Advertisement
ANATOMICAL PATHOLOGY| Volume 55, ISSUE 4, P486-491, June 2023

Download started.

Ok

The impact of additional pathology analysis on the diagnosis and management of soft tissue tumours: a 10-year retrospective study

      Summary

      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.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Pathology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Demicco E.G.
        Sarcoma diagnosis in the age of molecular pathology.
        Adv Anat Pathol. 2013; 20: 264-274
        • Ikeri N.Z.
        • Akinjo A.O.
        • Ajayi O.O.
        • Banjo A.A.
        An audit of the diagnosis and reporting of soft tissue sarcomas at the Lagos University Teaching Hospital.
        Niger J Clin Pract. 2018; 21: 1330-1336
        • WHO Classification of Tumours Editorial Board
        WHO Classification of Tumours of Soft Tissue and Bone.
        5th ed. IARC, Lyon2020
        • Ray-Coquard I.
        • Montesco M.C.
        • Coindre J.M.
        • et al.
        Sarcoma: concordance between initial diagnosis and centralized expert review in a population-based study within three European regions.
        Ann Oncol. 2012; 23: 2442-2449
        • Lehnhardt M.
        • Daigeler A.
        • Hauser J.
        • et al.
        The value of expert second opinion in diagnosis of soft tissue sarcomas.
        J Surg Oncol. 2008; 97: 40-43
        • Thway K.
        • Fisher C.
        Histopathological diagnostic discrepancies in soft tissue tumours referred to a specialist centre.
        Sarcoma. 2009; 2009741975
        • Lopez-Beltran A.
        • Canas-Marques R.
        • Cheng L.
        • Montironi R.
        Histopathologic challenges: the second OPINION issue.
        Eur J Surg Oncol. 2019; 45: 12-15
        • Italiano A.
        • Di Mauro I.
        • Rapp J.
        • et al.
        Clinical effect of molecular methods in sarcoma diagnosis (GENSARC): a prospective, multicentre, observational study.
        Lancet Oncol. 2016; 17: 532-538
        • Neuville A.
        • Ranchère-Vince D.
        • Paolo Dei Tos A.
        • et al.
        Impact of molecular analysis on the final sarcoma diagnosis: a study on 763 cases collected during a European epidemiological study.
        Am J Surg Pathol. 2013; 37: 1259-1268
        • Thway K.
        • Noujaim J.
        • Jones R.L.
        • Fisher C.
        Advances in the pathology and molecular biology of sarcomas and the impact on treatment.
        Clin Oncol. 2017; 29: 471-480
        • Steele C.D.
        • Pillay N.
        The genomics of undifferentiated sarcoma of soft tissue: progress, challenges and opportunities.
        Semin Cancer Biol. 2019; 61: 42-55
        • Schaefer I.-M.
        • Cote G.M.
        • Hornick J.L.
        Contemporary sarcoma diagnosis, genetics, and genomics.
        J Clin Oncol. 2018; 36: 101-110
        • Thway K.
        • Wang J.
        • Swansbury J.
        • Min T.
        • Fisher C.
        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; 2015812089
        • Le Guellec S.
        • Decouvelaere A.-V.
        • Filleron T.
        • et al.
        Malignant peripheral nerve sheath tumor is a challenging diagnosis: a systematic pathology review, immunohistochemistry, and molecular analysis in 160 patients from the French sarcoma group database.
        Am J Surg Pathol. 2016; 40: 896-908
        • Schaefer I.-M.
        • Fletcher C.D.
        • Hornick J.L.
        Loss of H3K27 trimethylation distinguishes malignant peripheral nerve sheath tumors from histologic mimics.
        Mod Pathol. 2016; 29: 4-13
        • Doyle L.A.
        • Moller E.
        • Dal Cin P.
        • Fletcher C.D.
        • Mertens F.
        • Hornick J.L.
        MUC4 is a highly sensitive and specific marker for low-grade fibromyxoid sarcoma.
        Am J Surg Pathol. 2011; 35: 733-741
        • Yoshida A.
        • Tsuta K.
        • Ohno M.
        • et al.
        STAT6 immunohistochemistry is helpful in the diagnosis of solitary fibrous tumors.
        Am J Surg Pathol. 2014; 38: 552-559
        • Casali P.G.
        • Abecassis N.
        • Aro H.T.
        • et al.
        Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2018; 29: iv51-iv67
        • Cancer Council Australia Sarcoma Guidelines Working Party
        Clinical Practice Guidelines for the Management of Adult Onset Sarcoma.
        Australia and New Zealand Sarcoma Association (formerly known as the Australian Sarcoma Group), Sydney2013
        • Bozzo A.
        • Seow H.
        • Pond G.
        • Ghert M.
        Changes in soft-tissue sarcoma treatment patterns over time: a population-based study in a country with universal and centralized healthcare.
        Sarcoma. 2019; 2019: 1-7