within the network, contrasting with 6.5 weeks (±9.1) outside the network (p < 0.001). Systematic re-reading by an expert pathologist facilitated diagnosis readjustment in 75% of the 256 cases, with 68% of all diagnostic variations occurring preoperatively. CONCLUSION Early management within the expert network significantly reduced major diagnostic discrepancies and shortened the diagnosis delay by approximately a month. Expert pathologist systematic re-readings were responsible for diagnosis readjustments in three-quarters of cases, with two-thirds of all diagnostic variations occurring preoperatively, thereby mitigating the consequences of mistreatment.
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Affiliation(s)
- Vincent Crenn
- Nantes University, Nantes University Hospital (CHU Nantes), Orthopedic and Traumatological Surgical Clinic, Nantes, France; CRCI2NA (Center for Cancer Research and Immunology Nantes-Angers), INSERM, UMR 1307, CNRS UMR 6075-Team 9 CHILD (CHromatin and Transcriptional Deregulation in Pediatric Bone Sarcoma), Nantes University, Nantes, France.
| | - François Lataste
- Nantes University, Nantes University Hospital (CHU Nantes), Orthopedic and Traumatological Surgical Clinic, Nantes, France.
| | - Louise Galmiche
- Nantes University, Nantes University Hospital (CHU Nantes), Department of Pathology, Nantes, France.
| | - Louis-Romée Le Nail
- Department of Orthopedic Surgery, Tours University Hospital (CHU de Tours), Faculty of Medicine, University of Tours, Tours, France.
| | - Mickaël Ropars
- Department of Orthopedic Surgery, Rennes University Hospital (CHU de Rennes), Faculty of Medicine, University of Rennes, Rennes, France.
| | - Jean-Yves Blay
- Department of Medical Oncology, Leon Berard Center, Lyon, France.
| | - Gonzague de Pinieux
- Department of Pathology, Tours University Hospital (CHU de Tours), Faculty of Medicine, University of Tours, Tours, France.
| | - Francois Gouin
- Department of Surgery, Leon Berard Center, Lyon, France.
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Douglas C, Potter A, Davidson T, Schipp D, Crowe P. The impact of additional pathology analysis on the diagnosis and management of soft tissue tumours: a 10-year,retrospective study. Pathology 2023; 55:486-491. [PMID: 37032199 DOI: 10.1016/j.pathol.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/22/2022] [Accepted: 01/14/2023] [Indexed: 03/17/2023]
Abstract
In order to characterise soft tissue tumours, pathologists often utilise specialised additional tests, or may seek opinions from subspecialist pathologists due to rarity or complex morphology. Additionally, further review may be sought by subspecialist sarcoma pathologists, such as those at our tertiary referral centre in Sydney, Australia. The aim of this study was to examine the impact on diagnosis and management of this external review, following diagnosis at a specialised sarcoma unit. We collated the results of all additional external ancillary tests and specialist reviews over a 10-year period and characterised the impact on the preliminary diagnosis as 'confirmed', 'new' or 'no clear diagnosis'. We subsequently noted whether the additional findings resulted in a clinically significant change in management. Of the 136 cases sent away, 103 patients had their initial diagnosis confirmed, 29 patients received a new diagnosis and, for four patients, the diagnosis remained uncertain. Nine of the 29 patients receiving a new diagnosis had their management altered. This study demonstrated that within our specialised sarcoma unit, the majority of diagnoses provided by our specialist pathologists are confirmed on additional external testing and review, but external review does provide additional assurance and benefit to the patient.
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Affiliation(s)
| | | | | | - Diane Schipp
- Prince of Wales Hospital, Randwick, NSW, Australia
| | - Philip Crowe
- Prince of Wales Hospital, Randwick, NSW, Australia
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3
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Daley J, Williams N, Salgado CM, Schultz C, Meade J, Ozolek J, Lindsey B, Bailey KM. Cutaneous Ewing Sarcoma Presenting as a Second Primary Malignancy in a Child. J Pediatr Hematol Oncol 2022; 44:486-488. [PMID: 35426856 PMCID: PMC9562594 DOI: 10.1097/mph.0000000000002457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/24/2022] [Indexed: 01/26/2023]
Abstract
Ewing sarcoma is an EWS-ETS family member-driven malignancy that most commonly arises from bone. Cutaneous Ewing sarcoma is a rare variant which harbors an EWS-ETS family fusion but demonstrates an immunohistochemical staining pattern distinct from classic Ewing tumors. EWSR1 fluorescence in situ hybridization testing interpretation can be challenging in the setting of cutaneous Ewing sarcoma, making an integrated histologic and sequencing approach key for an accurate diagnosis. Here, we report a pediatric patient with a history of neuroblastoma treated with surgery only that developed a cutaneous nodule and was diagnosed with cutaneous Ewing sarcoma as a second primary cancer.
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Affiliation(s)
- Jessica Daley
- Department of Pediatrics, Division of Pediatric Oncology, University of Pittsburgh School of Medicine
| | | | | | - Charles Schultz
- Department of Pathology, West Virginia University School of Medicine
| | - Julia Meade
- Department of Pediatrics, Division of Pediatric Oncology, University of Pittsburgh School of Medicine
| | - John Ozolek
- Department of Pathology, West Virginia University School of Medicine
| | - Brock Lindsey
- Department of Orthopaedics, West Virginia University School of Medicine
| | - Kelly M. Bailey
- Department of Pediatrics, Division of Pediatric Oncology, University of Pittsburgh School of Medicine
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Time and Accuracy to Establish the Diagnosis of Soft Tissue Tumors: A Comparative Analysis from the Swiss Sarcoma Network. Sarcoma 2022; 2022:7949549. [PMID: 35535046 PMCID: PMC9078856 DOI: 10.1155/2022/7949549] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/28/2022] [Accepted: 04/19/2022] [Indexed: 11/23/2022] Open
Abstract
Soft tissue tumors are rare tumors, and their histological examination remains a challenge. The establishment of the correct initial histopathologic diagnosis is critical. However, due to the rarity of soft tissue and bone tumors and the inherent difficulty of their classification 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 final histopathological diagnosis of two comparable institutions with similar case load, but different workflows: (i) institution A, with an initial diagnosis performed by a local pathologist, and reviewed by a reference pathologist, and (ii) institution B, with the final 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 influenced the treatment strategy directly. Establishing the final report took significantly longer in institution A (4.7 working days) than in institution B (3.3 working days; p < 0.01). Our results confirm 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.
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5
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Vats K, Spafford M, Groot G, Graham P, Banerjee T, Deobald R, Osmond A. Moving towards the optimization of diagnosis for patients with sarcoma: A 10-year review of externally consulted sarcoma cases in a general anatomical pathology service. Ann Diagn Pathol 2022; 60:151958. [DOI: 10.1016/j.anndiagpath.2022.151958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
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Nepon H, Safran T, Reece EM, Murphy AM, Vorstenbosch J, Davison PG. Radiation-Induced Tissue Damage: Clinical Consequences and Current Treatment Options. Semin Plast Surg 2021; 35:181-188. [PMID: 34526866 PMCID: PMC8432995 DOI: 10.1055/s-0041-1731464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Radiation therapy is a valuable tool in the treatment of numerous malignancies but, in certain cases, can also causes significant acute and chronic damage to noncancerous neighboring tissues. This review focuses on the pathophysiology of radiation-induced damage and the clinical implications it has for plastic surgeons across breast reconstruction, osteoradionecrosis, radiation-induced skin cancers, and wound healing. The current understanding of treatment modalities presented here include hyperbaric oxygen therapy, autologous fat grafting and stem cells, and pharmaceutical agents.
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Affiliation(s)
- Hillary Nepon
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Tyler Safran
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | - Edward M. Reece
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Amanda M. Murphy
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Peter G. Davison
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
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7
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Diagnostic Differences in Expert Second-Opinion Consultation Cases at a Tertiary Sarcoma Center. Sarcoma 2020; 2020:9810170. [PMID: 33061792 PMCID: PMC7542501 DOI: 10.1155/2020/9810170] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/11/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022] Open
Abstract
Soft tissue tumors are diagnostically challenging, and it is recommended that these are reported or reviewed by specialist soft tissue pathologists. We present our experience with second-opinion (consultation) cases in a specialist tertiary sarcoma center. The aim of this study was to determine areas of diagnostic difficulty in soft tissue pathology. We assessed 581 second-opinion cases which were reviewed by two experienced pathologists in a period of one year. There was 62% concordance between the original and the second-opinion diagnosis, with diagnostic discrepancy in 38%. The largest group of soft tissue neoplasms received for second opinion was fibroblastic/myofibroblastic tumors, and most major diagnostic problems were encountered in adipocytic and so-called “fibrohistiocytic” tumors. Major diagnostic errors impacting management were found in 148 cases (25%). Morphologic assessment of tumors, judicious use of molecular techniques, newer immunostains and their interpretation, along with importance of knowledge of rarer entities were found to be most useful in avoiding errors.
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8
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Abstract
The treatment of choice for soft tissue sarcomas with local involvement is still the complete surgical removal into healthy tissue. The aim of surgery is to achieve tumor-free resection margins in the sense of a R0 resection. No other treatment option can equally replace this important oncological condition. The enormous development in the field of reconstructive plastic surgery and in particular the advances in flap techniques and microsurgery enable limb salvage and the functional reconstruction even in the case of extensive tumors.
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9
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Perrier L, Rascle P, Morelle M, Toulmonde M, Ranchere Vince D, Le Cesne A, Terrier P, Neuville A, Meeus P, Farsi F, Ducimetière F, Blay JY, Ray Coquard I, Coindre JM. The cost-saving effect of centralized histological reviews with soft tissue and visceral sarcomas, GIST, and desmoid tumors: The experiences of the pathologists of the French Sarcoma Group. PLoS One 2018; 13:e0193330. [PMID: 29621244 PMCID: PMC5886412 DOI: 10.1371/journal.pone.0193330] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/08/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE This study examined the types of discordance occurring in the diagnosis of soft tissue and visceral sarcomas, gastrointestinal stromal tumors (GIST), and desmoid tumors, as well as the economic impact of diagnostic discrepancies. METHODS We carried out a retrospective, multicenter analysis using prospectively implemented databases performed on a cohort of patients within the French RRePS network in 2010. Diagnoses were deemed to be discordant based on the 2013 World Health Organization (WHO) classification. Predictive factors of discordant diagnoses were explored. A decision tree was used to assess the expected costs of two strategies of disease management: one based on revised diagnoses after centralized histological review (option 1), the other on diagnoses without centralized review (option 2). Both were defined based on the patient and the disease characteristics, according to national or international guidelines. The time horizon was 12 months and the perspective of the French National Health Insurance (NHI) was retained. Costs were expressed in Euros for 2013. Sensitivity analyses were performed using low and high scenarios that included ± 20% estimates for cost. RESULTS A total of 2,425 patients were included. Three hundred forty-one patients (14%) had received discordant diagnoses. These discordances were determined to mainly be benign tumors diagnosed as sarcomas (n = 124), or non-sarcoma malignant tumors diagnosed as sarcomas (n = 77). The probability of discordance was higher for a final diagnosis of desmoid tumors when compared to liposarcomas (odds ratio = 5.1; 95%CI [2.6-10.4]). The expected costs per patient for the base-case analysis (low- and high-case scenarios) amounted to €8,791 (€7,033 and €10,549, respectively) for option 1 and €8,904 (€7,057 and €10,750, respectively) for option 2. CONCLUSIONS Our findings highlight misdiagnoses of sarcomas, which were found to most often be confused with benign tumors. Centralized histological reviews are likely to provide cost-savings for the French NHI.
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Affiliation(s)
- Lionel Perrier
- University of Lyon, Léon Bérard Cancer Centre, GATE L-SE UMR 5824, Lyon, France.,Direction of Clinical Research and Innovation, DRCI, Léon Bérard Cancer Centre, Lyon, France
| | - Pauline Rascle
- Direction of Clinical Research and Innovation, DRCI, Léon Bérard Cancer Centre, Lyon, France
| | - Magali Morelle
- University of Lyon, Léon Bérard Cancer Centre, GATE L-SE UMR 5824, Lyon, France.,Direction of Clinical Research and Innovation, DRCI, Léon Bérard Cancer Centre, Lyon, France
| | - Maud Toulmonde
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | | | - Axel Le Cesne
- Department of Medecine, Institut Gustave Roussy, Villejuif, France
| | | | - Agnès Neuville
- Department of Anatomopathology, Institut Bergonié, Bordeaux, France
| | - Pierre Meeus
- Department of Surgery, Cancer Centre Léon Bérard, Lyon, France
| | - Fadila Farsi
- Réseau Espace Santé Cancer Rhône-Alpes, Lyon, France
| | | | - Jean-Yves Blay
- Department of Medicine, Cancer Centre Léon Bérard, Lyon, France
| | - Isabelle Ray Coquard
- Santé-Individu-société EA-INSERM 4129, Cancer centre Léon Bérard, Lyon, France.,Department of Medicine, Cancer Centre Léon Bérard, Lyon, France
| | - Jean-Michel Coindre
- Department of Anatomopathology, Institut Bergonié, Bordeaux, France.,University Victor Ségalen, Bordeaux, France
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10
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Merabi Z, Boulos F, Santiago T, Jenkins J, Abboud M, Muwakkit S, Tarek N, Zaatari G, Jeha S, El-Solh H, Saab R. Pediatric cancer pathology review from a single institution: Neuropathology expert opinion is essential for accurate diagnosis of pediatric brain tumors. Pediatr Blood Cancer 2018; 65. [PMID: 28675683 DOI: 10.1002/pbc.26709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Second pathology review has been reported to improve accuracy in oncologic diagnoses, including pediatric malignancies. We assessed the impact of second review on the diagnosis of pediatric malignancies at a tertiary care referral center in Beirut, Lebanon. METHODS Pathology reports of patients treated at the Children's Cancer Institute in Lebanon were retrospectively reviewed for the period 2008-2016 and compared with same samples' diagnoses at St. Jude Children's Research Hospital. Diagnostic disagreements were divided into major, minor, and none based on their effect on diagnosis and/or patient management. RESULTS Second review was requested for 171 cases, accounting for 19% of all cases during that period. Second opinion was mostly requested for brain tumors (62% of all brain tumor cases) and neuroblastoma for NMYC testing (65% of all neuroblastoma), while hematologic malignancies had the fewest referrals (3% of all hematologic cases). Major disagreements in second review occurred in 20 cases (12% of total), and minor disagreements in 21 cases (12% of total). The largest proportion of major disagreements (71%) occurred in pediatric brain tumors, and novel molecular tests contributed to the diagnosis in 55% of these cases. CONCLUSIONS The availability of a specialized pediatric neuropathologist and a basic panel of relevant molecular testing are essential for appropriate diagnosis of pediatric brain tumors. Centers that do not have the available infrastructure in place can benefit greatly from second review referrals for this challenging subset of tumors.
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Affiliation(s)
- Zeina Merabi
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fouad Boulos
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Jesse Jenkins
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Miguel Abboud
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samar Muwakkit
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nidale Tarek
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghazi Zaatari
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sima Jeha
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Hassan El-Solh
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raya Saab
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Penel N, Coindre JM, Giraud A, Terrier P, Ranchere-Vince D, Collin F, Guellec SLE, Bazille C, Lae M, de Pinieux G, Ray-Coquard IL, Bonvalot S, Cesne ALE, Robin YM, Stoeckle E, Toulmonde M, Blay JY. Presentation and outcome of frequent and rare sarcoma histologic subtypes: A study of 10,262 patients with localized visceral/soft tissue sarcoma managed in reference centers. Cancer 2017; 124:1179-1187. [PMID: 29211310 DOI: 10.1002/cncr.31176] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/16/2017] [Accepted: 10/23/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The objective of this study was to describe characteristics at diagnosis and outcomes of adults with soft tissue sarcoma. METHODS The authors conducted a retrospective multicenter study of 12,262 patients who were treated between January 1980 and 31 December 2013 in French Sarcoma Group centers and enrolled in the "Conticabase." Diagnoses were systematically reviewed by expert pathologists, and entities were classified according to the 2013 World Health Organization classification. Diagnostic characteristics, treatments, and outcomes are described for the entire cohort, for the subgroup of patients with translocation-related sarcomas, and for 9 different histologic subtypes. RESULTS The results stressed the magnitude of heterogeneity among adult sarcomas. For example, compared with other sarcomas, translocation-related sarcomas (2143 tumors; 20.8%) were associated with a younger age at presentation (40.6 vs 60.0 years; P < .0001), a low rate of predisposing conditions (0.01% vs 22.3%; P < .0001), a higher rate of lymph node involvement (4.7% vs 1.3%; P < .0001), and a higher rate of synchronous metastasis (11.9% vs 6.7%; P < .001); and complete (R0) resection (41.6% vs 31.9%; P < .0001), receipt of (neo)adjuvant radiation therapy (62.6% vs 42.2%; P < .0001), and receipt of (neo)adjuvant chemotherapy (36.6% vs 22.3%; P < .0001) were significantly more frequent. Overall, translocation-related sarcomas were associated with a lower rate of local relapse (18.1% vs 26.0%; P < .0001) but a higher rate of metastatic relapse (42.0% vs 30.7%; P < .0001). CONCLUSIONS Collaborative efforts are urgently needed to better assess the natural history and management options for every histologic subtype of sarcoma. Cancer 2018;124:1179-87. © 2017 American Cancer Society.
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Affiliation(s)
- Nicolas Penel
- Department of Medical Oncology, Oscar Lambret Center, Lille, France.,Methodology Clinical Research Platform, Lille French Comprehensive Cancer Center (SIRIC OncoLille), Lille, France
| | - Jean-Michel Coindre
- Department of Biopathology, National Institute of Health and Medical Research (INSERM) Unit 916, Bergonie Institute, University of Bordeaux, Bordeaux, France
| | - Antoine Giraud
- Clinical and Epidemiologic Research Unit, INSERM Clinical Investigation Center 1401, Bergonie Institute, Bordeaux, France
| | - Philippe Terrier
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | | | - Françoise Collin
- Department of Pathology, Georges-Francois Leclerc Center, Dijon, France
| | - Sophie L E Guellec
- Department of Pathology, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Céline Bazille
- Department of Pathologic Anatomy, University Hospital, Caen, Basse-Normandie, France
| | - Marick Lae
- Department of Pathology, Curie Institute, Paris, France
| | - Gonzague de Pinieux
- Department of Pathology, University Hospital of Tours and Francois Rabelais University, Tours, France
| | | | - Sylvie Bonvalot
- Department of Medical Oncology and Surgery, Gustave Roussy Institute, Villejuif, France
| | - Axel L E Cesne
- Department of Medical Oncology and Surgery, Gustave Roussy Institute, Villejuif, France
| | | | | | - Maud Toulmonde
- Department of Medical Oncology, Bergonie Institute, Bordeaux, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Leon Berard Center, Lyon, France
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12
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Abouarab MH, Salem IL, Degheidy MM, Henn D, Hirche C, Eweida A, Uhl M, Kneser U, Kremer T. Therapeutic options and postoperative wound complications after extremity soft tissue sarcoma resection and postoperative external beam radiotherapy. Int Wound J 2017; 15:148-158. [PMID: 29205902 DOI: 10.1111/iwj.12851] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 10/11/2017] [Indexed: 01/31/2023] Open
Abstract
Soft tissue sarcomas occur most commonly in the lower and upper extremities. The standard treatment is limb salvage surgery combined with radiotherapy. Postoperative radiotherapy is associated with wound complications. This systematic review aims to summarise the available evidence and review the literature of the last 10 years regarding postoperative wound complications in patients who had limb salvage surgical excision followed by direct closure vs flap coverage together with postoperative radiotherapy and to define the optimal timeframe for adjuvant radiotherapy after soft tissue sarcomas resection and flap reconstruction. A literature search was performed using PubMed. The following keywords were searched: limb salvage, limb-sparing, flaps, radiation therapy, radiation, irradiation, adjuvant radiotherapy, postoperative radiotherapy, radiation effects, wound healing, surgical wound infection, surgical wound dehiscence, wound healing, soft tissue sarcoma and neoplasms. In total, 1045 papers were retrieved. Thirty-seven articles were finally selected after screening of abstracts and applying dates and language filters and inclusion and exclusion criteria. Plastic surgery provides a vast number of reconstructive flap procedures that are directly linked to decreasing wound complications, especially with the expectant postoperative radiotherapy. This adjuvant radiotherapy is better administered in the first 3-6 weeks after reconstruction to allow timely wound healing and avoid local recurrence.
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Affiliation(s)
- Mohamed H Abouarab
- Department of Plastic and Reconstructive Surgery and Burns, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.,Department of Hand, Plastic, and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Iman L Salem
- Department of Plastic and Reconstructive Surgery and Burns, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Magdy M Degheidy
- Department of Plastic and Reconstructive Surgery and Burns, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Dominic Henn
- Department of Hand, Plastic, and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Christoph Hirche
- Department of Hand, Plastic, and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Ahmad Eweida
- Department of Hand, Plastic, and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany.,Head, Neck and Endocrine Surgery Unit, Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Matthias Uhl
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic, and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Thomas Kremer
- Department of Hand, Plastic, and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
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13
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Caracciolo JT, Letson GD. Radiologic Approach to Bone and Soft Tissue Sarcomas. Surg Clin North Am 2016; 96:963-76. [DOI: 10.1016/j.suc.2016.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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14
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Al-Ibraheemi A, Folpe AL. Voluntary Second Opinions in Pediatric Bone and Soft Tissue Pathology: A Retrospective Review of 1601 Cases From a Single Mesenchymal Tumor Consultation Service. Int J Surg Pathol 2016; 24:685-691. [PMID: 27363432 DOI: 10.1177/1066896916657591] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The diagnosis of bone and soft tissue tumors in children is challenging. These lesions are especially difficult for general pathologists. We reviewed our experience with pediatric mesenchymal tumors sent in consultation to our service, with the goal of identifying issues that most often prompted second-opinion referral. Roughly 16 000 cases were seen in toto, of which 1601 occurred in children. These included 491 bone cases and 1110 soft tissue cases. The cases were referred by private practices/nonacademic medical centers (85%), academic medical centers (8%), and pediatric hospitals (7%). Reasons for referral were (a) self-perceived lack of experience with pediatric mesenchymal tumors (n = 930), (b) second opinion requested by the clinician or patient (n = 132), and (c) perceived or real need for ancillary studies not available at the referring institution (n = 116). The referring pathologists suggested a diagnosis for 670 cases; of these, 476 (71%) were in essential agreement with our final diagnosis. Of the remaining, 139 (21%) were considered "minor disagreements" and 55 (8%) "major disagreements." The "major disagreement" cases could be divided into (a) malignant tumors submitted with benign diagnoses (58%), (b) benign tumors submitted with malignant diagnoses (25%), (c) nonneoplastic conditions submitted as representing neoplasms (11%), and (d) neoplasm submitted as representing nonneoplastic conditions (6%). Pediatric mesenchymal tumors comprised 10% of cases sent to our mesenchymal tumor consultation practice. The rates of diagnostic disagreement found in this study are roughly in accordance with prior studies of mandatory and voluntary second opinion in adult soft tissue tumors. Given the rarity of these tumors, expert second opinion may be of value.
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Nakhleh RE, Nosé V, Colasacco C, Fatheree LA, Lillemoe TJ, McCrory DC, Meier FA, Otis CN, Owens SR, Raab SS, Turner RR, Ventura CB, Renshaw AA. Interpretive Diagnostic Error Reduction in Surgical Pathology and Cytology: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology. Arch Pathol Lab Med 2016; 140:29-40. [PMID: 25965939 DOI: 10.5858/arpa.2014-0511-sa] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Additional reviews of diagnostic surgical and cytology cases have been shown to detect diagnostic discrepancies. OBJECTIVE To develop, through a systematic review of the literature, recommendations for the review of pathology cases to detect or prevent interpretive diagnostic errors. DESIGN The College of American Pathologists Pathology and Laboratory Quality Center in association with the Association of Directors of Anatomic and Surgical Pathology convened an expert panel to develop an evidence-based guideline to help define the role of case reviews in surgical pathology and cytology. A literature search was conducted to gather data on the review of cases in surgical pathology and cytology. RESULTS The panel drafted 5 recommendations, with strong agreement from open comment period participants ranging from 87% to 93%. The recommendations are: (1) anatomic pathologists should develop procedures for the review of selected pathology cases to detect disagreements and potential interpretive errors; (2) anatomic pathologists should perform case reviews in a timely manner to avoid having a negative impact on patient care; (3) anatomic pathologists should have documented case review procedures that are relevant to their practice setting; (4) anatomic pathologists should continuously monitor and document the results of case reviews; and (5) if pathology case reviews show poor agreement within a defined case type, anatomic pathologists should take steps to improve agreement. CONCLUSIONS Evidence exists that case reviews detect errors; therefore, the expert panel recommends that anatomic pathologists develop procedures for the review of pathology cases to detect disagreements and potential interpretive errors, in order to improve the quality of patient care.
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Affiliation(s)
- Raouf E Nakhleh
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida (Dr Nakhleh); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Nosé); Governance (Ms Colasacco) and the Pathology and Laboratory Quality Center (Mss Fatheree and Ventura), College of American Pathologists, Northfield, Illinois; Hospital Pathology Associates, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Lillemoe); the Department of Medicine, Duke University, Durham, North Carolina (Dr McCrory); the Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan (Dr Meier); the Department of Pathology, Baystate Medical Center, Springfield, Massachusetts (Dr Otis); the Department of Pathology, University of Michigan Medical School, Ann Arbor (Dr Owens); the Department of Pathology, Memorial University of Newfoundland/Eastern Health Authority, St John's, Newfoundland, Canada (Dr Raab); the Department of Pathology, St John's Health Center, Santa Monica, California (Dr Turner); and the Department of Pathology, Homestead Hospital, Homestead, Florida (Dr Renshaw). Dr Meier is currently with the Department of Pathology, Massachusetts General Hospital, Boston
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16
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Bouman W, Richards C, Addinall R, Arango de Montis I, Arcelus J, Duisin D, Esteva I, Fisher A, Harte F, Khoury B, Lu Z, Marais A, Mattila A, Nayarana Reddy D, Nieder T, Robles Garcia R, Rodrigues O, Roque Guerra A, Tereshkevich D, T’Sjoen G, Wilson D. Yes and yes again: are standards of care which require two referrals for genital reconstructive surgery ethical? SEXUAL AND RELATIONSHIP THERAPY 2014. [DOI: 10.1080/14681994.2014.954993] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Ramos-Pascua L, Sánchez-Herráez S, Casas-Ramos P, Izquierdo-García F, Maderuelo-Fernández J. Health care circuit for patients with soft tissue sarcomas of the extremities. A tortuous and slow road to referral units. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014. [DOI: 10.1016/j.recote.2014.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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18
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Ramos-Pascua LR, Sánchez-Herráez S, Casas-Ramos P, Izquierdo-García FJ, Maderuelo-Fernández JA. [Health care circuit for patients with soft tissue sarcomas of the extremities. A tortuous and slow road to referral units]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:160-70. [PMID: 24629725 DOI: 10.1016/j.recot.2014.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/26/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To analyse the waiting periods elapsed since soft tissue sarcomas become symptomatic until their specific treatment in our unit, and to determine new strategies for the improvement of referral circuits. MATERIAL AND METHODS This is an ambispective observational study of a cohort of 61 patients, with previously untreated soft tissue sarcomas, obtained from our Musculoskeletal Tumors Database. Several variables related to the patient, tumour, and health care circuit were analysed, as well as the different periods between the initial symptoms of the disease and the first consultation in our unit. The significance level was α=0.05. RESULTS The mean size of the sarcomas was 11.3 cm. Thirty-six patients (59%) followed the usual circuit of the National Health System in Spain. The time elapsed since the disease became symptomatic until the first medical consultation was greater than 9.5 months, and nearly another 8.5 months to the consultation in our specific unit. Statistically significant relationships were found between the independent and dependent variables. DISCUSSION The study shows that the care of patients with soft tissue sarcomas in our environment is far away from the times of care in our neighbouring countries. CONCLUSIONS It is essential to make the population and health professionals aware of this disease, as well as to remember that there is a referral circuit that must be used.
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Affiliation(s)
- L R Ramos-Pascua
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), León, España.
| | - S Sánchez-Herráez
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), León, España
| | - P Casas-Ramos
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), León, España
| | - F J Izquierdo-García
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), León, España
| | - J A Maderuelo-Fernández
- Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla León (SACYL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de Investigación de Actividades Preventivas y Promoción de la Salud (RedIAPP), Salamanca, España
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Gits CMM, van Kuijk PF, Jonkers MBE, Boersma AWM, Smid M, van Ijcken WF, Coindre JM, Chibon F, Verhoef C, Mathijssen RHJ, den Bakker MA, Verweij J, Sleijfer S, Wiemer EAC. MicroRNA expression profiles distinguish liposarcoma subtypes and implicate miR-145 and miR-451 as tumor suppressors. Int J Cancer 2014; 135:348-61. [PMID: 24375455 DOI: 10.1002/ijc.28694] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 12/03/2013] [Accepted: 12/05/2013] [Indexed: 12/13/2022]
Abstract
Liposarcomas are rare, heterogeneous and malignant tumors that can be divided into four histological subtypes with different characteristics and clinical behavior. Treatment consists of surgery in combination with systemic chemotherapy, but nevertheless mortality rates are high. More insight into the biology of liposarcoma tumorigenesis is needed to devise novel therapeutic approaches. MicroRNAs (miRNAs) have been associated with carcinogenesis in many tumors and may function as tumor suppressor or oncogene. In this study we examined miRNA expression in an initial series of 57 human liposarcomas (including all subtypes), lipomas and normal fat by miRNA microarrays. Supervised hierarchical clustering of the most differentially expressed miRNAs (p < 0.0002) distinguished most liposarcoma subtypes and control tissues. The distinction between well differentiated liposarcomas and benign lipomas was blurred, suggesting these tumor types may represent a biological continuum. MiRNA signatures of liposarcoma subtypes were established and validated in an independent series of 58 liposarcomas and control tissues. The expression of the miR-143/145 and miR-144/451 cluster members was clearly reduced in liposarcomas compared to normal fat. Overexpression of miR-145 and miR-451 in liposarcoma cell lines decreased cellular proliferation rate, impaired cell cycle progression and induced apoptosis. In conclusion, we show that miRNA expression profiling can be used to discriminate liposarcoma subtypes, which can possibly aid in objective diagnostic decision making. In addition, our data indicate that miR-145 and miR-451 act as tumor suppressors in adipose tissue and show that re-expression of these miRNAs could be a promising therapeutic strategy for liposarcomas.
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Affiliation(s)
- Caroline M M Gits
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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20
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Steinau HU, Steinsträsser L, Hauser J, Tilkorn D, Stricker I, Daigeler A. [Soft tissue sarcoma : resection and plastic reconstruction]. Chirurg 2014; 83:673-84. [PMID: 22782179 DOI: 10.1007/s00104-011-2241-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adequate surgical removal of soft tissue sarcomas of the trunk and extremities employing safety margins of 1-2 cm is the accepted basis of multidisciplinary treatment. In cases of high risk tumors (grades G2/G3) the tumor board decision should include radiochemotherapy under study conditions. Difficult peripheral locations or perioperative complications require additional techniques, such as hyperthermic perfusion with tumor necrosis factor alpha or the complete spectrum of reconstructive plastic procedures. Patients with soft tissue sarcoma of the trunk or of the extremities should always be referred to high volume centers.
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Affiliation(s)
- H U Steinau
- Klinik für Plastische Chirurgie und Schwerbrandverletzte, Operatives Referenzzentrum für Weichgewebssarkome, BG Universitätsklinik Bergmannsheil der RUB, Bürkle de la Camp Platz 1, 44799, Bochum, Deutschland.
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21
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Gaudi S, Zarandona JM, Raab SS, English JC, Jukic DM. Discrepancies in dermatopathology diagnoses: The role of second review policies and dermatopathology fellowship training. J Am Acad Dermatol 2013; 68:119-28. [DOI: 10.1016/j.jaad.2012.06.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 06/14/2012] [Accepted: 06/29/2012] [Indexed: 10/28/2022]
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22
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Obtaining expert opinions in diagnostically difficult cases. Pathology 2012; 45:80. [PMID: 23255031 DOI: 10.1097/pat.0b013e32835baec7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Ray-Coquard I, Montesco MC, Coindre JM, Dei Tos AP, Lurkin A, Ranchère-Vince D, Vecchiato A, Decouvelaere AV, Mathoulin-Pélissier S, Albert S, Cousin P, Cellier D, Toffolatti L, Rossi CR, Blay JY. Sarcoma: concordance between initial diagnosis and centralized expert review in a population-based study within three European regions. Ann Oncol 2012; 23:2442-2449. [PMID: 22331640 PMCID: PMC3425368 DOI: 10.1093/annonc/mdr610] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 12/07/2011] [Accepted: 12/07/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sarcomas represent a heterogeneous group of tumors. Accurate determination of histological diagnosis and prognostic factors is critical for the delineation of treatment strategies. The contribution of second opinion (SO) to improve diagnostic accuracy has been suggested for sarcoma but has never been established in population-based studies. METHODS Histological data of patients diagnosed with sarcoma in Rhone-Alpes (France), Veneto (Italy) and Aquitaine (France) over a 2-year period were collected. Initial diagnoses were systematically compared with SO from regional and national experts. RESULTS Of 2016 selected patients, 1463 (73%) matched the inclusion criteria and were analyzed. Full concordance between primary diagnosis and SO (the first pathologist and the expert reached identical conclusions) was observed in 824 (56%) cases, partial concordance (identical diagnosis of connective tumor but different grade or histological subtype) in 518 (35%) cases and complete discordance (benign versus malignant, different histological type or invalidation of the diagnosis of sarcoma) in 121 (8%) cases. The major discrepancies were related to histological grade (n = 274, 43%), histological type (n = 144, 24%), subtype (n = 18, 3%) and grade plus subtype or grade plus histological type (n = 178, 29%). CONCLUSION More than 40% of first histological diagnoses were modified at second reading, possibly resulting in different treatment decisions.
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Affiliation(s)
- I Ray-Coquard
- University Lyon, EAM 4129 Health Individual Society, Hôtel Dieu, Lyon; Centre Léon Bérard, Lyon, France.
| | - M C Montesco
- Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy
| | - J M Coindre
- University Bordeaux Segalen; INSERM U916, Bordeaux, France
| | | | - A Lurkin
- University Lyon, EAM 4129 Health Individual Society, Hôtel Dieu, Lyon; Centre Léon Bérard, Lyon, France
| | | | - A Vecchiato
- Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy
| | | | - S Mathoulin-Pélissier
- University Bordeaux Segalen; INSERM U916, Bordeaux, France; INSERM CIC-EC7 and Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux
| | - S Albert
- INSERM CIC-EC7 and Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux
| | - P Cousin
- Centre Léon Bérard, Lyon, France
| | | | | | - C R Rossi
- Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy; University of Padova, Italy
| | - J Y Blay
- Centre Léon Bérard, Lyon, France; NSERM U590 Cytokine and Cancer, Centre Léon Bérard, Lyon, France
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Santiago TC, Jenkins JJ, Pedrosa F, Billups C, Quintana Y, Ribeiro RC, Qaddoumi I. Improving the histopathologic diagnosis of pediatric malignancies in a low-resource setting by combining focused training and telepathology strategies. Pediatr Blood Cancer 2012; 59:221-5. [PMID: 22315236 DOI: 10.1002/pbc.24071] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 12/13/2011] [Indexed: 11/05/2022]
Abstract
BACKGROUND Accurate diagnosis is critical for optimal management of pediatric cancer. Pathologists with experience in pediatric oncology are in short supply in the developing world. Telepathology is increasingly used for consultations but its overall contribution to diagnostic accuracy is unknown. PROCEDURE We developed a strategy to provide a focused training in pediatric cancer and telepathology support to pathologists in the developing world. After the training period, we compared trainee's diagnoses with those of an experienced pathologist. We next compared the effectiveness of static versus dynamic telepathology review in 127 cases. Results were compared by Fisher's exact test. RESULTS The diagnoses of the trainee and the expert pathologist differed in only 6.5% of cases (95% CI, 1.2-20.0%). The overall concordance between the telepathology and original diagnoses was 90.6% (115/127; 95% CI, 84.1-94.6%). CONCLUSIONS Brief, focused training in pediatric cancer histopathology can improve diagnostic accuracy. Dynamic and static telepathology analyses are equally effective for diagnostic review.
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Affiliation(s)
- Teresa C Santiago
- Department of Pathology, Instituto Materno-Infantil de Pernambuco, Recife, Pernambuco, Brazil
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25
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Steinau HU, Steinsträsser L, Hauser J, Tilkorn D, Stricker I, Daigeler A. [Soft tissue sarcoma. Resection and plastic reconstruction]. DER ORTHOPADE 2012; 41:165-75; quiz 176. [PMID: 22349373 DOI: 10.1007/s00132-011-1876-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Adequate surgical removal of soft tissue sarcomas of the trunk and extremities employing safety margins of 1-2 cm is the accepted basis of multidisciplinary treatment. In cases of high risk tumors (grades G2/G3) the tumor board decision should include radiochemotherapy under study conditions. Difficult peripheral locations or perioperative complications require additional techniques, such as hyperthermic perfusion with tumor necrosis factor alpha or the complete spectrum of reconstructive plastic procedures. Patients with soft tissue sarcoma of the trunk or of the extremities should always be referred to high volume centers.
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Affiliation(s)
- H U Steinau
- Handchirurgiezentrum, Operatives Referenzzentrum für Weichgewebssarkome, Klinik für Plastische Chirurgie und Schwerbrandverletzte, BG-Universitätsklinik Bergmannsheil, Ruhr-Universität Bochum, Bürkle de la Camp Platz 1, 44799, Bochum, Deutschland.
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26
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Mastrangelo G, Coindre JM, Ducimetière F, Dei Tos AP, Fadda E, Blay JY, Buja A, Fedeli U, Cegolon L, Frasson A, Ranchère-Vince D, Montesco C, Ray-Coquard I, Rossi CR. Incidence of soft tissue sarcoma and beyond. Cancer 2012; 118:5339-48. [DOI: 10.1002/cncr.27555] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 02/10/2012] [Accepted: 02/27/2012] [Indexed: 12/26/2022]
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27
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Vanhoenacker FM, Van Looveren K, Trap K, Desimpelaere J, Wouters K, Van Dyck P, Parizel PM, De Schepper AM. Grading and characterization of soft tissue tumors on magnetic resonance imaging: the value of an expert second opinion report. Insights Imaging 2012; 3:131-8. [PMID: 22696039 PMCID: PMC3314736 DOI: 10.1007/s13244-012-0151-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 01/09/2012] [Accepted: 01/23/2012] [Indexed: 01/27/2023] Open
Abstract
Objective To retrospectively compare the accuracy of the initial MRI (magnetic resonance imaging) report of referring radiologists and the second opinion report. Material and methods MRI of 155 patients presenting with a soft tissue tumor (STT) in a single large community center were referred for inclusion in the Belgian Soft Tissue Neoplasm Registry (BSTNR). The initial report and the second opinion report were made independently. Histopathology (gold standard) was obtained in 90 patients (group 1). In 65 patients, the diagnosis was made by the combination of clinical findings and/or follow-up (group 2). In group 1, the concordance in grading and tissue-specific (TS) diagnosis between the referring center (RC) and expert center (EC) was reviewed. Results In group 1, MR grading yields a sensitivity of 100% and a specificity of 89% in the EC. The sensitivity was 88% and the specificity 81% in the RC. The accuracy was significantly higher in the EC (92%) compared to the RC (83%) (p = 0.039). The TS diagnosis was correct in 50% versus 38.5% of malignant tumors and in 71.8% versus 51.6% of benign tumors in the EC and RC respectively. Conclusion A second opinion report increases the accuracy in the diagnosis of STT on MRI. Main Messages • A second opinion MRI report increases the overall accuracy in the diagnosis of soft tissue tumors. • There is a good overall agreement in MR grading between the referring and expert institution. • In the expert center, there were fewer false-negative and false-positive diagnoses. • MRI performs better in the tissue-specific diagnosis of benign versus malignant STT.
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Affiliation(s)
- F M Vanhoenacker
- Dept. of Radiology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat, 10, 2650, Edegem, Belgium,
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Ferrari A, Sultan I, Huang TT, -Galindo CR, Shehadeh A, Meazza C, Ness KK, Casanova M, Spunt SL. Soft tissue sarcoma across the age spectrum: a population-based study from the Surveillance Epidemiology and End Results database. Pediatr Blood Cancer 2011; 57:943-9. [PMID: 21793180 PMCID: PMC4261144 DOI: 10.1002/pbc.23252] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 05/31/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a heterogeneous group of mesenchymal malignancies that occur throughout the lifespan. The impact of age on disease features and outcome is unclear. METHODS We analyzed the clinical features and outcome of all STS cases registered between 1973 and 2006 in the SEER database. RESULTS There were 48,012 cases that met the selection criteria. Individuals less than 20 years of age represented 5.6%, with rhabdomyosarcoma being the most common subtype. In adults, the most common types were Kaposi sarcoma, fibrohistiocytic tumors, and leiomyosarcoma. Rhabdomyosarcoma was the only entity with a median age <20 years. Male predominance (male/female of 1.5:1) was noticed for almost all types of STS, except for alveolar soft part sarcoma and leiomyosarcoma. Tumor stage was similar across different age groups. Younger patients (<50 years) had significantly better survival than older patients (88.8 ± 0.2% vs. 40 ± 0.3%, P < 0.001), but for most histologies the survival decline with advancing age was gradual and did not occur abruptly at the onset of adulthood. The decline in survival with advancing age was particularly significant for rhabdomyosarcoma. CONCLUSION With few exceptions, the clinical features of STS are similar in children and adults. However, individuals over 50 years of age have an inferior survival.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Istituto Nazionale Tumori, Milano, Italy
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan,Corresponding author: Iyad Sultan, MD, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman 11941, Jordan. , Telephone: +962-6-530-0460, Fax: +962-6-534-2567
| | - Tseng Tien Huang
- Department of Epidemiology & Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Carlos Rodriguez -Galindo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmad Shehadeh
- Department of Surgery, Orthopedic Oncology Unit, King Hussein Cancer Center, Amman, Jordan
| | - Cristina Meazza
- Pediatric Oncology Unit, Istituto Nazionale Tumori, Milano, Italy
| | - Kirsten K. Ness
- Department of Epidemiology & Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Michela Casanova
- Pediatric Oncology Unit, Istituto Nazionale Tumori, Milano, Italy
| | - Sheri L. Spunt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA and Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
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Palmieri B, Iannitti T. The Web Babel syndrome. PATIENT EDUCATION AND COUNSELING 2011; 85:331-333. [PMID: 21450437 DOI: 10.1016/j.pec.2011.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 02/15/2011] [Accepted: 02/16/2011] [Indexed: 05/30/2023]
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Reconstructive treatment of soft tissue sarcoma of the upper extremity. J Hand Surg Am 2011; 36:1241-7. [PMID: 21664071 DOI: 10.1016/j.jhsa.2011.04.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 04/27/2011] [Indexed: 02/02/2023]
Abstract
Limb-sparing surgery is currently the cornerstone of treatment for most patients with soft-tissue sarcoma of the upper extremity. To achieve the best outcome, the reconstructive surgeon must be part of a multidisciplinary team and is required to have a thorough understanding of the whole treatment concept. This article provides an update for the current surgical management of patients with soft tissue sarcoma of the upper extremity. Relevant nonsurgical aspects are also highlighted.
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Bannasch H, Eisenhardt SU, Grosu AL, Heinz J, Momeni A, Stark GB. The diagnosis and treatment of soft tissue sarcomas of the limbs. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:32-8. [PMID: 21286000 DOI: 10.3238/arztebl.2011.0032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 03/01/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND The diagnosis of soft-tissue sarcomas of the limbs is often delayed, sometimes markedly so, even though prompt and appropriate treatment improves survival and lowers the amputation rate. METHODS On the basis of a selective literature review and consideration of the relevant guidelines, we developed an algorithm that can serve as a guide to the diagnosis of soft-tissue tumors in general and to the treatment of soft-tissue sarcomas of the limbs. RESULTS Surgical resection accompanied by multimodal therapy is the only treatment strategy for soft-tissue sarcoma that provides a chance of cure. Particularly when the tumor is located in the distal part of a limb, plastic-reconstructive surgical techniques often enable adequate local control, along with limb salvage and preservation of function. The role of adjuvant or neo-adjuvant radiotherapy and/or chemotherapy is currently debated. The overall survival rate at 5 years is 87% for low-grade sarcomas and 62% for high-grade sarcomas. CONCLUSION Any solid mass of the limbs that has been present for more than four weeks requires diagnostic evaluation. Excisional biopsy is suitable only for epifascial lesions measuring less than 5 cm in diameter. All other lesions should be imaged with MRI and then diagnosed with an incisional biopsy. Patients with soft tissue sarcomas must be treated in an interdisciplinary collaboration so that they can undergo multimodal treatment. The proposed algorithm should help avoid delays in diagnosis and optimize treatment strategies.
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Affiliation(s)
- Holger Bannasch
- Abteilung Plastische und Handchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
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Detection and classification of diagnostic discrepancies (errors) in surgical pathology. Adv Anat Pathol 2010; 17:359-65. [PMID: 20733354 DOI: 10.1097/pap.0b013e3181ece0db] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Detecting and classifying error in a surgical pathology (SP) practice is an important part of a comprehensive quality assurance program. There are a number of mechanisms to detect error, including secondary review, examination of amended reports, correlation studies (cytology-histology and frozen-final diagnosis correlation). These different detection methods are reviewed in this paper. Additionally, the most common methods for error classification are also reviewed, along with the benefits and limitations of each. Although there is presently no gold standard for detecting or classifying errors in SP, based on this review of the literature, it is clearly good practice to consistently apply a standard method. Most importantly, these data should be incorporated into quality assurance and quality improvement activities, such that departments strive to reduce errors, and to help improve overall quality in SP.
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Hsu CY, Su IJ, Lin MC, Kuo TT, Jung SM, Ho DMT. Extra-departmental anatomic pathology expert consultation inTaiwan: a research grant supported 4-year experience. J Surg Oncol 2010; 101:430-5. [PMID: 20119977 DOI: 10.1002/jso.21494] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This report analyzed a research project supported nationwide expert consultation of anatomic pathology in Taiwan. METHODS The data were collected from the requisitions and consultation reports of 2,686 cases in this project from 2003 to 2006. The number of cases, tissue origin, additional special stains, turnaround time (TAT), concordance, discordance, referring pathologists, and consultants were analyzed. RESULTS Skin, hematopoietic system, and bone and soft tissue were the most common (48.3%) specimens sent for consultation. The tentative diagnosis and consultation diagnosis were discordant in 1,074 (64.3%) cases. Major discrepancy was seen in 205 (12.3%) cases, of which 66.8% were changed from malignant to benign, 21.0% were changed from benign to malignant, whereas 12.2% were changed from one category of malignancy to another. Additional special stains were performed on 38.7% of cases and hematology specimen was the most frequent. The mean TAT was 3.4 days. Pathologists working in institutes having fewer pathologists sent more cases for consultation. The opinion of the estimated annual consultation rate from the pathologists in Taiwan was 0.7%. CONCLUSIONS This program was beneficial simply by helping the referring pathologists in the workup and diagnosis. This result made the entire program a reasonable quality improvement program.
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Affiliation(s)
- Chih-Yi Hsu
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Lurkin A, Ducimetière F, Vince DR, Decouvelaere AV, Cellier D, Gilly FN, Salameire D, Biron P, de Laroche G, Blay JY, Ray-Coquard I. Epidemiological evaluation of concordance between initial diagnosis and central pathology review in a comprehensive and prospective series of sarcoma patients in the Rhone-Alpes region. BMC Cancer 2010; 10:150. [PMID: 20403160 PMCID: PMC2873387 DOI: 10.1186/1471-2407-10-150] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 04/19/2010] [Indexed: 11/10/2022] Open
Abstract
Background Sarcomas are rare malignant tumors. Accurate initial histological diagnosis is essential for adequate management. We prospectively assessed the medical management of all patients diagnosed with sarcoma in a European region over a one-year period to identify the quantity of first diagnosis compared to central expert review (CER). Methods Histological data of all patients diagnosed with sarcoma in Rhone-Alpes between March 2005 and Feb 2006 were collected. Primary diagnoses were systematically compared with second opinion from regional and national experts. Results Of 448 patients included, 366 (82%) matched the inclusion criteria and were analyzed. Of these, 199 (54%) had full concordance between primary diagnosis and second opinion (the first pathologist and the expert reached identical conclusions), 97 (27%) had partial concordance (identical diagnosis of conjonctive tumor but different grade or subtype), and 70 (19%) had complete discordance (different histological type or invalidation of the diagnosis of sarcoma). The major discrepancies were related to histological grade (n = 68, 19%), histological type (n = 39, 11%), subtype (n = 17, 5%), and grade plus subtype or grade plus histological type (n = 43, 12%). Conclusions Over 45% of first histological diagnoses were modified at second reading, possibly resulting in different treatment decisions. Systematic second expert opinion improves the quality of diagnosis and possibly the management of patients.
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Regan RC, Rassnick KM, Balkman CE, Bailey DB, McDonough SP. Comparison of first-opinion and second-opinion histopathology from dogs and cats with cancer: 430 cases (2001-2008). Vet Comp Oncol 2010; 8:1-10. [DOI: 10.1111/j.1476-5829.2009.00203.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Steinau HU, Daigeler A, Langer S, Steinsträsser L, Hauser J, Goertz O, Lehnhardt M. Limb salvage in malignant tumors. Semin Plast Surg 2010; 24:18-33. [PMID: 21286302 PMCID: PMC2887000 DOI: 10.1055/s-0030-1253240] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Limb-sparing resection and reconstruction has become the treatment of choice in extremity malignancies, as amputation does not provide better long-term survival rates or functional advantages. R0 resection, the removal of the tumor in sano, remains the prerequisite and most important oncologic parameter to avoid local recurrence. Successful treatment requires the combination of surgical eradication and the patient's specific functional and aesthetic rehabilitation. Our clinical rationale resulting from more than 2000 cases will be demonstrated. The problematic aspects of different tumor entities and the locoregional clearance of lymphatic pathways will be discussed. Differential diagnosis and multimodality treatment in high-volume tumor centers is likely to achieve superior oncologic statistics. Long-term survivors after microsurgical reconstructions and possible secondary malignancies will be addressed.
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Affiliation(s)
- Hans-Ulrich Steinau
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Adrien Daigeler
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Stefan Langer
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Lars Steinsträsser
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Jörg Hauser
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Ole Goertz
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Markus Lehnhardt
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
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Lapeyrere N, Parrens M, Coindre JM, Soubeyran I, de Mascarel A, Merlio JP, Lebail B, Lepreux S, Jaffre A, Gilleron V, Mathoulin-Pélissier S, Vergier B. [Impact of pathological review by an expert on the diagnosis and management of patients with cancer in Aquitania]. Ann Pathol 2008; 28:478-85. [PMID: 19084716 DOI: 10.1016/j.annpat.2008.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2008] [Indexed: 11/26/2022]
Abstract
AIMS The goal of this work was to evaluate the impact of expert pathological second opinion on the diagnosis and management of patients with cancer, in a French region (Aquitaine) and with an economic point of view. MATERIAL AND METHODS The study was first quantitative, performed retrospectively on all cases of cancer, voluntary sent for a second opinion to an expert pathologist of two centers. Secondly, we restricted the study to lymphoid, melanocytic and soft tissue tumors sent for second opinion. We considered that the expert review had an important diagnostic impact either when the initial pathologist sent the specimen to identify or classify malignant tumor or hesitated between benign and malignant tumor or had no hypothesis, or if there were discordant diagnoses (malignant/benign) between the two pathologists. We considered that the expert review had a high therapeutic impact if the disagreement between initial and expert diagnoses induced a complete modification in therapy. We evaluated the cost of second opinion for the expert centers and the cost of care management. RESULTS Over the year 2006, the expert centers received 5077 lesions for consultation: 3769 specimens were sent by a pathologist for a second review, 1324 by pathologists of Aquitania and of these, 751 samples were submitted for lymphoid (55%), soft tissues (30%) or melanocytic tumors (15%). There was an important diagnostic impact for 75% of the samples; the impact of the expert review on patient management was considered high for 46% of specimens and the expert pathological diagnosis modified the clinical prognosis for 40% of the specimens. We estimated that for 53 discordant diagnoses (malignant/benign), second opinion allowed an economy of 500,000 euro. CONCLUSION Expert second opinion is very important not only for diagnosis and management for patient with cancer but also for economic reasons.
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Affiliation(s)
- Nadège Lapeyrere
- Réseau de cancérologie d'Aquitaine, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
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Daigeler A, Kuhnen C, Moritz R, Stricker I, Goertz O, Tilkorn D, Steinstraesser L, Steinau HU, Lehnhardt M. Lymph node metastases in soft tissue sarcomas: a single center analysis of 1,597 patients. Langenbecks Arch Surg 2008; 394:321-9. [PMID: 18594854 DOI: 10.1007/s00423-008-0371-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 06/10/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to examine the clinical course of patients with the rare finding of regional lymph node metastasis (RLNM) from soft tissue sarcoma. MATERIALS AND METHODS Data from 28 out of 1,597 consecutive soft tissue sarcoma patients with RLNM were from the patients' charts and interviewing patients and general practitioners. Survival, including possible influencing factors, was statistically calculated. RESULTS RLNM was seen in 21.4% for epithelioid sarcoma and 17.6% for clear cell sarcoma. All other entities presented RLNM rates below 10%. At follow-up after an average of 9.6 years, only three patients were alive with no evidence of disease. Survival was independent from surgical resection status of the primary tumor and the RLNM as well as from adjuvant radiation and chemotherapy. Tumor entity as well as the length of the time period from primary to RLNM affect survival. CONCLUSIONS Surgical treatment as well as radiation and chemotherapy may improve survival in selected cases but probably have their value much more in terms of local disease control and improvement life quality of patients who probably already suffer from an aggressive systemic disease at time of nodal involvement.
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Affiliation(s)
- A Daigeler
- Department of Plastic Surgery, Burn Center, Hand Surgery, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
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Lehnhardt M, Daigeler A, Homann HH, Schwaiberger V, Goertz O, Kuhnen C, Steinau HU. MFH revisited: outcome after surgical treatment of undifferentiated pleomorphic or not otherwise specified (NOS) sarcomas of the extremities -- an analysis of 140 patients. Langenbecks Arch Surg 2008; 394:313-20. [PMID: 18584203 DOI: 10.1007/s00423-008-0368-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 06/06/2008] [Indexed: 01/28/2023]
Abstract
BACKGROUND Undifferentiated pleomorphic sarcoma/NOS (not otherwise specified; former pleomorphic and storiform MFH) of the extremities is a common malignant soft tissue tumor in adults. The objective of this study is to determine prognostic factors for the outcome after surgical treatment with respect to the recent developments in classification. METHODS From 1996 to 2004, 140 undifferentiated pleomorphic sarcomas/NOS were identified out of 1,200 soft tissue sarcomas of the extremities that were treated at our institution and recorded in a prospective database. Overall survival (OS) and isolated local recurrence (ILR) were determined by Kaplan-Meier analysis. All tumors were retrospectively analyzed regarding prognostic factors of the disease, including patient's background (primary or recurrent), histological grade (G2/G3), adjuvant chemotherapy and radiotherapy, size (T1-2) and depth of the tumor, and surgical margins (R0, R1, R2). RESULTS In 123 patients, a wide resection was performed (limb-sparing surgery). In nine patients, an amputation was necessary. The overall 5-year survival rate was 72% (median follow up: 52 months). There was a significant difference between the group presenting with primary tumors (5-year survival: 84%, p < 0.05) and recurrent tumors (5-year survival: 62%, p < 0.05). Isolated local recurrence occurred in 36 patients. CONCLUSIONS In terms of OS and ILR, primary or recurrence, negative surgical margins, size and grading had a highly significant influence, whereas the site of surgery and adjuvant chemotherapy, adjuvant radiation and tumor depth did not. Prognosis for patients with undifferentiated pleomorphic sarcoma of the extremities depends predominantly on adequate wide resection of the primary tumor.
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Affiliation(s)
- Marcus Lehnhardt
- Department of Plastic Surgery, Burn Center, Handsurgery, Sarcoma Reference Center, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
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Lehnhardt M, Daigeler A, Homann H, Hauser J, Langer S, Steinsträßer L, Soimaru C, Puls A, Steinau H. Die Bedeutung von Referenzzentren in Diagnose und Therapie von Weichgewebssarkomen der Extremitäten. Chirurg 2008; 80:341-7. [DOI: 10.1007/s00104-008-1562-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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