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Tatsis D, Sinha D, Le Grange F, Jay A, Salli M, Sadeghian G, Morley S, Wan S, Karavasilis V, Windsor R, Strauss SJ, Kalavrezos N. Improving head and neck sarcoma care: The impact of a specialized multidisciplinary team approach on diagnosis and patient outcomes. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108531. [PMID: 38996585 DOI: 10.1016/j.ejso.2024.108531] [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: 05/06/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE Globally, head & neck sarcoma care pathways remain unclear. In 2018, the London Sarcoma Service (LSS) set up a dedicated head and neck sarcoma (HNS) multidisciplinary team (MDT) with a clear objective to provide formal access to super-specialist expertise in diagnosis, treatment planning and management of HNS. The aim of the study is to provide first results of a dedicated HNS MDT. METHODS All patients discussed between 2018 and 2022, in HNS MDT, with a new histologically confirmed HNS diagnosis were included in the study. Demographics, anatomic site, morphology, MDT recommendation, treatment details and outcomes were obtained from electronic patient records. RESULTS A total of 337 patients were discussed in the HNS MDT of which 178 patients were included in the study, with a median age of 53 years(range 2-94); 67 % were soft tissue sarcomas(STS) and 33 % were bone sarcomas(BS), of which 43 % and 71 % were high grade, respectively. 55 % BS and 39 % STS underwent surgery. 9 % of BS and 7 % of STS received adjuvant Proton Beam therapy. With a median follow-up of 2.16 years, recurrence was observed in 12 %, distant metastasis in 6 % of patients and overall survival was 72 %. CONCLUSION The HNS MDT provides expertise on diagnosis and multi-modality management of HNS. STS are more likely to be misdiagnosed. Atypical imaging characteristics should trigger a specialist referral. Adequate surgery at first presentation remains the mainstay of treatment and the strongest prognosticator of overall survival. Formation of an expert working group specific to HNS must work towards streamlining sarcoma care.
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Affiliation(s)
- Dimitris Tatsis
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK.
| | - Deepti Sinha
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Franel Le Grange
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Amrita Jay
- University College London Hospitals NHS Trust, London, UK
| | - Malla Salli
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Golnaz Sadeghian
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Simon Morley
- University College London Hospitals NHS Trust, London, UK
| | - Simon Wan
- University College London Hospitals NHS Trust, London, UK
| | - Vasilios Karavasilis
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Rachael Windsor
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Sandra J Strauss
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Nicholas Kalavrezos
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
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Syros A, Baron MC, Adalbert J, Remer HB, Heng M, Crawford B. Barriers to care for musculoskeletal sarcoma patients: a public health perspective. Front Public Health 2024; 12:1399471. [PMID: 39234070 PMCID: PMC11373356 DOI: 10.3389/fpubh.2024.1399471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/07/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction This study seeks to investigate the barriers to care that exist for patients presenting with sarcomas of musculoskeletal origin. Understanding the roots of delays in care for patients with musculoskeletal sarcoma is particularly important given the necessity of prompt treatment for oncologic diagnoses. Investigators reviewed relevant studies of publications reporting barriers to care in patients undergoing diagnosis and treatment of musculoskeletal tumors. Methods A comprehensive literature search was conducted using Scopus, Embase, Web of Science, and PubMed-MEDLINE. Twenty publications were analyzed, including a total of 114,056 patients. Results Four barrier subtypes were identified: Socioeconomic Status, Geographic Location, Healthcare Quality, Sociocultural Factors. Socioeconomic status included access to health insurance and income level. Geographic location included distance traveled by patients, access to referral centers, type of hospital system and resource-challenged environments. Healthcare quality included substandard imaging, access to healthcare resources, and healthcare utilization prior to diagnosis. Sociocultural factors included psychological states, nutrition, education and social support. Conclusion After identifying the most significant barriers in this study, we can target specific public health issues within our community that may reduce delays in care. The assessment of barriers to care is an important first step for improving the delivery of oncologic patient care to this patient population.
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Affiliation(s)
- Alina Syros
- Harvard Combined Orthopaedic Residency Program, Harvard University, Boston, MA, United States
| | - Max C Baron
- Department of Education, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jenna Adalbert
- Department of Orthopedics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Hallie B Remer
- Department of Education, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Marilyn Heng
- Department of Orthopedics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Brooke Crawford
- Department of Orthopedics, Miller School of Medicine, University of Miami, Miami, FL, United States
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Noebauer-Huhmann IM, Vanhoenacker FM, Vilanova JC, Tagliafico AS, Weber MA, Lalam RK, Grieser T, Nikodinovska VV, de Rooy JWJ, Papakonstantinou O, Mccarthy C, Sconfienza LM, Verstraete K, Martel-Villagrán J, Szomolanyi P, Lecouvet FE, Afonso D, Albtoush OM, Aringhieri G, Arkun R, Aström G, Bazzocchi A, Botchu R, Breitenseher M, Chaudhary S, Dalili D, Davies M, de Jonge MC, Mete BD, Fritz J, Gielen JLMA, Hide G, Isaac A, Ivanoski S, Mansour RM, Muntaner-Gimbernat L, Navas A, O Donnell P, Örgüç Ş, Rennie W, Resano S, Robinson P, Sanal HT, Ter Horst SAJ, van Langevelde K, Wörtler K, Koelz M, Panotopoulos J, Windhager R, Bloem JL. Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023-overview, and primary local imaging: how and where? Eur Radiol 2024; 34:4427-4437. [PMID: 38062268 PMCID: PMC11213759 DOI: 10.1007/s00330-023-10425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Early, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary. The guidelines are intended to support radiologists in their decision-making and contribute to interdisciplinary tumor board discussions. MATERIALS AND METHODS A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements were scored online by level of agreement (0 to 10) during two iterative rounds. Either "group consensus," "group agreement," or "lack of agreement" was achieved. RESULTS Eight sections were defined that finally contained 145 statements with comments. Overall, group consensus was reached in 95.9%, and group agreement in 4.1%. This communication contains the first part consisting of the imaging algorithm for suspected soft tissue tumors, methods for local imaging, and the role of tumor centers. CONCLUSION Ultrasound represents the initial triage imaging modality for accessible and small tumors. MRI is the modality of choice for the characterization and local staging of most soft tissue tumors. CT is indicated in special situations. In suspicious or likely malignant tumors, a specialist tumor center should be contacted for referral or teleradiologic second opinion. This should be done before performing a biopsy, without exception. CLINICAL RELEVANCE The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability both in individual patients and in future studies on individualized strategies. KEY POINTS • Ultrasound remains the best initial triage imaging modality for accessible and small suspected soft tissue tumors. • MRI is the modality of choice for the characterization and local staging of soft tissue tumors in most cases; CT is indicated in special situations. Suspicious or likely malignant tumors should undergo biopsy. • In patients with large, indeterminate or suspicious tumors, a tumor reference center should be contacted for referral or teleradiologic second opinion; this must be done before a biopsy.
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Affiliation(s)
- Iris-Melanie Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.
| | - Filip M Vanhoenacker
- Department of Radiology AZ Sint Maarten Mechelen, University Hospital Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Joan C Vilanova
- Department of Radiology, Clínica Girona, Institute of Diagnostic Imaging (IDI) Girona, University of Girona, Girona, Spain
| | - Alberto S Tagliafico
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Radhesh K Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Thomas Grieser
- Dept. for Diagnostic and Interventional, Radiology University Hospital Augsburg, Augsburg, Germany
| | - Violeta Vasilevska Nikodinovska
- Medical Faculty, Ss. Cyril and Methodius University, Skopje, Macedonia
- Department of Radiology, University Surgical Clinic "St. Naum Ohridski" Skopje, Skopje, Macedonia
| | - Jacky W J de Rooy
- Department of Imaging, Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olympia Papakonstantinou
- 2Nd Department of Radiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Catherine Mccarthy
- Oxford Musculoskeletal Radiology and Oxford University Hospitals, Oxford, UK
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milan, Italy
| | | | | | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Frédéric E Lecouvet
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Diana Afonso
- Hospital Particular da Madeira, and Hospital da Luz Lisboa, Lisbon, Portugal
| | - Omar M Albtoush
- Department of Radiology, University of Jordan, Ammam, Jordan
| | - Giacomo Aringhieri
- Academic Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Remide Arkun
- Ege University Medical School Izmir, Izmir, Turkey Star Imaging Center Izmir, Izmir, Turkey
| | - Gunnar Aström
- Department of Immunology, Genetics and Pathology (Oncology) and Department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | | | | | - Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), London, UK
| | - Mark Davies
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - Milko C de Jonge
- Department of Radiology, St. Antonius Hospital, Utrecht, The Netherlands
| | - Berna D Mete
- Department of Radiology School of Medicine, Izmir Demokrasi University, Izmir, Turkey
| | - Jan Fritz
- Department of Radiology, NYU Grossman School of Medicine, New York, USA
- Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Jan L M A Gielen
- Department of Radiology and Medical Imaging, University Hospital Antwerp, Edegem, Belgium
| | - Geoff Hide
- Department of Radiology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Slavcho Ivanoski
- St. Erasmo Hospital for Orthopaedic Surgery and Traumatology Ohrid, Ohrid, Macedonia
| | | | | | - Ana Navas
- Department of Radiology, Division of Musculoskeletal Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Winston Rennie
- Clinical MSK Radiology, Loughborough University, Leicester Royal Infirmary, Leicester, UK
| | | | - Philip Robinson
- Musculoskeletal Radiology Department Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Hatice T Sanal
- Radiology Department, University of Health Sciences, Gülhane Training and Research Hospital, Istanbul, Turkey
| | - Simone A J Ter Horst
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Klaus Wörtler
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, Technical University of Munich - TUM School of Medicine, Munich, Germany
| | - Marita Koelz
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Joannis Panotopoulos
- Departement of Orthopaedics and Traumatology, Division of Orthopaedics, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Departement of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
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Udhawani NS, Hoover DL. Differential screen and treatment of sternocleidomastoid syndrome versus eagle syndrome: a case report. Physiother Theory Pract 2024; 40:1072-1082. [PMID: 36384424 DOI: 10.1080/09593985.2022.2144560] [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: 03/31/2021] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Differential screening is a complex process in chronic pain conditions. There is significant uncertainty that surrounds the pathophysiology of many chronic pain syndromes that may lead to misdiagnosis and treatment failures. Such differential screening is even more challenging where there is regional overlapping from surrounding tissues. This case report chronicles the differential screening and treatment of a patient with sternocleidomastoid syndrome (SCMS) originally diagnosed as Eagle's syndrome (ES). CASE DESCRIPTION A 55-year-old woman, referred to a physical therapist (PT) by an ear, nose and throat (ENT) physician with the diagnosis of ES. The patient complained of yearlong left-sided otalgia, blurred vision, excessive lacrimation, dysphagia, hyperesthesia on the left side of the face, unilateral temporal headaches, and both left mandibular and anterior neck pain. OUTCOMES The PT examination revealed the patient did not exhibit hallmark findings for clinical confirmation of ES and instead demonstrated multiple signs consistent with SCMS. DISCUSSION Manual therapy techniques and therapeutic exercises resolved the patient's year-long chronic symptoms within 6 sessions.
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Affiliation(s)
- Nitin S Udhawani
- Physical Therapy Department, Three Rivers Health Outpatient Physical Therapy, Three Rivers, Michigan, United States
| | - Donald L Hoover
- Doctor of Physical Therapy Department, Western Michigan University, Kalamazoo, Michigan, United States
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5
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Yang BW, Rahman R, Urban C, Victoria C, Lee SK. Referral Patterns Associated With Delayed Care for Traumatic Brachial Plexus Injuries. J Hand Surg Am 2023:S0363-5023(23)00257-5. [PMID: 37389495 DOI: 10.1016/j.jhsa.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 04/19/2023] [Accepted: 05/03/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Traumatic brachial plexus injuries (BPI) are devastating, time-sensitive conditions that often require definitive treatment at academic tertiary care centers. Delays to presentation and surgery have been associated with inferior outcomes. In this study, we evaluate referral patterns associated with delayed presentation and late surgery in traumatic BPI patients. METHODS Patients diagnosed with a traumatic BPI at our institution from 2000 to 2020 were identified. Medical charts were reviewed for demographic characteristics, prereferral work-up, and referring provider characteristics. Delayed presentation was defined as greater than 3 months from date of injury to initial evaluation by our brachial plexus specialists. Late surgery was defined as greater than 6 months from date of injury. Multivariable logistic regression was used to identify factors associated with delayed presentation or surgery. RESULTS A total of 99 patients were included, 71 of whom underwent surgery. Sixty-two patients presented delayed (62.6%), with 26 receiving late surgery (36.6%). There were similar rates of delayed presentation or late surgery by referring provider specialty. Patients whose initial diagnostic EMG was ordered by the referring provider prior to initial presentation at our institution were more likely to have a delayed presentation (76.2% vs 31.3%) and undergo late surgery (44.9% vs 10.0%). CONCLUSIONS Delayed presentation and late surgery in traumatic BPI patients were associated with initial diagnostic EMG ordered by the referring provider. CLINICAL RELEVANCE Delayed presentation and surgery have been associated with inferior outcomes in traumatic BPI patients. We recommend that providers direct patients with clinical concern of traumatic BPI directly to a brachial plexus center without further work-up before referral and encourage referral centers to accept these patients.
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Affiliation(s)
- Brian W Yang
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
| | - Rafa Rahman
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
| | - Casey Urban
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
| | - Christian Victoria
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
| | - Steve K Lee
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY.
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Sasi A, Ganguly S, Biswas B, Pushpam D, Kumar A, Agarwala S, Khan SA, Kumar VS, Deo S, Sharma DN, Bakhshi S. Determinants and impact of diagnostic interval in bone sarcomas: A retrospective cohort study. Pediatr Blood Cancer 2023; 70:e30135. [PMID: 36524611 DOI: 10.1002/pbc.30135] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/30/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Diagnostic delays in cancers are frequent in developing countries due to poor health infrastructure. Existing literature from developed countries suggests that diagnostic interval in bone sarcomas is primarily dictated by tumour biology with no impact on survival. This study evaluates the social and biological determinants of the diagnostic interval in bone sarcomas in a resource-challenged setting and assesses its impact on treatment outcomes. METHODS A retrospective single-institutional study was conducted on patients with high-grade bone sarcomas recorded in the sarcoma clinic database between 2003 and 2018. Baseline clinical characteristics and treatment outcomes were recorded. Logistic regression was performed to assess the impact of baseline clinical and social characteristics (distance from treating centre and rural vs. urban residence) on the diagnostic interval. Further, the impact of diagnostic interval on histologic response to neoadjuvant chemotherapy, amputation requirement in extremity sarcomas and survival was evaluated. RESULTS A total of 1227 patients were included for analysis. The median diagnostic interval was 4 months (3-7 months). Age above 18 years, Ewing sarcoma (ES) diagnosis, absence of fever at presentation and tumour size above 7.5 cm were predictors of a longer diagnostic interval (>4 months). The length of the diagnostic interval did not impact amputation requirement or survival outcomes. However, the proportion of patients with good necrosis post-neoadjuvant chemotherapy was lower among patients with longer diagnostic intervals (25% vs. 34·16%; p-value = .04). CONCLUSION Tumour characteristics rather than social factors determined the diagnostic interval. Diagnostic interval did not impact survival outcomes even in a resource-constrained setting.
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Affiliation(s)
- Archana Sasi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shuvadeep Ganguly
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Kumar
- Department of Medical Oncology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Agarwala
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Suryanarayana Deo
- Department of Surgical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Gowda P, Bajaj G, Silva FD, Ashikyan O, Xi Y, Chhabra A. Does the apparent diffusion coefficient from diffusion-weighted MRI imaging aid in the characterization of malignant soft tissue tumors and sarcomas. Skeletal Radiol 2023:10.1007/s00256-023-04289-5. [PMID: 36725723 DOI: 10.1007/s00256-023-04289-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify trends in apparent diffusion coefficient (ADC) measurements from diffusion-weighted imaging (DWI) with respect to tumor type classification and other tumor characteristics whether common malignant soft tissue tumors can be distinguished. MATERIALS AND METHODS A consecutive series of extremity malignant soft tissue tumors and soft tissue sarcomas (STS) among 78 adult patients with conventional MRI and DWI were included. Each case was evaluated with respect to T1/T2 signal alterations and heterogeneity, presence of peritumoral edema, necrosis, cystic changes, internal hemorrhage, and maximum longitudinal dimension blinded to the histology. The ADC mean and minimum were obtained using a free-hand region of interest of the whole tumor and the darkest (lowest signal area) ADC area of the tumor. Kruskal-Wallis and Wilcoxon Rank-Sum Tests were used to determine associations and significance between tumor subtypes. Intraclass correlation (ICC) and kappa calculations were utilized to assess inter-reader agreements for ADC values and reader diagnosis. RESULTS Liposarcomas showed more heterogenous T1W images with hyperintense T1W signal when compared to tumors not classified as liposarcoma (P = 0.046 and P = 0.010, respectively). Liposarcomas were relatively consistent in demonstrating an absence of hemorrhage (81.8%) while undifferentiated pleomorphic sarcomas consistently showed intralesional hemorrhage (90%). When comparing individual tumor classifications against the rest of the samples, lymphomas registered lower mean and minimum ADC values in the whole tumor and in the most hypointense area of the tumor for both readers (P < 0.05). The interobserver agreement between the two readers was good to excellent for all four ADC measurements (ICC = 0.65-0.98). CONCLUSION Diffusion-weighted imaging generated ADC measurements are reproducible but currently offer limited insight in being able to differentiate among different malignant soft tissue tumor and sarcoma histologies. T1W and T2W signal characteristics also offer limited insight in differentiating between soft tissue malignancies.
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Affiliation(s)
- Prajwal Gowda
- Radiology, UT Southwestern Medical Center, Dallas, TX, 75022, USA
| | - Gitanjali Bajaj
- Radiology, University of Arkansas Medical School, Little Rock, AR, USA
| | | | - Oganes Ashikyan
- Radiology, UT Southwestern Medical Center, Dallas, TX, 75022, USA
| | - Yin Xi
- Radiology, UT Southwestern Medical Center, Dallas, TX, 75022, USA
| | - Avneesh Chhabra
- Radiology, UT Southwestern Medical Center, Dallas, TX, 75022, USA. .,Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
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8
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Soomers V, Husson O, Young R, Desar I, Van der Graaf W. The sarcoma diagnostic interval: a systematic review on length, contributing factors and patient outcomes. ESMO Open 2021; 5:S2059-7029(20)30008-9. [PMID: 32079621 PMCID: PMC7046415 DOI: 10.1136/esmoopen-2019-000592] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 12/27/2022] Open
Abstract
Sarcomas are rare and heterogeneous mesenchymal tumours of soft tissue or bone, making them prone to late diagnosis. In other malignancies, early diagnosis has an impact on stage of disease, complexity of therapeutic procedures, survival and health-related quality of life (HRQoL). Little is known about what length of diagnostic interval should be considered as delay in patients with bone (BS) or soft tissue sarcomas (STS). To quantify total interval (defined as time from first symptom to histological diagnosis) and its components, identify contributing factors to its length and determine the impact on patients’ outcome in terms of mortality and HRQoL. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventy-six articles out of 2310 met the predefined inclusion criteria. Total intervals, varied broadly; 9–120.4 weeks for BS and 4.3–614.9 weeks for STS. Older age and no initial radiological examinations were contributing factors for a long interval in BS, while in STS results were conflicting. The impact of length of total interval on clinical outcomes in terms of survival and morbidity remains ambiguous; no clear relation could be identified for both BS and STS. No study examined the impact on HRQoL. The length of total interval is variable in BS as well as STS. Its effect on outcomes is contradictory. There is no definition of a clinically relevant cut-off point that discriminates between a short or long total interval. Prospero: CRD42017062492.
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Affiliation(s)
- Vicky Soomers
- Medical Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Olga Husson
- Institute of Cancer Research, London, London, UK.,Psychosocial research and epidemiology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Robin Young
- Medical Oncology, Weston Park Hospital, Sheffield, Sheffield, UK
| | - Ingrid Desar
- Medical Oncology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Winette Van der Graaf
- Medical Oncology, Antoni van Leewenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands.,Medical Oncology, Radboudumc, Nijmegen, The Netherlands
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Vasilevska Nikodinovska V, Ivanoski S, Samardziski M, Janevska V. Percutaneous Imaging-Guided versus Open Musculoskeletal Biopsy: Concepts and Controversies. Semin Musculoskelet Radiol 2020; 24:667-675. [PMID: 33307583 DOI: 10.1055/s-0040-1717113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Bone and soft tissue tumors are a largely heterogeneous group of tumors. Biopsy of musculoskeletal (MSK) tumors is sometimes a challenging procedure. Although the open biopsy is still considered the gold standard for the biopsy of MSK lesions, core needle biopsy can replace it in most cases, with similar accuracy and a low complication rate. The biopsy should be performed in a tertiary sarcoma center where the multidisciplinary team consists of at minimum a tumor surgeon, an MSK pathologist, and an MSK radiologist who can assess all steps of the procedure. Several factors can influence the success of the biopsy including the lesion characteristics, the equipment, and the method used for the procedure. This review highlights some of the important aspects regarding the biopsy of the MSK tumors, with special attention to imaging a guided core needle biopsy and highlighting some of the recent advancements and controversies in the field.
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Affiliation(s)
- Violeta Vasilevska Nikodinovska
- Department of Radiology, Faculty of Medicine, University Surgical Clinic, St. Naum Ohridski Skopje, Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
| | - Slavcho Ivanoski
- Department of Radiology, Special Hospital for Orthopedic Surgery and Traumatology, St. Erazmo - Ohrid, Macedonia, Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
| | - Milan Samardziski
- University Clinic for Orthopedic Surgery, Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
| | - Vesna Janevska
- Institute of Pathology, Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
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Featherall J, Curtis GL, Lawrenz JM, Jin Y, George J, Scott J, Shah C, Shepard D, Rubin BP, Nystrom LM, Mesko NW. Time to treatment initiation and survival in adult localized, high‐grade soft tissue sarcoma. J Surg Oncol 2019; 120:1241-1251. [DOI: 10.1002/jso.25719] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 09/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
| | - Gannon L. Curtis
- Department of Orthopaedic SurgeryOrthopaedic and Rheumatologic InstituteCleveland Ohio
| | - Joshua M. Lawrenz
- Department of Orthopaedic SurgeryOrthopaedic and Rheumatologic InstituteCleveland Ohio
| | - Yuxuan Jin
- Department of Quantitative Health SciencesLerner Research InstituteCleveland Ohio
| | - Jaiben George
- Department of Orthopaedic SurgeryOrthopaedic and Rheumatologic InstituteCleveland Ohio
| | - Jacob Scott
- Department of Radiation OncologyTaussig Cancer InstituteCleveland Ohio
| | - Chirag Shah
- Department of Radiation OncologyTaussig Cancer InstituteCleveland Ohio
| | - Dale Shepard
- Department of Hematology and Medical OncologyTaussig Cancer InstituteCleveland Ohio
| | - Brian P. Rubin
- Department of PathologyPathology and Laboratory Medicine InstituteCleveland Ohio
| | - Lukas M. Nystrom
- Department of Orthopaedic SurgeryOrthopaedic and Rheumatologic InstituteCleveland Ohio
| | - Nathan W. Mesko
- Department of Orthopaedic SurgeryOrthopaedic and Rheumatologic InstituteCleveland Ohio
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11
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Gantzer J, Di Marco A, Fabacher T, Weingertner N, Delhorme JB, Brinkert D, Bierry G, Ghnassia JP, Jégu J, Kurtz JE. Conformity to Clinical Practice Guidelines at Initial Management in Adult Soft Tissue and Visceral Tumors since the Implementation of the NetSarc Network in Eastern France. Oncologist 2019; 24:e775-e783. [PMID: 31073021 DOI: 10.1634/theoncologist.2018-0751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/03/2019] [Accepted: 03/18/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Soft tissue sarcomas are rare and heterogenous tumors that are hard to diagnose. The aim of this study was to evaluate local practices and conformity to clinical practice guidelines (CPGs) for their initial diagnostic management. MATERIALS AND METHODS Patients were carriers of a soft tissue or visceral tumor, presented at a sarcoma tumor board (STB) between 2010 and 2016. Conformity to CPGs was evaluated using ten criteria designed for this purpose. Associations between different factors and conformity to composite criteria, reflecting the three main diagnostic steps (imaging, biopsy and histological report) were analyzed. RESULTS A total of 643 patients were included. A preoperative tumor imaging assessment and a biopsy were performed according to CPGs in 80.8% and 36.8% of the cases, respectively. When done, the first surgical resection was R0 in 30.3% of cases, R1 in 28.6%, and R2 in 10.9%. The rest of the operated patients with sarcoma had a second surgical excision (11.4%), an intraoperative fragmentation (4.3%), or margins were unknown (14.4%). Six of the ten quality criteria presented a conformity rate higher than 70%. Two criteria with a conformity rate lower than 20% were the most controversial: presentation at a STB before biopsy and freezing of a tumor fragment. A multivariate analysis revealed that the common predictor of nonconformity to composite criteria was the initial management in a nonexpert center. CONCLUSION Initial diagnostic management requires improvement, especially outside of specialized centers. IMPLICATIONS FOR PRACTICE This article supports the essential need to refer patients with soft tissue tumors to specialized centers to improve the management of sarcomas beginning at the diagnostic phase. Indeed, the reported data were very similar to those already described at the national level of the NetSarc network and indicate the necessity to keep raising awareness about this simple issue: early referral to reference centers will save lives.
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Affiliation(s)
- Justine Gantzer
- Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Antonio Di Marco
- Department of Orthopedic Surgery and Traumatology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thibaut Fabacher
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Noelle Weingertner
- Department of Pathology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Baptiste Delhorme
- Department of Digestive Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - David Brinkert
- Department of Orthopedic Surgery and Traumatology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Guillaume Bierry
- Department of Radiology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Jérémie Jégu
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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12
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Conventional MR and diffusion-weighted imaging of musculoskeletal soft tissue malignancy: correlation with histologic grading. Eur Radiol 2018; 29:4485-4494. [PMID: 30511176 DOI: 10.1007/s00330-018-5845-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/22/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023]
Abstract
AIM To evaluate proven soft tissue musculoskeletal malignancies blinded to their Fédération Nationale des Centres de Lutte Contre le Cancer histologic grades to identify the predictive values of conventional MR findings and best fit region of interest (ROI) apparent diffusion coefficient (ADC) measurements. MATERIALS AND METHODS Fifty-one consecutive patients with different histologic grades were evaluated by four readers (R1-4) of different experience levels. Quantitatively, the maximum longitudinal size, tumor to muscle signal intensity ratios, and ADC measurements and, qualitatively, the spatial location of the tumor, its signal alterations, heterogeneity, intralesional hemorrhage or fat, and types of enhancement were assessed. Intraclass correlation, weighted kappa, ANOVA, and Fisher exact tests were used. RESULTS There were 22/51 (43%) men (mean age ± SD = 52 ± 16 years) and 29/51 (57%) women (mean age ± SD = 54± 17 years), with the majority of tumors 38/51 (75%) in the lower extremities. Histologic grades were I in 8/51 (16%), II in 17/51 (33%), and III in 26/51 (51%), respectively. The longitudinal dimensions were different among three grades (p = 0.0015), largest with grade I. More central enhancements and deep locations were seen in grade III tumors (p = 0.0191, 0.0246). The ADC mean was significantly lower in grade III than in grade I or II (p < 0.0001 and p = 0.04). The ADC min was significantly lower in grade III than in grade I (p = 0.02). Good to excellent agreements were seen for T1/T2 tumor/muscle ratios, longitudinal dimension, and ADC (ICC = 0.60-0.98). CONCLUSION Longitudinal tumor dimension, central enhancement, and ADC values differentiate histology grades in musculoskeletal soft tissue malignancy with good to excellent inter-reader reliability. KEY POINTS • The longitudinal tumor dimension of grade III malignancy is smaller than that of grade I (p < 0.0001), and higher-grade tumors are located deeper (p = 0.0246). • The ADC mean is significantly lower in grade III than in grade I or grade II (p < 0.0001 and p = 0.04). • The ADC minimum is significantly lower in grade III than in grade I (p = 0.02).
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Arinima P, Ishak A. Persistent Shoulder Pain in Young Male: Osteosarcoma. Korean J Fam Med 2018; 39:266-269. [PMID: 29972896 PMCID: PMC6056409 DOI: 10.4082/kjfm.17.0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/16/2017] [Indexed: 11/03/2022] Open
Abstract
A 16-year-old Malay boy presented to Kota Bharu Health Care Centre, Kelantan, with left shoulder pain after sustaining a fall. On further history taking, it was noted that the pain preceded the fall by 1 month. The early changes of osteosarcoma were visible on an X-ray during the initial presentation; however, this was missed by the primary care doctors. Three months later, the patient presented with persistent pain in the left shoulder and was diagnosed with osteosarcoma.
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Affiliation(s)
- Punitha Arinima
- Kota Bharu Health Centre, Kelantan, Malaysia,Corresponding Author: Punitha Arinima Tel: +60-173197609, Fax: +60-389411202, E-mail:
| | - Azlina Ishak
- Department of Family Medicine, Universiti Sains Malaysia, Kelantan, Malaysia
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14
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Curtis GL, Lawrenz JM, George J, Styron JF, Scott J, Shah C, Shepard DR, Rubin B, Nystrom LM, Mesko NW. Adult soft tissue sarcoma and time to treatment initiation: An analysis of the National Cancer Database. J Surg Oncol 2018; 117:1776-1785. [DOI: 10.1002/jso.25095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Gannon L. Curtis
- Department of Orthopaedic Surgery; Cleveland Clinic; Cleveland Ohio
| | | | - Jaiben George
- Department of Orthopaedic Surgery; Cleveland Clinic; Cleveland Ohio
| | - Joe F. Styron
- Department of Orthopaedic Surgery; Cleveland Clinic; Cleveland Ohio
| | - Jacob Scott
- Taussig Cancer Institute; Cleveland Clinic; Cleveland Ohio
| | - Chirag Shah
- Taussig Cancer Institute; Cleveland Clinic; Cleveland Ohio
| | | | - Brian Rubin
- Department of Pathology; Cleveland Clinic; Cleveland Ohio
| | - Lukas M. Nystrom
- Department of Orthopaedic Surgery; Cleveland Clinic; Cleveland Ohio
| | - Nathan W. Mesko
- Department of Orthopaedic Surgery; Cleveland Clinic; Cleveland Ohio
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