I Ray-Coquard1, M C Montesco2, J M Coindre3, A P Dei Tos4, A Lurkin5, D Ranchère-Vince6, A Vecchiato2, A V Decouvelaere6, S Mathoulin-Pélissier7, S Albert8, P Cousin6, D Cellier9, L Toffolatti4, C R Rossi10, J Y Blay11. 1. University Lyon, EAM 4129 Health Individual Society, Hôtel Dieu, Lyon; Centre Léon Bérard, Lyon, France. Electronic address: isabelle.ray-coquard@lyon.unicancer.fr. 2. Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy. 3. University Bordeaux Segalen; INSERM U916, Bordeaux, France. 4. General Hospital of Treviso, Italy. 5. University Lyon, EAM 4129 Health Individual Society, Hôtel Dieu, Lyon; Centre Léon Bérard, Lyon, France. 6. Centre Léon Bérard, Lyon, France. 7. University Bordeaux Segalen; INSERM U916, Bordeaux, France; INSERM CIC-EC7 and Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux. 8. INSERM CIC-EC7 and Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux. 9. Merck Serono, Lyon, France. 10. Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy; University of Padova, Italy. 11. Centre Léon Bérard, Lyon, France; NSERM U590 Cytokine and Cancer, Centre Léon Bérard, Lyon, France.
Abstract
BACKGROUND: Sarcomas represent a heterogeneous group of tumors. Accurate determination of histological diagnosis and prognostic factors is critical for the delineation of treatment strategies. The contribution of second opinion (SO) to improve diagnostic accuracy has been suggested for sarcoma but has never been established in population-based studies. METHODS: Histological data of patients diagnosed with sarcoma in Rhone-Alpes (France), Veneto (Italy) and Aquitaine (France) over a 2-year period were collected. Initial diagnoses were systematically compared with SO from regional and national experts. RESULTS: Of 2016 selected patients, 1463 (73%) matched the inclusion criteria and were analyzed. Full concordance between primary diagnosis and SO (the first pathologist and the expert reached identical conclusions) was observed in 824 (56%) cases, partial concordance (identical diagnosis of connective tumor but different grade or histological subtype) in 518 (35%) cases and complete discordance (benign versus malignant, different histological type or invalidation of the diagnosis of sarcoma) in 121 (8%) cases. The major discrepancies were related to histological grade (n = 274, 43%), histological type (n = 144, 24%), subtype (n = 18, 3%) and grade plus subtype or grade plus histological type (n = 178, 29%). CONCLUSION: More than 40% of first histological diagnoses were modified at second reading, possibly resulting in different treatment decisions.
BACKGROUND:Sarcomas represent a heterogeneous group of tumors. Accurate determination of histological diagnosis and prognostic factors is critical for the delineation of treatment strategies. The contribution of second opinion (SO) to improve diagnostic accuracy has been suggested for sarcoma but has never been established in population-based studies. METHODS: Histological data of patients diagnosed with sarcoma in Rhone-Alpes (France), Veneto (Italy) and Aquitaine (France) over a 2-year period were collected. Initial diagnoses were systematically compared with SO from regional and national experts. RESULTS: Of 2016 selected patients, 1463 (73%) matched the inclusion criteria and were analyzed. Full concordance between primary diagnosis and SO (the first pathologist and the expert reached identical conclusions) was observed in 824 (56%) cases, partial concordance (identical diagnosis of connective tumor but different grade or histological subtype) in 518 (35%) cases and complete discordance (benign versus malignant, different histological type or invalidation of the diagnosis of sarcoma) in 121 (8%) cases. The major discrepancies were related to histological grade (n = 274, 43%), histological type (n = 144, 24%), subtype (n = 18, 3%) and grade plus subtype or grade plus histological type (n = 178, 29%). CONCLUSION: More than 40% of first histological diagnoses were modified at second reading, possibly resulting in different treatment decisions.
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