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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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Kawai A, Yoshida A, Shimoi T, Kobayashi E, Yonemori K, Ogura K, Iwata S, Toshirou N. Histological diagnostic discrepancy and its clinical impact in bone and soft tissue tumors referred to a sarcoma center. Cancer Sci 2024. [PMID: 38763523 DOI: 10.1111/cas.16211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/21/2024] Open
Abstract
Histological diagnosis of sarcomas (malignant bone and soft tissue tumors) is challenging due to their rarity, morphological diversity, and constantly evolving diagnostic criteria. In this study, we aimed to assess the concordance in histological diagnosis of bone and soft tissue tumors between referring hospitals and a tertiary sarcoma center and analyzed the clinical impact of the diagnostic alteration. We analyzed 628 consecutively accessioned specimens from 624 patients who visited a specialized sarcoma center for treatment. The diagnoses at referring hospitals and those at the sarcoma center were compared and classified into four categories: agreed, disagreed, specified, and de-specified. Of the 628 specimens, the diagnoses agreed in 403 (64.2%) specimens, whereas some changes were made in 225 (35.8%) specimens: disagreed in 153 (24.3%), specified in 52 (8.3%), and de-specified in 20 (3.2%) cases. The benign/intermediate/malignant judgment changed for 92 cases (14.6%). The diagnostic change resulted in patient management modification in 91 cases (14.5%), including surgical and medical treatment changes. The main inferred reason for the diagnostic discrepancies was a different interpretation of morphological findings of the tumor, which accounted for 48.9% of the cases. This was followed by the unavailability of specialized immunohistochemical antibodies and the unavailability of genetic analysis. In summary, our study clarified the actual clinical impact of diagnostic discrepancy in bone and soft tissue tumors. This may underscore the value of pathology consultation, facilitating access to specialized diagnostic tools, and continued education. These measures are expected to improve diagnostic precision and ultimately benefit patients.
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Affiliation(s)
- Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Tokyo, Japan
- Rare Cancer Center, National Cancer Center, Tokyo, Japan
| | - Akihiko Yoshida
- Rare Cancer Center, National Cancer Center, Tokyo, Japan
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsunori Shimoi
- Rare Cancer Center, National Cancer Center, Tokyo, Japan
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Eisuke Kobayashi
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Tokyo, Japan
- Rare Cancer Center, National Cancer Center, Tokyo, Japan
| | - Kan Yonemori
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koichi Ogura
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Shintaro Iwata
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Tokyo, Japan
- Rare Cancer Center, National Cancer Center, Tokyo, Japan
| | - Nishida Toshirou
- Rare Cancer Center, National Cancer Center, Tokyo, Japan
- Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
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Abu-Hijlih R, Sharaf B, Salah S, Bani Hani H, Alqaisieh M, Alzibdeh A, Ababneh L, Mahafdah S, Abdel-Razeq H. Germline Genetic Mutations in Adult Patients with Sarcoma: Insight into the Middle East Genetic Landscape. Cancers (Basel) 2024; 16:1668. [PMID: 38730621 PMCID: PMC11083501 DOI: 10.3390/cancers16091668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Data on germline mutations in soft tissue and bone sarcomas are scarce. We sought to identify the prevalence of germline mutations in adult sarcoma patients treated at a tertiary cancer center. Newly diagnosed patients were offered germline genetic testing via an 84-gene panel. The prevalence of pathogenic germline variants (PGVs) and their association with disease-, and patient- related factors are reported. A total of 87 patients were enrolled, the median age was 48 (19-78) years, and 47 (54%) were females. Gastrointestinal stromal tumors (n = 12, 13.8%), liposarcoma (n = 10, 11.5%), and Ewing sarcoma (n = 10, 11.5%) were the main subtypes. A total of 20 PGVs were detected in 18 (20.7%) patients. Variants of uncertain significance, in the absence of PGVs, were detected in 40 (45.9%) patients. Young age (p = 0.031), presence of a second primary cancer (p = 0.019), and female gender (p = 0.042) were correlated with the presence of PGVs. All identified PGVs have potential clinical actionability and cascade testing, and eight (44.44%) suggested eligibility for a targeted therapy. Almost one in five adult patients with soft tissue and bone sarcomas harbor pathogenic or likely pathogenic variants. Many of these variants are potentially actionable, and almost all have implications on cancer screening and family counselling. In this cohort from the Middle East, younger age, presence of a second primary tumor, and female gender were significantly associated with higher PGVs rates. Larger studies able to correlate treatment outcomes with genetic variants are highly needed.
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Affiliation(s)
- Ramiz Abu-Hijlih
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan; (R.A.-H.); (A.A.)
| | - Baha Sharaf
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (B.S.); (S.S.); (H.B.H.); (M.A.)
| | - Samer Salah
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (B.S.); (S.S.); (H.B.H.); (M.A.)
| | - Hira Bani Hani
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (B.S.); (S.S.); (H.B.H.); (M.A.)
| | - Mohammad Alqaisieh
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (B.S.); (S.S.); (H.B.H.); (M.A.)
| | - Abdulla Alzibdeh
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan; (R.A.-H.); (A.A.)
| | - Layan Ababneh
- School of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Suleiman Mahafdah
- Department of Surgery, Royal Jordanian Medical Services, Amman 11855, Jordan;
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (B.S.); (S.S.); (H.B.H.); (M.A.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan
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Blay JY, Penel N, Valentin T, Anract P, Duffaud F, Dufresne A, Verret B, Cordoba A, Italiano A, Brahmi M, Henon C, Amouyel T, Ray-Coquard I, Ferron G, Boudou-Rouquette P, Tlemsani C, Salas S, Rochwerger R, Faron M, Bompas E, Ducassou A, Gangloff D, Gouin F, Firmin N, Piperno-Neumann S, Rios M, Ropars M, Kurtz JE, Le Nail LR, Bertucci F, Carrere S, Llacer C, Watson S, Bonvalot S, Leroux A, Perrin C, Gantzer J, Pracht M, Narciso B, Monneur A, Lebbe C, Hervieu A, Saada-Bouzid E, Dubray-Longeras P, Fiorenza F, Chaigneau L, Nevieres ZM, Soibinet P, Bouché O, Guillemet C, Spano JP, Ruzic JC, Isambert N, Vaz G, Meeus P, Karanian M, Ngo C, Coindre JM, De Pinieux G, Le Loarer F, Ducimetiere F, Chemin C, Morelle M, Toulmonde M, Le Cesne A. Improved nationwide survival of sarcoma patients with a network of reference centers. Ann Oncol 2024; 35:351-363. [PMID: 38246351 DOI: 10.1016/j.annonc.2024.01.001] [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: 11/01/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND We investigated the impact of the implementation of a network of reference centers for sarcomas (NETSARC) on the care and survival of sarcoma patients in France since 2010. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTBs), funded by the French National Cancer Institute (INCa) since 2010. Its aims are to improve the quality of diagnosis and care of sarcoma patients. Patients' characteristics, treatments, and outcomes are collected in a nationwide database. The objective of this analysis was to compare the survival of patients in three periods: 2010-2012 (non-exhaustive), 2013-2015, and 2016-2020. RESULTS A total of 43 975 patients with sarcomas, gastrointestinal stromal tumors (GISTs), or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n = 9266 before 2013, n = 12 274 between 2013 and 2015, n = 22 435 in 2016-2020). Median age was 56 years, 50.5% were women, and 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-2020 versus 2013-2015 versus 2010-2012 for the entire population, for patients >18 years of age, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (P < 0.0001). Over the three periods, we observed a significantly improved compliance to clinical practice guidelines (CPGs) nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTBs before first surgery increased from 31.7% to 44.4% (P < 0.0001). The proportion of patients with R0 resection on first surgery increased (from 36.1% to 46.6%), while R2 resection rate decreased (from 10.9% to 7.9%), with a better compliance and improvement in NETSARC centers. CONCLUSIONS The implementation of the national reference network for sarcoma was associated with an improvement of overall survival and compliance to guidelines nationwide in sarcoma patients. Referral to expert networks for sarcoma patients should be encouraged, though a better compliance to CPGs can still be achieved.
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Affiliation(s)
- J Y Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon.
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - T Valentin
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - P Anract
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - F Duffaud
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - A Dufresne
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - B Verret
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - A Cordoba
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - M Brahmi
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Henon
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - T Amouyel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - G Ferron
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | | | - C Tlemsani
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - S Salas
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - R Rochwerger
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - M Faron
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - E Bompas
- Department of Medical Oncology, Cochin Hospital, Paris; Department of Medical Oncology, Centre René Gauducheau, Nantes St. Herblain
| | - A Ducassou
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - D Gangloff
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - F Gouin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Service Orthopedie, CHU Nantes, Nantes
| | - N Firmin
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Piperno-Neumann
- INSERM U1194, IRCM, Univ Montpellier, Montpellier; Department of Medical Oncology, Institut Curie, Paris; Department of Surgical Oncology, Institut Curie, Paris
| | - M Rios
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Ropars
- Department of Orthopedics, CHU Rennes, Rennes
| | | | | | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - S Carrere
- Service Orthopedie, CHU Nantes, Nantes
| | - C Llacer
- Service Orthopedie, CHU Nantes, Nantes
| | - S Watson
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Bonvalot
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - A Leroux
- INSERM U1194, IRCM, Univ Montpellier, Montpellier
| | - C Perrin
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - J Gantzer
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Pracht
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - B Narciso
- Department of Orthopedic Surgery, Tours
| | - A Monneur
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - C Lebbe
- Department of Dermatology, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris; Department of CIC, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris
| | - A Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | - E Saada-Bouzid
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice
| | - P Dubray-Longeras
- Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand
| | - F Fiorenza
- Department of Orthopedic Surgery, CHU Limoges, Limoges
| | - L Chaigneau
- Department of Medicine, CHU Besancon, Besancon
| | | | - P Soibinet
- Department of Medicine, Centre Francois Baclesse, Caen
| | - O Bouché
- Department of Gastroenterology, CHU Reims, Reims
| | - C Guillemet
- Department of Medical Oncology, Centre J Godinot Reims, Reims
| | - J P Spano
- Department of Oncology, Hôpital Pitié-Salpétriere, Paris
| | - J C Ruzic
- Departement d'oncologie, CHU, La Reunion
| | - N Isambert
- Service d'oncologie, CHU Poitiers, Poitiers, France
| | - G Vaz
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - P Meeus
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Karanian
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Ngo
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - J M Coindre
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | | | - F Le Loarer
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - F Ducimetiere
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Chemin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Morelle
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - A Le Cesne
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
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Napolitano A, Thway K, Huang P, Jones RL. Centralisation of care improves overall survival for sarcoma patients. Ann Oncol 2024; 35:338-339. [PMID: 38342185 DOI: 10.1016/j.annonc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/13/2024] Open
Affiliation(s)
- A Napolitano
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London
| | - K Thway
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London
| | - P Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London
| | - R L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London; Division of Clinical Studies, The Institute of Cancer Research, London, UK.
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Zaib N, Maqsood A, Ghayas S, Ansari F, Kiyani A, Masood R. Analysis of Discrepancy Index between Clinical and Histopathological Diagnosis of Oral Lesions. Asian Pac J Cancer Prev 2023; 24:3207-3212. [PMID: 37774073 PMCID: PMC10762748 DOI: 10.31557/apjcp.2023.24.9.3207] [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: 05/17/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE To analyze the discrepancy index between the clinical and histological diagnosis of oral lesions. MATERIALS AND METHOD A sample of 910 cases from year 2013-2021 were analyzed using non probability convenience sampling technique. This included patient records and histopathological reports of patients treated at IIDC & H and FUCD & H. Clinical presentations were classified under five categories; growth/swelling, vesico-ulcerative, white, red/pigmented, and cystic lesions. To evaluate the details of diagnostic discrepancies, the data was categorized into 4 major groups: 1) Neoplastic-Neoplastic,2) Non-Neoplastic-Non-Neoplastic ,3) Neoplastic-Non-Neoplastic and 4) Non-Neoplastic-Neoplastic. The association between clinical diagnosis and histopathological diagnosis was calculated by using pearson chi square test and statistical significance was considered with the p value less than (0.05). RESULTS Most common clinical presentation was swelling/growth; 601 (66%), followed by ulceration; 223 (24.5%). There were 528 (58%) incisional and 382 (42%) excisional biopsies. The definitive diagnosis based on histopathological findings showed malignant neoplasms as the commonest category; 287 (31.5%) followed by inflammatory/reactive lesions 271 (29.8%). A consensus was noted between the clinical and histologic diagnosis in 74.8% cases, while a discrepancy index of 25.1 % was calculated. Regarding diagnostic discrepancy among four major categories of our research, maximum discrepancy was noted in neoplastic-nonneoplastic category (29.6%) and minimum discrepancy was noted in malignant - benign category (2.7%). Statistically significant difference between the clinical and histopathological diagnosis was observed with a p value of 0.000. CONCLUSION Considerable amount of diagnostic discordance was observed in all types of pathologies analyzed in the study.
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Affiliation(s)
- Nadia Zaib
- Oral Pathology Department, Foundation University College of Dentistry, Islamabad, Pakistan.
| | - Ayesha Maqsood
- Oral Surgery Department, Foundation University College of Dentistry, Islamabad, Pakistan.
| | - Sidra Ghayas
- Oral Pathology Department, Foundation University College of Dentistry, Islamabad, Pakistan.
| | - Fakeha Ansari
- Oral Pathology Department, Foundation University College of Dentistry, Islamabad, Pakistan.
| | - Amber Kiyani
- Oral Medicine, Riphah International University, Islamabad, Pakistan.
| | - Rabia Masood
- Oral Pathology Department, Riphah International University, Islamabad, Pakistan.
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Yeo S, Lee U, Xu YH, Simmons C, Smrke A, Wang Y. Survival Outcomes of Ewing Sarcoma and Rhabdomyosarcoma by High- versus Low-Volume Cancer Centres in British Columbia, Canada. Diagnostics (Basel) 2023; 13:diagnostics13111973. [PMID: 37296824 DOI: 10.3390/diagnostics13111973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Due to the rarity and complexity of treatment for Ewing sarcoma and rhabdomyosarcoma, studies demonstrate improved patient outcomes when managed by a multidisciplinary team at high-volume centres (HVCs). Our study explores the difference in outcomes of Ewing sarcoma and rhabdomyosarcoma patients based on the centre of initial consultation in British Columbia, Canada. This retrospective study assessed adults diagnosed with Ewing sarcoma and rhabdomyosarcoma between 1 January 2000 and 31 December 2020 undergoing curative intent therapy in one of five cancer centres across the province. Seventy-seven patients were included, 46 seen at HVCs and 31 at low-volume centres (LVCs). Patients at HVCs were younger (32.1 vs. 40.8 years, p = 0.020) and more likely to receive curative intent radiation (88% vs. 67%, p = 0.047). The time from diagnosis to first chemotherapy was 24 days shorter at HVCs (26 vs. 50 days, p = 0.120). There was no significant difference in overall survival by treatment centre (HR 0.850, 95% CI 0.448-1.614). Variations in care exist amongst patients treated at HVCs vs. LVCs, which may reflect differences in access to resources, clinical specialists, and varying practice patterns across centres. This study can be used to inform decisions regarding triaging and centralization of Ewing sarcoma and rhabdomyosarcoma patient treatment.
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Affiliation(s)
- Sarah Yeo
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Ursula Lee
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Surrey, Surrey, BC V3V 1Z2, Canada
| | - Ying Hui Xu
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Christine Simmons
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
| | - Alannah Smrke
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
| | - Ying Wang
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
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8
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Strönisch A, Märdian S, Flörcken A. Centralized and Interdisciplinary Therapy Management in the Treatment of Sarcomas. Life (Basel) 2023; 13:life13040979. [PMID: 37109507 PMCID: PMC10144040 DOI: 10.3390/life13040979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Sarcoma treatment requires a high level of expertise due to its rarity and heterogeneity. Sarcoma patients should, therefore, be referred to an expert centre as early as possible to ensure optimal treatment. Numerous studies have been carried out to provide evidence for this strategy. In compliance with the 2020 PRISMA guidelines, a systematic search was conducted in PubMed, EMBASE, Ovid Medline, ClinicalTrials.gov and Cochrane Library databases. The subject of these studies was the centralised treatment of adult sarcoma patients at expert centres and the use of interdisciplinary tumour boards. Uncertainty in therapy, delays in referral to expert centres, and limited access to therapeutic modalities continue to be a challenge in sarcoma therapy. At expert centres, diagnostic procedures were more frequently and adequately performed, and treatment was associated with an improvement in outcomes in the majority of studies: patients benefited from longer survival, lower local recurrence rates and a better postoperative outcome. The implementation of an interdisciplinary tumour board was associated with discrepant results. In a greater number of studies, it was associated with a lower local relapse rate, better overall survival and surgical outcome. In two studies, however, a shorter overall survival was observed. The establishment of expert centres and the consistent use of interdisciplinary tumour boards are important structures for ensuring multidisciplinary therapy approaches. There is growing evidence that this holds great potential for optimising sarcoma therapy.
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Affiliation(s)
- Annika Strönisch
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sven Märdian
- Centre for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anne Flörcken
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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9
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Dei Tos AP, Webster F, Agaimy A, Bovée J, Dickson B, Doyle L, Dry S, Gronchi A, Hameed M, Hemmings C, Liegl-Atzwanger B, Thway K, Wagner AJ, Wang J, Yoshida A, Fletcher C. Datasets for reporting of soft-tissue sarcoma: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2023; 82:745-754. [PMID: 36631406 DOI: 10.1111/his.14862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023]
Abstract
AIMS Soft-tissue tumours are rare and both accurate diagnosis and proper treatment represent a global challenge. Current treatment guidelines also recommend review by specialised pathologists. Here we report on international consensus-based datasets for the pathology reporting of biopsy and resection specimens of soft-tissue sarcomas. The datasets were produced under the auspices of the International Collaboration on Cancer Reporting (ICCR), a global alliance of international pathology and cancer organisations. METHODS AND RESULTS According to the ICCR's guidelines for dataset development, an international expert panel consisting of pathologists, a surgical oncologist, and a medical oncologist produced a set of core and noncore data items for biopsy and resection specimens based on a critical review and discussion of current evidence. All professionals involved were subspecialised soft-tissue sarcoma experts and affiliated with tertiary referral centres. Commentary was provided for each data item to explain the rationale for selecting it as a core or noncore element, its clinical relevance, and to highlight potential areas of disagreement or lack of evidence, in which case a consensus position was formulated. Following international public consultation, the documents were finalised and ratified, and the datasets, which included a synoptic reporting guide, were published on the ICCR website. CONCLUSION These first international datasets for soft-tissue sarcomas are aimed to promote high-quality, standardised pathology reporting. Their adoption will improve consistency of reporting, facilitate multidisciplinary communication, and enhance comparability of data, all of which will help to improve patient's management.
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Affiliation(s)
- Angelo Paolo Dei Tos
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy.,Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Fleur Webster
- International Collaboration on Cancer Reporting, Sydney, NSW, Australia
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Judith Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Brendan Dickson
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital and Department of Pathobiology & Laboratory Medicine, University of Toronto, Toronto, ON, Canada
| | - Leona Doyle
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Dry
- Department of Pathology, University of California, Los Angeles, CA, USA
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Meera Hameed
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chris Hemmings
- Department of Anatomic Pathology, Canterbury Health Laboratories, Christchurch, New Zealand.,Department of Pathology and Biomedical Science, University of Otago Medical School, Christchurch, New Zealand
| | - Bernadette Liegl-Atzwanger
- Diagnostic and Research Institute of Pathology, Comprehensive Cancer Centre Graz, Medical University of Graz, Graz, Austria
| | - Khin Thway
- The Royal Marsden NHS Foundation Trust, London, UK.,The Institute of Cancer Research, London, UK
| | - Andrew J Wagner
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.,Rare Cancer Center, National Cancer Center Hospital, Tokyo, Japan
| | - Christopher Fletcher
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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10
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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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11
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Blay JY, Italiano A, Penel N, Le Loarer F, Karanian M, De Pinieux G, Coindre JM, Ducimetiere F, Chemin C, Morelle M, Gouin F, Toulmonde M, Le Cesne A. Impact d’un réseau de centre de référence pour le diagnostic et la prise en charge des patients atteints de sarcomes en France depuis 2010. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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12
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Soft Tissue Tumours—Study of a Short Panel of 8 Immunohistochemical Markers. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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13
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Lam L, Tien T, Wildung M, White L, Sellon RK, Fidel JL, Shelden EA. Comparative whole transcriptome analysis of gene expression in three canine soft tissue sarcoma types. PLoS One 2022; 17:e0273705. [PMID: 36099287 PMCID: PMC9469979 DOI: 10.1371/journal.pone.0273705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Soft tissue sarcomas are pleiotropic tumors of mesenchymal cell origin. These tumors are rare in humans but common in veterinary practice, where they comprise up to 15% of canine skin and subcutaneous cancers. Because they present similar morphologies, primary sites, and growth characteristics, they are treated similarly, generally by surgical resection followed by radiation therapy. Previous studies have examined a variety of genetic changes as potential drivers of tumorigenesis and progression in soft tissue sarcomas as well as their use as markers for soft tissue sarcoma subtypes. However, few studies employing next generation sequencing approaches have been published. Here, we have examined gene expression patterns in canine soft tissue sarcomas using RNA-seq analysis of samples obtained from archived formalin-fixed and paraffin-embedded tumors. We provide a computational framework for using resulting data to categorize tumors, perform cross species comparisons and identify genetic changes associated with tumorigenesis. Functional overrepresentation analysis of differentially expressed genes further implicate both common and tumor-type specific transcription factors as potential mediators of tumorigenesis and aggression. Implications for tumor-type specific therapies are discussed. Our results illustrate the potential utility of this approach for the discovery of new therapeutic approaches to the management of canine soft tissue sarcomas and support the view that both common and tumor-type specific mechanisms drive the development of these tumors.
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Affiliation(s)
- Lydia Lam
- School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States of America
| | - Tien Tien
- Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States of America
| | - Mark Wildung
- School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States of America
| | - Laura White
- Washington Animal Disease Diagnostic Laboratory, College of Veterinary Medicine, Washington State University, Pullman, WA, United States of America
| | - Rance K. Sellon
- Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States of America
| | - Janean L. Fidel
- Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States of America
| | - Eric A. Shelden
- School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States of America
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14
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Canady Cold Helios Plasma Reduces Soft Tissue Sarcoma Viability by Inhibiting Proliferation, Disrupting Cell Cycle, and Inducing Apoptosis: A Preliminary Report. Molecules 2022; 27:molecules27134168. [PMID: 35807413 PMCID: PMC9268132 DOI: 10.3390/molecules27134168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Soft tissue sarcomas (STS) are a rare and highly heterogeneous group of solid tumors, originating from various types of connective tissue. Complete removal of STS by surgery is challenging due to the anatomical location of the tumor, which results in tumor recurrence. Additionally, current polychemotherapeutic regimens are highly toxic with no rational survival benefit. Cold atmospheric plasma (CAP) is a novel technology that has demonstrated immense cancer therapeutic potential. Canady Cold Helios Plasma (CHCP) is a device that sprays CAP along the surgical margins to eradicate residual cancer cells after tumor resection. This preliminary study was conducted in vitro prior to in vivo testing in a humanitarian compassionate use case study and an FDA-approved phase 1 clinical trial (IDE G190165). In this study, the authors evaluate the efficacy of CHCP across multiple STS cell lines. CHCP treatment reduced the viability of four different STS cell lines (i.e., fibrosarcoma, synovial sarcoma, rhabdomyosarcoma, and liposarcoma) in a dose-dependent manner by inhibiting proliferation, disrupting cell cycle, and inducing apoptosis-like cell death.
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15
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Toki S, Sone M, Yoshida A, Nishisho T, Gokita T, Kobayashi E, Nakatani F, Chuman H, Sugawara S, Arai Y, Kawai A. Image-guided core needle biopsy for musculoskeletal lesions. J Orthop Sci 2022; 27:448-455. [PMID: 33531215 DOI: 10.1016/j.jos.2020.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Image-guided percutaneous core needle biopsy (CNB) has been an important diagnostic procedure for musculoskeletal lesions. Here we surveyed the variety of diagnostic strategies available and assessed the clinical usefulness and limitations of image-guided CNB carried out by a multidisciplinary team comprising specialists in various fields. METHODS We conducted a retrospective study of 284 image-guided CNBs among 1899 consecutive biopsy procedures carried out at our institution for musculoskeletal tumorous conditions, focusing on their effectiveness including diagnostic accuracy and utility for classification of specimens according to malignant potential and histological subtype as well as their correlation with biopsy routes. RESULTS Among the 284 studied biopsies, 252 (88.7%) were considered clinically "effective". The sensitivity for detection of malignancy was 94.0% (110/117) and the specificity was 95.3% (41/43). The diagnostic accuracy for detection of malignancy was 94.4% (151/160) and that for histological subtype was 92.3% (48/52). The clinical effectiveness of the procedure was correlated with the complexity of the biopsy route (P = 0.015); the trans-pedicular, trans-retroperitoneal and trans-sciatic foramen approaches tended to yield ineffective results. Repeat biopsy did not have a significant impact on the effectiveness of image-guided CNB (P = 0.536). CONCLUSIONS The diagnostic accuracy rates of image-guided CNB performed at multidisciplinary sarcoma units were usable even for patients who have variety of diagnostic biopsy procedures. It is important to establish and implement diagnostic strategies based on an understanding that complicated routes, especially for spine and pelvic lesions, may be associated with ineffectiveness and/or complications.
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Affiliation(s)
- Shunichi Toki
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan; Rare Cancer Center, National Cancer Center Hospital, Tokyo, Japan
| | - Toshihiko Nishisho
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tabu Gokita
- Department of Orthopedic Oncology, Saitama Cancer Center, Saitama, Japan
| | - Eisuke Kobayashi
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Rare Cancer Center, National Cancer Center Hospital, Tokyo, Japan
| | - Fumihiko Nakatani
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Rare Cancer Center, National Cancer Center Hospital, Tokyo, Japan
| | - Hirokazu Chuman
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Rare Cancer Center, National Cancer Center Hospital, Tokyo, Japan
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16
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Lundeberg KR, Vidis LJ, Martin J, Randolph-Habecker J. Invaluable role of histopathology in the diagnosis of cutaneous leiomyosarcoma in insulin injection site reaction. BMJ Case Rep 2021; 14:14/11/e241333. [PMID: 34799385 PMCID: PMC8606758 DOI: 10.1136/bcr-2020-241333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Soft tissue sarcomas (STSs) are rare and may often be misdiagnosed, resulting in delays in treatment. A 67-year-old cisgender woman with type 2 diabetes mellitus and obesity presented to her primary care physician with a mass on her left proximal arm. The clinical opinion of the attending physician was that of an insulin injection site reaction. After further evaluation from the physician, the patient was diagnosed with a lipoma without confirmatory histology. The patient continued to present with an enlarging mass, decline in health status and continued with local wound care. The patient underwent a confirmatory biopsy following which, the patient was diagnosed with leiomyosarcoma. This case report highlights the case of a person with a low or moderate income with a self-reported low health literacy living in a rural community and how STS may be misdiagnosed in medically underserved. The patient’s primary or oncology care team are not involved in the production or review of this case report.
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Affiliation(s)
- Kathleen Renee Lundeberg
- Student Physician, Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, Washington, USA
| | - Laura J Vidis
- Student Physician, Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, Washington, USA.,Department of Pathology & Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jennifer Martin
- School of Occupational Therapy, Texas Woman's University, Dallas, Texas, USA
| | - Julie Randolph-Habecker
- Department of Biomedical Sciences, Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, Washington, USA
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17
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Diagnostic and management challenges for MDM2-, CDK4-negative fatty tumors of the retroperitoneum. J Cancer Res Clin Oncol 2021; 147:1137-1144. [PMID: 33550433 DOI: 10.1007/s00432-021-03512-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/09/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neoplasms of the retroperitoneum that contain a major fat component may represent either benign entities, such as lipomas or angiomyolipomas, or malignancy such as liposarcoma. Distinguishing these diagnoses has important implications for management. While liposarcomas often stain positively for MDM2 and CDK4 proteins, absence of these markers can lead to diagnostic and management challenges. METHODS We examined three cases in our institution of fat-containing masses of the retroperitoneum that lacked MDM2 and CDK4 markers to highlight the challenges in diagnosing and managing these cases. A thorough review of the literature examining radiologic and histologic features that can be used to determine that diagnosis was conducted and summarized. RESULTS The three cases we present represent the three main diagnostic entities that can be found in among fatty tumors of the retroperitoneum: lipoma, angiomyolipoma, and liposarcoma. While radiologic features and analysis of histology helped to inform management, these cases in conjunction with the literature also illustrate the limitations of the diagnostic work up and importance also factoring the biologic behavior of the tumor in its management. CONCLUSION Fat-containing tumors of the retroperitoneum that do not stain for MDM2 or CDK4 can pose a diagnostic challenge. Assessing radiologic and pathologic features in conjunction with the biologic behavior of these tumors should inform their management.
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18
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Diessner BJ, Weigel BJ, Murugan P, Zhang L, Poynter JN, Spector LG. Racial and Ethnic Differences in Sarcoma Incidence Are Independent of Census-Tract Socioeconomic Status. Cancer Epidemiol Biomarkers Prev 2020; 29:2141-2148. [PMID: 32928933 PMCID: PMC7641997 DOI: 10.1158/1055-9965.epi-20-0520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/15/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Epidemiologic analyses of sarcoma are limited by the heterogeneity and rarity of the disease. Utilizing population-based surveillance data enabled us to evaluate the contribution of census tract-level socioeconomic status (CT-SES) and race/ethnicity on sarcoma incidence rates. METHODS We utilized the Surveillance, Epidemiology, and End Results program to evaluate associations between CT-SES and race/ethnicity on the incidence rates of sarcoma. Incidence rate ratios and 99% confidence intervals were estimated from quasi-Poisson models. All models were stratified by broad age groups (pediatric: <20 years, adult: 20-65 years, older adult: 65+ years) and adjusted for sex, age, and year of diagnosis. Within each age group, we conducted analyses stratified by somatic genome (fusion-positive and fusion-negative sarcomas) and for subtypes with >200 total cases. A P value less than 0.01 was considered statistically significant. RESULTS We included 55,415 sarcoma cases in 35 sarcoma subtype-age group combinations. Increasing CT-SES was statistically significantly associated with 11 subtype-age group combinations, primarily in the older age group strata (8 subtypes), whereas malignant peripheral nerve sheath tumors in adults were associated with decreasing CT-SES. Nearly every sarcoma subtype-age group combination displayed racial/ethnic disparities in incidence that were independent of CT-SES. CONCLUSIONS We found race/ethnicity to be more frequently associated with sarcoma incidence than CT-SES. Our findings suggest that genetic variation associated with ancestry may play a stronger role than area-level SES-related factors in the etiology of sarcoma. IMPACT These findings provide direction for future etiologic studies of sarcomas.
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Affiliation(s)
- Brandon J Diessner
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
| | - Brenda J Weigel
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Lin Zhang
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Jenny N Poynter
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Logan G Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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19
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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: 13] [Impact Index Per Article: 3.3] [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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20
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Diessner BJ, Weigel BJ, Murugan P, Zhang L, Poynter JN, Spector LG. Associations of Socioeconomic Status, Public vs Private Insurance, and Race/Ethnicity With Metastatic Sarcoma at Diagnosis. JAMA Netw Open 2020; 3:e2011087. [PMID: 32766799 PMCID: PMC7414392 DOI: 10.1001/jamanetworkopen.2020.11087] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Approximately 10% to 30% of patients with sarcoma present with detectable metastases at diagnosis. However, the extent to which presentation with metastases is due to delayed diagnosis vs other factors remains unclear. OBJECTIVE To evaluate whether socioeconomic status, insurance status, or race/ethnicity were associated with the presence of metastases at diagnosis of sarcoma. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the population-based Surveillance, Epidemiology, and End Results program. Adult and pediatric patients with an initial diagnosis of soft-tissue and bone sarcoma between 2001 and 2015 were stratified by age group (pediatric, <20 years; adult, 20-65 years; older adult, >65 years) and sarcoma subtype. Statistical analyses were performed between August 2019 and January 2020. EXPOSURES Surveillance, Epidemiology, and End Results Census tract-level socioeconomic status index, insurance status, and race/ethnicity. MAIN OUTCOMES AND MEASURES The odds of presenting with metastases at diagnosis were calculated. RESULTS A total of 47 337 patients with first primary malignant sarcoma were included (24 343 male patients [51.4%]), with 29 975 non-Hispanic White patients (63.3%), 5673 non-Hispanic Black patients (12.0%), 7504 Hispanic patients (15.8%), and 4185 American Indian-Alaskan Native and Asian Pacific Islander patients (8.8%). Liposarcoma in adults was the only subtype and age group combination that demonstrated a significant trend in incidence across socioeconomic status levels (odds ratio, 0.85; 99% CI, 0.76-0.96; P = .001). However, compared with having non-Medicaid insurance, having Medicaid or no insurance in adults was associated with an increased odds of metastases at diagnosis for 6 of the 8 sarcoma subtypes evaluated; osteosarcoma and Ewing sarcoma were the only 2 subtypes in adults for which metastases were not associated with insurance status. In addition, there was an increased risk of presenting with metastases among non-Hispanic Black adults diagnosed with leiomyosarcoma (odds ratio, 1.87; 99% CI, 1.41-2.48) and unclassified sarcomas (odds ratio, 1.65; 99% CI, 1.01-2.67) compared with non-Hispanic White adults that was independent of socioeconomic and insurance status. CONCLUSIONS AND RELEVANCE These findings suggest that delayed access to care is associated with advanced stage at diagnosis for several soft-tissue sarcoma subtypes in adults, whereas other factors may be associated with the metastatic progression of osteosarcoma and Ewing sarcoma, as well as the racial disparities observed with metastatic leiomyosarcoma and unclassified sarcomas.
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Affiliation(s)
- Brandon J. Diessner
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis
| | - Brenda J. Weigel
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis
| | - Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Lin Zhang
- Division of Biostatistics, University of Minnesota, Minneapolis
| | - Jenny N. Poynter
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis
| | - Logan G. Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis
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Yue SYP, Lucas SB, Brown M, Chiodini PL, Walker SL, Mahadeva U. Utility of an infectious and tropical disease histopathology diagnostic review service. J Clin Pathol 2020; 73:836-839. [PMID: 32576629 DOI: 10.1136/jclinpath-2020-206546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/05/2020] [Accepted: 04/28/2020] [Indexed: 11/03/2022]
Abstract
AIM To assess the utility of a London-based infectious and tropical disease histopathology diagnostic review service. METHODS The original and specialist review histopathology reports of 457 samples from over 3 years of referrals were compared retrospectively. RESULTS Overall 329 (72.0%) showed no significant difference; 34 (7.4%) showed a non-clinically significant difference; and 94 (20.6%) showed a clinically significant difference. Of the 94 clinically significant discrepancies, 46 (48.9%) were incorrectly suspected infections; 19 (20.2%) were missed infections; 8 (8.5%) were different infections; and in 20 (21.3%), the specialist review yielded more specific identification of an organism or a more correct assessment of its viability. CONCLUSIONS A review of histopathology cases by an infectious disease (ID) histopathology referral centre has yielded a 20.6% clinically significant error rate. Measures to improve training in ID histopathology in the UK are discussed.
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Affiliation(s)
- Sum Yu Pansy Yue
- Department of Medicine, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Sebastian B Lucas
- Faculty of Life Sciences and Medicine, King's College London, London, UK.,Department of Histopathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Michael Brown
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter L Chiodini
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen L Walker
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ula Mahadeva
- Faculty of Life Sciences and Medicine, King's College London, London, UK .,Department of Histopathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
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22
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A serum microRNA classifier for the diagnosis of sarcomas of various histological subtypes. Nat Commun 2019; 10:1299. [PMID: 30898996 PMCID: PMC6428849 DOI: 10.1038/s41467-019-09143-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/20/2019] [Indexed: 12/15/2022] Open
Abstract
Due to their rarity and diversity, sarcomas are difficult to diagnose. Consequently, there is an urgent demand for a novel diagnostic test for these cancers. In this study, we investigated serum miRNA profiles from 1002 patients with bone and soft tissue tumors representing more than 43 histological subtypes, including sarcomas, intermediate tumors, and benign tumors, to determine whether serum miRNA profiles could be used to specifically detect sarcomas. Circulating serum miRNA profiles in sarcoma patients were clearly distinct from those in patients with other types of tumors. Using the serum levels of seven miRNAs, we developed a molecular detector, Index VI, that could distinguish sarcoma patients from benign and healthy controls with remarkably high sensitivity (90%) and specificity (95%), regardless of histological subtype. Index VI provides an approach to the early and precise detection of sarcomas, potentially leading to curative treatment and longer survival.
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23
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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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24
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A novel protein expression signature differentiates benign lipomas from well-differentiated liposarcomas. Mol Clin Oncol 2017; 7:315-321. [PMID: 28781809 PMCID: PMC5530308 DOI: 10.3892/mco.2017.1325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/13/2017] [Indexed: 01/03/2023] Open
Abstract
Benign lipomas and well-differentiated liposarcomas share many histological and molecular features. Due to their similarities, patients with these lipomatous tumors are misdiagnosed up to 40% of the time following radiological detection, up to 17% of the time following histological examination, and in as many as 15% of cases following fluorescent in situ hybridization for chromosomal anomalies. Incorrect classification of these two tumor types leads to increased costs to the patient and delayed accurate diagnoses. In this study, we used genomics analysis to identify several genes whose mRNA expression patterns were significantly altered between lipomas and well-differentiated liposarcomas. We confirmed our findings at the protein level using a panel of 30 human lipomatous tumors, revealing that C4BPB, class II, major histocompatibility complex, CIITA, EPHB2, HOXB7, GLS2, RBBP5, and regulator of RGS2 protein levels were increased in well-differentiated liposarcomas compared to lipomas. We developed a multi-protein model of these markers to increase discriminatory ability, finding the combined expression model with CIITA and RGS2 provided a high ability (AUC=0.93) to differentiate between lipomas and well-differentiated liposarcomas with sensitivity at 83.3% and specificity at 90.9%.
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25
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Shahi F, Alishahi R, Pashaiefar H, Jahanzad I, Kamalian N, Ghavamzadeh A, Yaghmaie M. Differentiating and Categorizing of Liposarcoma and Synovial Sarcoma Neoplasms by Fluorescence in Situ Hybridization. IRANIAN JOURNAL OF PATHOLOGY 2017; 12. [PMID: 29531545 PMCID: PMC5835368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND & OBJECTIVE Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumors of mesenchymal origin and various cytogenetic abnormalities ranging from distinct genomic rearrangements, such as chromosomal translocations and amplifications, to more intricate rearrangements involving multiple chromosomes. Fluorescence in situ hybridization (FISH) can be used to identify these chromosomal translocations and amplifications, and sub classify STS precisely. The current study aimed at investigating the usefulness of FISH, as a diagnostic ancillary aid, to detect cytogenetic abnormalities such as MDM2 (murine double minute 2) amplification and CHOP(C/EBP homologous protein) rearrangement in liposarcoma, as well as SYT (synaptotagmin) rearrangement in synovial sarcoma. METHODS The FISH technique was used to analyze 17 specimens of liposarcoma for MDM2 amplification and CHOP rearrangement, and 10 specimens of synovial sarcoma for SYT rearrangement. The subtypes of liposarcoma and synovial sarcomas were reclassified according to the FISH results and compared with those of the respective histological findings. RESULTS According to the FISH results in 17 liposarcoma cases, well-differentiated liposarcoma(WDLPS), dedifferentiated liposarcoma (DDLPS), and myxoidliposarcoma (MLPS)subtypes were 41%, 53%, and 6%, respectively. In different subtypes of liposarcoma, a total of 30% mismatches were observed between pathologic and cytogenetic results. According to the histological findings from FISH analysis, SYT rearrangement was found only in three out of 10 (30%) synovial sarcomas. CONCLUSION The detection of cytogenetic abnormalities in patients with liposarcoma and synovial sarcoma by FISH technique provides an important objective tool to confirm sarcoma diagnosis and sub classification of specific sarcoma subtypes in such patients.
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Affiliation(s)
- Farhad Shahi
- Dept. of Hematology and Medical Oncology, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Razieh Alishahi
- Dept. of Biology, Faculty of Sciences, International Pardis, University of Guilan, Rasht, Iran
| | - Hossein Pashaiefar
- Dept. of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Isa Jahanzad
- Dept. of Pathology, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Kamalian
- Dept. of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Ghavamzadeh
- Hematology, Oncology and Stem Cell Transplantation Research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Yaghmaie
- Hematology, Oncology and Stem Cell Transplantation Research center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Information: Dr. Marjan Yaghmaie, Hematology, Oncology and Stem Cell Transplantation Research center, Tehran University of Medical Sciences, Tehran, Iran, e-mail to: , tel: +98-2184902709
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26
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Boerkamp KM, Hellmén E, Willén H, Grinwis GCM, Teske E, Rutteman GR. Unclassified sarcomas: a study to improve classification in a cohort of Golden Retriever dogs. J Vet Diagn Invest 2016; 28:623-631. [PMID: 27698172 DOI: 10.1177/1040638716660130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Morphologically, canine soft-tissue sarcomas (STSs) resemble human STSs. In humans, proper classification of STSs is considered essential to improve insight in the biology of these tumors, and to optimize diagnosis and therapy. To date, there is a paucity of data published on the significance of detailed classification of STSs in the dog. We revised a cohort (n = 110) of proliferative lesions obtained from a study in Golden Retrievers that were considered "soft tissue sarcoma, not otherwise specified or of uncertain subtype" in order to optimize the diagnoses of these lesions. The criteria according to the veterinary WHO classification, recent veterinary literature, and the WHO classification for humans were applied. Revision was initially based on morphologic characteristics of hematoxylin and eosin-stained histologic sections of the neoplasms. If considered necessary (n = 76), additional immunohistochemistry was applied to aid characterization. The diagnosis of STS was confirmed in 75 neoplasms (68%). Of this group, diagnosis of a specific subtype of the STSs was possible in 58 neoplasms. Seven neoplasms had morphologic characteristics that were suggestive for sarcoma subtypes only described in the WHO classification for humans. Seventeen neoplasms remained "unclassified STSs." Thirty-one lesions (28%) were diagnosed "neoplasm, not being STS." Four lesions (4%) were considered nonneoplastic. Because incorrect classification of a tumor could lead to inappropriate therapeutic intervention and prognostication, the results of our study clearly illustrate the importance of revision and further diagnosis of "unclassified STSs" in dogs.
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Affiliation(s)
- Kim M Boerkamp
- Departments of Clinical Sciences of Companion Animals (Boerkamp, Teske), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsPathobiology (Grinwis), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden (Hellmén)University Hospital, Clinical Pathology and Cytology, Uppsala, Sweden (Willén)Oncology Section, Veterinary Specialist Center De Wagenrenk, Wageningen, The Netherlands (Rutteman)
| | - Eva Hellmén
- Departments of Clinical Sciences of Companion Animals (Boerkamp, Teske), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsPathobiology (Grinwis), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden (Hellmén)University Hospital, Clinical Pathology and Cytology, Uppsala, Sweden (Willén)Oncology Section, Veterinary Specialist Center De Wagenrenk, Wageningen, The Netherlands (Rutteman)
| | - Helena Willén
- Departments of Clinical Sciences of Companion Animals (Boerkamp, Teske), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsPathobiology (Grinwis), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden (Hellmén)University Hospital, Clinical Pathology and Cytology, Uppsala, Sweden (Willén)Oncology Section, Veterinary Specialist Center De Wagenrenk, Wageningen, The Netherlands (Rutteman)
| | - Guy C M Grinwis
- Departments of Clinical Sciences of Companion Animals (Boerkamp, Teske), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsPathobiology (Grinwis), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden (Hellmén)University Hospital, Clinical Pathology and Cytology, Uppsala, Sweden (Willén)Oncology Section, Veterinary Specialist Center De Wagenrenk, Wageningen, The Netherlands (Rutteman)
| | - Erik Teske
- Departments of Clinical Sciences of Companion Animals (Boerkamp, Teske), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsPathobiology (Grinwis), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden (Hellmén)University Hospital, Clinical Pathology and Cytology, Uppsala, Sweden (Willén)Oncology Section, Veterinary Specialist Center De Wagenrenk, Wageningen, The Netherlands (Rutteman)
| | - Gerard R Rutteman
- Departments of Clinical Sciences of Companion Animals (Boerkamp, Teske), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsPathobiology (Grinwis), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden (Hellmén)University Hospital, Clinical Pathology and Cytology, Uppsala, Sweden (Willén)Oncology Section, Veterinary Specialist Center De Wagenrenk, Wageningen, The Netherlands (Rutteman)
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27
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Stoeckle E, Michot A, Henriques B, Sargos P, Honoré C, Ferron G, Meeus P, Babre F, Bonvalot S. [Surgery for soft-tissue sarcomas of the limbs and trunk wall]. Cancer Radiother 2016; 20:657-65. [PMID: 27599681 DOI: 10.1016/j.canrad.2016.07.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/08/2016] [Accepted: 07/11/2016] [Indexed: 11/16/2022]
Abstract
Soft-tissue sarcoma of the limbs or the trunk wall determine a heterogeneous group of tumours that tends to receive a more individualized approach. The surgeon in charge with soft-tissue sarcoma has to be familiar with these tumours in order to deliver an adequate treatment. Most important is the initial diagnostic procedure, comprising imaging with MRI, a core needle biopsy, and in France, referral to a centre of expertise within the clinical network NETSARC. Prior to surgery, a multidisciplinary conference determines its moment and the extent of surgical resection within the frame of a multidisciplinary approach, and also plans reconstructive surgery, when needed. A standardized operative report summarizes items necessary to describe the resection quality (i.e. tumour seen, tumour infiltrated?). In multidisciplinary staff meetings, they are compared to margins measured by the pathologist on the operative specimen. Hence, resection quality is determined collegially and defined by resection type R (R0, R1, R2) as a qualitative result. The quality of resection directly determines the 5-year risk of local recurrence, estimated between 10 and 20% in specialized centres, with the objective to attain 10%. Early rehabilitation favours better functional outcome. The surgeon's experience with soft-tissue sarcoma, as part of a multidisciplinary treatment, is key in achieving the best adequacy between oncological resection and favourable functional outcome. In France, a specific university course for soft-tissue sarcoma will be set-up.
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Affiliation(s)
- E Stoeckle
- Service de chirurgie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
| | - A Michot
- Service de chirurgie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - B Henriques
- Service de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - P Sargos
- Service de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - C Honoré
- Service de chirurgie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - G Ferron
- Service de chirurgie, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - P Meeus
- Service de chirurgie, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex, France
| | - F Babre
- Service d'anesthésie-réanimation, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - S Bonvalot
- Service de chirurgie, institut Curie, 26, rue d'Ulm, 75248 Paris, France
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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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Italiano A, Di Mauro I, Rapp J, Pierron G, Auger N, Alberti L, Chibon F, Escande F, Voegeli AC, Ghnassia JP, Keslair F, Laé M, Ranchère-Vince D, Terrier P, Baffert S, Coindre JM, Pedeutour F. Clinical effect of molecular methods in sarcoma diagnosis (GENSARC): a prospective, multicentre, observational study. Lancet Oncol 2016; 17:532-538. [PMID: 26970672 DOI: 10.1016/s1470-2045(15)00583-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/30/2015] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Advances in molecular genetics of sarcoma have enabled the identification of type-specific aberrations. We aimed to assess the clinical effect of systematic implementation of molecular assays to improve sarcoma misdiagnosis. METHODS In this multicentre, observational study, we recruited patients from 32 centres of the French Sarcoma Group/Reference Network in Pathology of Sarcomas. Eligibility criteria included: biopsy or surgical resection; suspicion of: dermatofibrosarcoma protuberans (cohort 1), dedifferentiated liposarcoma (cohort 2), Ewing's sarcoma family of tumours (cohort 3), synovial sarcoma (cohort 4), alveolar rhabdomyosarcoma (cohort 5), and myxoid or round cell liposarcoma (cohort 6); review by one sarcoma-expert pathologist; availability of frozen material (except for cohort 1 of patients with dermatofibrosarcoma protuberans because anti-CD34 immunohistochemistry is performed on paraffin-embedded tissue); and patient information. For each case, the pathologist made one primary diagnosis followed by up to two differential diagnoses, based on histological characteristics only. Each diagnosis was classified as certain, probable, or possible. For each case to determine the molecular classification, we did fluorescence in-situ hybridisation on paraffin-embedded samples. We also did comparative genomic hybridisation and quantitative PCR (cohort 2) or reverse transcriptase PCR (cohorts 3-6) on frozen and paraffin-embedded samples. We made a final diagnosis based on the molecular results. The clinical effect of diagnosis correction was assessed by a board of experts. FINDING Between June 22, 2009, and Oct 30, 2012, 395 patients were enrolled in the study, of which 384 were eligible for inclusion. The diagnosis was eventually modified by molecular genetics for 53 patients: eight (16%) of 50 patients with dermatofibrosarcoma (cohort 1), seven (23%) of 30 patients with dedifferentiated liposarcoma (cohort 2), 13 (12%) of 112 with Ewing's sarcoma family of tumours (cohort 3), 16 (16%) of 97 patients with synovial sarcoma (cohort 4), seven (15%) of 46 patients with alveolar rhabdomyosarcoma (cohort 5), and two (4%) of 49 patients with myxoid or round cell liposarcoma (cohort 6), with an effect on primary management or prognosis assessment in 45 cases. INTERPRETATION Molecular genetic testing should be mandatory for diagnostic accuracy of sarcoma and appropriate clinical management, even when histological diagnosis is made by pathologist experts in this field. FUNDING French National Cancer Institute and Nice University Hospital.
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Affiliation(s)
- Antoine Italiano
- Early Phase Trials and Sarcoma Units, Bergonie Cancer Institute, Bordeaux, France.
| | - Ilaria Di Mauro
- Laboratory of Solid Tumor Genetics, Nice University Hospital, Nice, France; Institute for Research on Cancer and Aging of Nice (IRCAN), Faculty of Medicine, University of Nice-Sophia-Antipolis, CNRS, Nice, France
| | - Jocelyn Rapp
- Laboratory of Solid Tumor Genetics, Nice University Hospital, Nice, France; Institute for Research on Cancer and Aging of Nice (IRCAN), Faculty of Medicine, University of Nice-Sophia-Antipolis, CNRS, Nice, France
| | | | - Nathalie Auger
- Department of Pathology and Medical Biology, Gustave-Roussy Institute, Villejuif, France
| | | | - Frédéric Chibon
- Department of Pathology, Bergonié Cancer Institute, INSERM U916, University of Bordeaux, France
| | - Fabienne Escande
- Department of Biochemistry and Molecular Biology, Lille University Hospital, Lille, France
| | - Anne-Claire Voegeli
- Department of Biochemistry and Molecular Biology, Department of Pathology, Strasbourg University Hospital, Strasbourg, France
| | | | - Frédérique Keslair
- Laboratory of Solid Tumor Genetics, Nice University Hospital, Nice, France; Institute for Research on Cancer and Aging of Nice (IRCAN), Faculty of Medicine, University of Nice-Sophia-Antipolis, CNRS, Nice, France
| | - Marick Laé
- Department of Pathology, Institut Curie, Paris, France
| | | | - Philippe Terrier
- Department of Pathology and Medical Biology, Gustave-Roussy Institute, Villejuif, France
| | | | - Jean-Michel Coindre
- Department of Pathology, Bergonié Cancer Institute, INSERM U916, University of Bordeaux, France
| | - Florence Pedeutour
- Laboratory of Solid Tumor Genetics, Nice University Hospital, Nice, France; Institute for Research on Cancer and Aging of Nice (IRCAN), Faculty of Medicine, University of Nice-Sophia-Antipolis, CNRS, Nice, France
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30
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Shah C, Wang J, Mubako T, Fisher C, Thway K. Gross examination and reporting of soft tissue tumours: evaluation of compliance with the UK Royal College of Pathologists soft tissue sarcoma dataset. J Clin Pathol 2016; 69:761-6. [DOI: 10.1136/jclinpath-2015-203495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/17/2016] [Indexed: 12/13/2022]
Abstract
AimsSoft tissue tumours are a heterogeneous group of neoplasms that can arise at almost every anatomical site. As they often show similar clinical and radiological findings, histology is the definitive diagnostic method and it is crucial that the surgical pathology report contains accurate, useful information for management and prognostication. The soft tissue sarcoma minimum dataset produced by the Royal College of Pathologists in the UK outlines a structure for handling and reporting soft tissue tumours, including the core data required, and aiding pathologists in forming a consistent reporting approach.MethodsWe assessed the information in surgical pathology reports for soft tissue lesions at a tertiary soft tissue centre, in 1 year prior to the development of this dataset, and 1 year after its release, to audit the comparative adequacy of macroscopic and microscopic information provided, and to assess for differences in reporting since the advent of routine ancillary molecular diagnostic testing.Results and conclusionsWe found that while essential information was always included in reports, more specific details contributing to better quality reports such as more detailed macroscopic descriptions and a higher proportion of clinical summaries with radiological correlation were included in 2011 than 2006, despite increasing workload. Specimen handling, particularly of core biopsies, was also improved, reflecting the increasing need to conserve the maximum amount of patient material for molecular investigations.
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Vroobel K, Gonzalez D, Wren D, Thompson L, Swansbury J, Fisher C, Thway K. Ancillary molecular analysis in the diagnosis of soft tissue tumours: reassessment of its utility at a specialist centre. J Clin Pathol 2015; 69:505-10. [DOI: 10.1136/jclinpath-2015-203380] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/23/2015] [Indexed: 12/13/2022]
Abstract
AimsThe histological diagnosis of soft tissue tumours (STTs) can be difficult, sometimes requiring a combination of morphology, immunophenotype and ancillary molecular tests. Many STTs are associated with characteristic genetic aberrations that can be assessed using fluorescence in situ hybridisation (FISH), reverse transcription-PCR (RT-PCR) or mutational analysis. We have previously assessed the practicality and sensitivity of using these modalities as part of the routine diagnosis of STT in paraffin-embedded material and now revisit the subject in light of further experience in this field.Methods200 consecutive cases from 2013 that had undergone FISH, RT-PCR or mutational analysis were assessed to evaluate their diagnostic utility compared with preliminary histological assessment.Results218 FISH, 91 RT-PCR and 43 mutational analysis tests were performed. Compared with the previous study, FISH for MDM2 amplification in possible well-differentiated/dedifferentiated liposarcomas, and mutational analysis for assessing KIT, PDGFR and BRAF mutations made up a large proportion of the workload (107 and 43 tests, respectively). As in the previous study, alveolar rhabdomyosarcoma showed the best FISH:RT-PCR concordance. Unlike previously, RT-PCR showed marginally higher sensitivity than FISH (78.9% and 76.9%), while continuing to demonstrate higher specificity (90.9% and 84.3%). RT-PCR again showed an increased failure rate (5.5%; 1% for FISH).ConclusionsWe demonstrate the continuing utility of RT-PCR and FISH for STT diagnosis, and that each has advantages in specific contexts. These ancillary molecular tests are important tools in both defining and excluding diagnoses of STT, which is crucial in determining prognosis and guiding appropriate management.
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Honoré C, Méeus P, Stoeckle E, Bonvalot S. Le sarcome des tissus mous en France en 2015 : épidémiologie, classification et structuration de la prise en charge. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jchirv.2015.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mourtzoukou D, Fisher C, Thway K. Evaluation of Molecular and Immunohistochemical Adjunct Modalities in the Diagnosis of Soft Tissue Neoplasms. Int J Surg Pathol 2015; 23:601-8. [PMID: 26310271 DOI: 10.1177/1066896915600521] [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] [Indexed: 01/07/2023]
Abstract
The accurate diagnosis of soft tissue neoplasms has crucial therapeutic and prognostic importance. There is frequent morphologic overlap between entities, and ancillary modalities are used in the vast majority of diagnoses. Immunohistochemistry is rapid and inexpensive, and in addition to the older markers that mainly detected cytoplasmic proteins, antibodies can indirectly detect tumor-specific genetic and molecular abnormalities. The use of molecular diagnostic techniques is now widespread, with molecular services often integrated into routine histopathology laboratories; as their cost and turnaround times begin to parallel those for immunohistochemistry, we compared the usefulness of ancillary immunohistochemistry, molecular genetic, and molecular cytogenetic techniques in the diagnosis of soft tissue lesions. We evaluated the number and contribution of immunohistochemical tests and panels and of ancillary molecular techniques in the primary histopathologic diagnosis of 150 soft tissue lesions. Ninety of 150 cases required either only one immunohistochemical panel or minimal immunohistochemistry for diagnosis, while 39/150 required 2 to 4 panels. In 5/150, ancillary molecular tests alone (without immunohistochemistry) were diagnostically sufficient. The majority of cases required one immunohistochemical panel for diagnosis, with a smaller proportion requiring a second, and a minority requiring a third or fourth (which mainly comprised neoplasms for which the final diagnosis was uncertain). Certain neoplasms required both extensive immunohistochemistry and ancillary molecular testing, despite which the final diagnosis was inconclusive. Ancillary molecular techniques now make a significant contribution to soft tissue tumor diagnosis, being required in over one third (52/150) of cases, and were useful in confirming or excluding tumors that were not possible to conclusively diagnose with histology and immunohistochemistry. Only a small proportion of soft tissue neoplasms (16/150; all benign) did not require immunohistochemistry or ancillary molecular methods, with morphology alone being sufficient for diagnosis.
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Honoré C, Méeus P, Stoeckle E, Bonvalot S. Soft tissue sarcoma in France in 2015: Epidemiology, classification and organization of clinical care. J Visc Surg 2015; 152:223-30. [PMID: 26088366 DOI: 10.1016/j.jviscsurg.2015.05.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Four thousand new cases of soft tissue sarcomas are diagnosed each year in France, 23% of which are localized in the abdomen and pelvis; the treatment of non-metastatic tumor is based on wide surgical resection, the quality of which determines the long-term outcome. To ensure appropriate care, the European Society of Medical Oncology (ESMO) recommends that any patient with an unexplained soft tissue mass (of any size for deep lesions or of>5cm for superficial lesions) be referred to a specialized center with capacities for multidisciplinary team decision; appropriate imaging should be performed prior to treatment and a percutaneous image-guided needle biopsy should be routinely performed. In France, clinical and pathology networks (NetSarc and RRePS) currently offer patients a structured means to make a systematic diagnosis of soft tissue sarcoma and help to provide access to appropriate treatment in a specialized center.
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Affiliation(s)
- C Honoré
- Département de chirurgie générale, Gustave Roussy Cancer Center, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
| | - P Méeus
- Département de chirurgie, centre Léon-Bérard, 69008 Lyon, France
| | - E Stoeckle
- Institut Bergonié, département de chirurgie, 33076 Bordeaux, France
| | - S Bonvalot
- Institut Curie, Service de chirurgie, 26, rue d'Ulm, 75005 Paris, France
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Fluorescence In Situ Hybridization for MDM2 Amplification as a Routine Ancillary Diagnostic Tool for Suspected Well-Differentiated and Dedifferentiated Liposarcomas: Experience at a Tertiary Center. Sarcoma 2015; 2015:812089. [PMID: 25810689 PMCID: PMC4355609 DOI: 10.1155/2015/812089] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/05/2015] [Accepted: 01/19/2015] [Indexed: 02/01/2023] Open
Abstract
Background. The assessment of MDM2 gene amplification by fluorescence in situ hybridization (FISH) has become a routine ancillary tool for diagnosing atypical lipomatous tumor (ALT)/well-differentiated liposarcoma and dedifferentiated liposarcoma (WDL/DDL) in specialist sarcoma units. We describe our experience of its utility at our tertiary institute. Methods. All routine histology samples in which MDM2 amplification was assessed with FISH over a 2-year period were included, and FISH results were correlated with clinical and histologic findings. Results. 365 samples from 347 patients had FISH for MDM2 gene amplification. 170 were positive (i.e., showed MDM2 gene amplification), 192 were negative, and 3 were technically unsatisfactory. There were 122 histologically benign cases showing a histology:FISH concordance rate of 92.6%, 142 WDL/DDL (concordance 96.5%), and 34 cases histologically equivocal for WDL (concordance 50%). Of 64 spindle cell/pleomorphic neoplasms (in which DDL was a differential diagnosis), 21.9% showed MDM2 amplification. Of the cases with discrepant histology and FISH, all but 3 had diagnoses amended following FISH results. For discrepancies of benign histology but positive FISH, lesions were on average larger, more frequently in "classical" (intra-abdominal or inguinal) sites for WDL/DDL and more frequently core biopsies. Discrepancies of malignant histology but negative FISH were smaller, less frequently in "classical" sites but again more frequently core biopsies. Conclusions. FISH has a high correlation rate with histology for cases with firm histologic diagnoses of lipoma or WDL/DDL. It is a useful ancillary diagnostic tool in histologically equivocal cases, particularly in WDL lacking significant histologic atypia or DDL without corresponding WDL component, especially in larger tumors, those from intra-abdominal or inguinal sites or core biopsies. There is a significant group of well-differentiated adipocytic neoplasms which are difficult to diagnose on morphology alone, in which FISH for MDM2 amplification is diagnostically contributory.
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Somcutian O, Buiga R, Galatir M, Tudor Eniu D, Rachieru C, Coza D, Terrier P. [Histopathological diagnostic concordance in bone and soft tissue sarcomas between two comprehensive cancer centers from eastern and western Europe: a collaborative experience]. Ann Pathol 2014; 35:32-40. [PMID: 25541117 DOI: 10.1016/j.annpat.2014.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study aims to assess the degree of concordance of histological diagnosis of bone and soft tissue sarcomas between a Comprehensive Cancer Center (CCC) of Eastern Europe - not specialized in this area of pathology - and an important CCC of Western Europe, which is one of the coordinators of a clinical reference network in sarcoma pathology. The goal is to have an overview of the sarcomatous pathology in a region of Eastern Europe and to discover diagnostic discrepancies between the two centers, while determining their cause. MATERIALS AND METHODS The initial diagnosis was compared with the revised diagnosis on 110 specimens from 88 patients with bone or soft tissue sarcomas from East-European CCC, in a one-year period of time. RESULTS Complete diagnostic agreement was observed in 55 cases (62.5%), a partial agreement in 23 cases (26.1%) and a major disagreement in 10 cases (11.4%). Major discrepancies of the histological type was observed in only 3 cases (3.4%): one case of discordance benign/malignant and 2 cases of discordance mesenchymal/non mesenchymal. Minor histological discrepancies - not affecting the management of the patient - were observed in 18 cases (20.4%). A major discordance in grading - potentially changing the management of the patient - was noted in 7 cases (7.9%), and a minor discrepancy in 5 cases (5.7%). DISCUSSIONS Some histological types were clearly overdiagnosed, like "adult fibrosarcomas" and "malignant peripheral nerve sheet tumors" (MPNST), mostly converted after the audit into "undifferentiated spindle cell sarcomas" or other types of sarcomas. Some "unclassified" sarcomas and "undifferentiated pleomorphic sarcomas" could be re-classified with the aid of an extensive panel of antibodies. Overall, immunohistochemistry was responsible, but not in exclusivity, for half of the minor discrepancies, and for 2 out of 3 cases of major histological discrepancies. Otherwise, the main cause of discrepancies was the difficulties in the interpretation of the morphology. Molecular biology was decisive in one case. Most grading discrepancies resulted from the appreciation of the mitotic index. CONCLUSIONS The profile of the sarcomatous pathology in the northwest region of Romania does not appear to differ significantly from other parts of Europe or the world, but a prospective epidemiological study would be necessary to confirm this assessment. The expansion of immunohistochemical antibody panel, the over-specialization of pathologists and, in the future, the establishment of a national network of referral centers in sarcoma pathology, are required for a high level of histological diagnosis in Eastern Europe. A periodic external audit, continuing this trans-European collaboration between the two centers, would be beneficial for monitoring progress.
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Affiliation(s)
- Oana Somcutian
- Institut oncologique Prof. Dr. I. Chiricuta, 34-36, rue Republicii, 400015 Cluj-Napoca, Roumanie
| | - Rares Buiga
- Institut oncologique Prof. Dr. I. Chiricuta, 34-36, rue Republicii, 400015 Cluj-Napoca, Roumanie.
| | - Mihaela Galatir
- Institut oncologique Prof. Dr. I. Chiricuta, 34-36, rue Republicii, 400015 Cluj-Napoca, Roumanie
| | - Dan Tudor Eniu
- Institut oncologique Prof. Dr. I. Chiricuta, 34-36, rue Republicii, 400015 Cluj-Napoca, Roumanie; Université de médecine et pharmacie Iuliu Haţieganu, 8, rue Babeş, 400012 Cluj-Napoca, Roumanie
| | - Claudiu Rachieru
- Université de médecine et pharmacie Iuliu Haţieganu, 8, rue Babeş, 400012 Cluj-Napoca, Roumanie
| | - Daniela Coza
- Institut oncologique Prof. Dr. I. Chiricuta, 34-36, rue Republicii, 400015 Cluj-Napoca, Roumanie; Registre régional de cancer du nord-ouest, 34-36, rue Republicii, 400015 Cluj-Napoca, Roumanie
| | - Philippe Terrier
- Institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
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Histopathological diagnostic discrepancies in soft tissue tumours referred to a specialist centre: reassessment in the era of ancillary molecular diagnosis. Sarcoma 2014; 2014:686902. [PMID: 25165418 PMCID: PMC4138733 DOI: 10.1155/2014/686902] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/15/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Soft tissue tumour pathology is a highly specialised area of surgical pathology, but soft tissue neoplasms can occur at virtually all sites and are therefore encountered by a wide population of surgical pathologists. Potential sarcomas require referral to specialist centres for review by pathologists who see a large number of soft tissue lesions and where appropriate ancillary investigations can be performed. We have previously assessed the types of diagnostic discrepancies between referring and final diagnosis for soft tissue lesions referred to our tertiary centre. We now reaudit this 6 years later, assessing changes in discrepancy patterns, particularly in relation to the now widespread use of ancillary molecular diagnostic techniques which were not prevalent in our original study. Materials and Methods. We compared the sarcoma unit's histopathology reports with referring reports on 348 specimens from 286 patients with suspected or proven soft tissue tumours in a one-year period. Results. Diagnostic agreement was seen in 250 cases (71.8%), with 57 (16.4%) major and 41 (11.8%) minor discrepancies. There were 23 cases of benign/malignant discrepancies (23.5% of all discrepancies). 50 ancillary molecular tests were performed, 33 for aiding diagnosis and 17 mutational analyses for gastrointestinal stromal tumour to guide therapy. Findings from ancillary techniques contributed to 3 major and 4 minor discrepancies. While the results were broadly similar to those of the previous study, there was an increase in frequency of major discrepancies. Conclusion. Six years following our previous study and notably now in an era of widespread ancillary molecular diagnosis, the overall discrepancy rate between referral and tertiary centre diagnosis remains similar, but there is an increase in frequency of major discrepancies likely to alter patient management. A possible reason for the increase in major discrepancies is the increasing lack of exposure to soft tissue cases in nonspecialist centres in a time of subspecialisation. The findings support the national guidelines in which all suspected soft tissue tumour pathology specimens should be referred to a specialist sarcoma unit.
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Benson C, Judson I. Role of expert centres in the management of sarcomas – A UK perspective. Eur J Cancer 2014; 50:1951-6. [DOI: 10.1016/j.ejca.2014.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/02/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
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Neil DAH, Roberts ISD, Bellamy COC, Wigmore SJ, Neuberger JM. Improved access to histopathology using a digital system could increase the organ donor pool and improve allocation. Transpl Int 2014; 27:759-64. [PMID: 24629110 DOI: 10.1111/tri.12320] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/13/2014] [Accepted: 03/11/2014] [Indexed: 11/30/2022]
Abstract
Improvements in digital slide scanners have reached a stage that digital whole slide images (WSIs) can be used for diagnostic purposes. A digital system for histopathology, analogous to the systems used in radiology, would allow the establishment of networks of subspecialist histopathologists to provide a regional, national or even international rota to support out of hours histopathology for emergency frozen sections, urgent paraffin sections and to generally improve efficiencies with the provision of histopathology services. Such a system would promote appropriate organ utilization by allowing rapid characterization of unexpected lesions in the donor to determine whether donation should occur and further characterization of the organ, such as the degree of fibrosis in the kidney or steatosis in the liver, to determine whether the organ should be used. If introduced across Europe, this would promote safe and effective exchange of organs and support a cost efficient use of pathologist expertise. This review article outlines current issues with the provision of an urgent out of hours histopathology service and focuses on how such a service has the potential to increase organ donors, improve allocation, sharing and the use of available donor organs.
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Affiliation(s)
- Desley A H Neil
- Department of Histopathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Santiago TC, Jenkins JJ. Histopathologic Diagnosis of Pediatric Neoplasms: A Review of International Consultations. Arch Pathol Lab Med 2013; 137:1648-53. [DOI: 10.5858/arpa.2012-0571-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Correct histopathologic diagnosis is fundamental to defining proper treatment and improving outcomes in children with malignancies. The Department of Pathology at St. Jude Children's Research Hospital (SJCRH) has collaborated with SJCRH International Outreach Program partner sites to improve the accuracy of histopathologic diagnoses in countries with limited resources. Pathologists at SJCRH provide review and evaluation of cases that are considered difficult or complex.
Objectives.—To determine the quality of pathology diagnosis and to identify areas for improvement in our international partner sites, we retrospectively analyzed all the international cases that were submitted for review. A comparison of our data with selected reports of surgical pathology error rates published in the medical literature was performed.
Design.—From January 2009 through December 2011, SJCRH received 763 cases submitted by international pathologists from 37 countries for histopathologic review and evaluation. Of 763 cases reviewed, 705 (92.4%) met the criteria for inclusion in this study. Rates of concordance between the submitted diagnoses and SJCRH reviewed diagnoses were analyzed.
Results.—Overall concordance, minor disagreement, and major disagreement rates between submitted diagnoses and SJCRH reviewed diagnoses were 430 (61.0%), 98 (13.9%), and 177 (25.1%) of the cases, respectively. Major disagreement rates ranged from 13.7% to 37.1% among studied countries.
Conclusions.—The major disagreement rate between referring international sites and SJCRH was substantially higher than the major disagreement rate among US institutions. Lack of the availability of immunohistochemistry and the training of pathologists in the diagnosis of pediatric neoplasms may have contributed to the discrepancies.
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Affiliation(s)
- Teresa C. Santiago
- From the Department of Pathology, University of Tennessee Health Science Center, Memphis (Dr Santiago); and the Department of Pathology, St. Jude Children's Research Hospital, Memphis (Dr Jenkins)
| | - Jesse J. Jenkins
- From the Department of Pathology, University of Tennessee Health Science Center, Memphis (Dr Santiago); and the Department of Pathology, St. Jude Children's Research Hospital, Memphis (Dr Jenkins)
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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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Chojniak R, Grigio HR, Bitencourt AGV, Pinto PNV, Tyng CJ, Cunha IWD, Aguiar Junior S, Lopes A. Biópsia percutânea por agulha grossa de tumores de partes moles guiada por tomografia computadorizada: resultados e correlação com análise da peça cirúrgica. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000500005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a eficácia da biópsia percutânea por agulha grossa (BPAG) de tumores de partes moles guiada por tomografia computadorizada (TC), em relação ao sucesso na obtenção de amostra para análise, e comparar o diagnóstico da BPAG com o resultado anatomopatológico da peça cirúrgica, quando disponível. MATERIAIS E MÉTODOS: Foram revisados os prontuários e laudos diagnósticos de 262 pacientes com tumores de partes moles submetidos a BPAG guiada por TC em um centro de referência oncológico entre 2003 e 2009. RESULTADOS: Das 262 biópsias realizadas, foi possível a obtenção de amostra adequada em 215 (82,1%). Os tumores mais prevalentes foram os sarcomas (38,6%), carcinomas metastáticos (28,8%), tumores mesenquimais benignos (20,5%) e linfomas (9,3%). Foi possível realizar graduação histológica em 92,8% dos pacientes com sarcoma, sendo a maioria (77,9%) classificada como alto grau. Do total de pacientes, 116 (44,3%) realizaram cirurgia para exérese e confirmação diagnóstica. A BPAG mostrou acurácia de 94,6% na identificação de sarcomas, com sensibilidade de 96,4% e especificidade de 89,5%. A graduação histológica teve concordância significativa entre a BPAG e a peça cirúrgica (p < 0,001; kappa = 0,75). CONCLUSÃO: A BPAG guiada por TC demonstrou elevada acurácia diagnóstica na avaliação de tumores de partes moles e na graduação histológica dos sarcomas, permitindo um adequado planejamento terapêutico.
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Fountzilas E, Kelly AD, Perez-Atayde AR, Goldsmith J, Konstantinopoulos PA, Francoeur N, Correll M, Rubio R, Hu L, Gebhardt MC, Quackenbush J, Spentzos D. A microRNA activity map of human mesenchymal tumors: connections to oncogenic pathways; an integrative transcriptomic study. BMC Genomics 2012; 13:332. [PMID: 22823907 PMCID: PMC3443663 DOI: 10.1186/1471-2164-13-332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 07/06/2012] [Indexed: 11/10/2022] Open
Abstract
Background MicroRNAs (miRNAs) are nucleic acid regulators of many human mRNAs, and are associated with many tumorigenic processes. miRNA expression levels have been used in profiling studies, but some evidence suggests that expression levels do not fully capture miRNA regulatory activity. In this study we integrate multiple gene expression datasets to determine miRNA activity patterns associated with cancer phenotypes and oncogenic pathways in mesenchymal tumors – a very heterogeneous class of malignancies. Results Using a computational method, we identified differentially activated miRNAs between 77 normal tissue specimens and 135 sarcomas and we validated many of these findings with microarray interrogation of an independent, paraffin-based cohort of 18 tumors. We also showed that miRNA activity is imperfectly correlated with miRNA expression levels. Using next-generation miRNA sequencing we identified potential base sequence alterations which may explain differential activity. We then analyzed miRNA activity changes related to the RAS-pathway and found 21 miRNAs that switch from silenced to activated status in parallel with RAS activation. Importantly, nearly half of these 21 miRNAs were predicted to regulate integral parts of the miRNA processing machinery, and our gene expression analysis revealed significant reductions of these transcripts in RAS-active tumors. These results suggest an association between RAS signaling and miRNA processing in which miRNAs may attenuate their own biogenesis. Conclusions Our study represents the first gene expression-based investigation of miRNA regulatory activity in human sarcomas, and our findings indicate that miRNA activity patterns derived from integrated transcriptomic data are reproducible and biologically informative in cancer. We identified an association between RAS signaling and miRNA processing, and demonstrated sequence alterations as plausible causes for differential miRNA activity. Finally, our study highlights the value of systems level integrative miRNA/mRNA assessment with high-throughput genomic data, and the applicability of paraffin-tissue-derived RNA for validation of novel findings.
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Affiliation(s)
- Elena Fountzilas
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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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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de Vreeze RSA, de Jong D, Nederlof PM, Ariaens A, Tielen IHG, Frenken L, Haas RL, van Coevorden F. Added Value of Molecular Biological Analysis in Diagnosis and Clinical Management of Liposarcoma: A 30-Year Single-Institution Experience. Ann Surg Oncol 2010; 17:686-93. [PMID: 20183915 PMCID: PMC2820685 DOI: 10.1245/s10434-009-0806-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Treatment decisions and prognosis assessment for liposarcoma is based on a classification that depends on morphological and genetic features. Revisions by experienced referral pathologists are often advocated. Methods The process of histopathological classification in referring hospitals and subsequently in a referral center in relation to molecular biological information is evaluated. A total of 331 consecutive liposarcoma patients were evaluated for the added value of histological review at time of referral. Subsequently, cases were reclassified with implementation of present-day molecular information. For all patients, complete data on staging, treatment, and follow-up were available. Results Upon histological revision, 15/54 (28%) diagnoses were reclassified in the first decade, 14/65 (22%) in the second, and 14/53 (26%) in the last decade. Molecular biological analysis enabled well-differentiated liposarcoma with or without dedifferentiated component to be better recognized as such and distinguished from myxoid liposarcoma and pleomorphic liposarcoma. Inclusion of cytogenetic information resulted in reclassification after revision in 4/18 (22%) cases in the first decade, 10/38 (26%) cases in the second decade, and 19/75 (25%) cases in the last decade. Conclusions This study indicates that liposarcomas are heterogeneous tumors. Expert assessment and implementation of molecular biological analysis are valuable for adequate classification as a basis for treatment decisions.
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Affiliation(s)
- Ronald S A de Vreeze
- Departments of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Mutalima N, Molyneux EM, Johnston WT, Jaffe HW, Kamiza S, Borgstein E, Mkandawire N, Liomba GN, Batumba M, Carpenter LM, Newton R. Impact of infection with human immunodeficiency virus-1 (HIV) on the risk of cancer among children in Malawi - preliminary findings. Infect Agent Cancer 2010; 5:5. [PMID: 20152034 PMCID: PMC2831850 DOI: 10.1186/1750-9378-5-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 02/12/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The impact of infection with HIV on the risk of cancer in children is uncertain, particularly for those living in sub-Saharan Africa. In an ongoing study in a paediatric oncology centre in Malawi, children (aged = 15 years) with known or suspected cancers are being recruited and tested for HIV and their mothers or carers interviewed. This study reports findings for children recruited between 2005 and 2008. METHODS Only children with a cancer diagnosis were included. Odds ratios (OR) for being HIV positive were estimated for each cancer type (with adjustment for age (<5 years, >/= 5 years) and sex) using children with other cancers and non-malignant conditions as a comparison group (excluding the known HIV-associated cancers, Kaposi sarcoma and lymphomas, as well as children with other haematological malignancies or with confirmed non-cancer diagnoses). RESULTS Of the 586 children recruited, 541 (92%) met the inclusion criteria and 525 (97%) were tested for HIV. Overall HIV seroprevalence was 10%. Infection with HIV was associated with Kaposi sarcoma (29 cases; OR = 93.5, 95% CI 26.9 to 324.4) and with non-Burkitt, non-Hodgkin lymphoma (33 cases; OR = 4.4, 95% CI 1.1 to 17.9) but not with Burkitt lymphoma (269 cases; OR = 2.2, 95% CI 0.8 to 6.4). CONCLUSIONS In this study, only Kaposi sarcoma and non-Burkitt, non-Hodgkin lymphoma were associated with HIV infection. The endemic form of Burkitt lymphoma, which is relatively frequent in Malawi, was not significantly associated with HIV. While the relatively small numbers of children with other cancers, together with possible limitations of diagnostic testing may limit our conclusions, the findings may suggest differences in the pathogenesis of HIV-related malignancies in different parts of the world.
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Affiliation(s)
- Nora Mutalima
- Epidemiology and Genetics Unit, Department of Health Sciences, Seebohm Rowntree Building, Area 3, University of York, York YO10 5DD, UK
| | - Elizabeth M Molyneux
- Department of Paediatrics, University of Malawi, College of Medicine, P/Bag 360 Chichiri, Blantyre 3, Malawi
| | - William T Johnston
- Epidemiology and Genetics Unit, Department of Health Sciences, Seebohm Rowntree Building, Area 3, University of York, York YO10 5DD, UK
| | - Harold W Jaffe
- Department of Public Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Roosevelt Drive, Headington, Oxford OX3 7LF, UK
| | - Steve Kamiza
- Department of Histopathology, University of Malawi, College of Medicine, P/Bag 360 Chichiri, Blantyre 3, Malawi
| | - Eric Borgstein
- Department of Surgery, University of Malawi, College of Medicine, P/Bag 360 Chichiri, Blantyre 3, Malawi
| | - Nyengo Mkandawire
- Department of Surgery, University of Malawi, College of Medicine, P/Bag 360 Chichiri, Blantyre 3, Malawi
| | - George N Liomba
- Department of Histopathology, University of Malawi, College of Medicine, P/Bag 360 Chichiri, Blantyre 3, Malawi
| | - Mkume Batumba
- Department of Ophthalmology, University of Malawi, College of Medicine, P/Bag 360 Chichiri, Blantyre 3, Malawi
| | - Lucy M Carpenter
- Department of Public Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Roosevelt Drive, Headington, Oxford OX3 7LF, UK
| | - Robert Newton
- Epidemiology and Genetics Unit, Department of Health Sciences, Seebohm Rowntree Building, Area 3, University of York, York YO10 5DD, UK
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