Hussein R, Smith M A
Department of Orthopaedics, Guy's Hospital, London, UK.
Ann R Coll Surg Engl. 2005 May;87(3):171-3. doi: 10.1308/1478708051658.
To investigate the adequacy of current early referral guidelines for patients with extremity soft tissue sarcomas.
PATIENTS & METHODS: 365 patients with confirmed soft tissue sarcomas were evaluated. Data were collected prospectively and included the length of history and the presence of features in current guidelines suggestive of malignancy (pain, rapidity of growth, depth and tumour size). Statistical analysis included the t-test, ANOVA and the Chi test.
Deep tumours were the commonest (306 patients with deep tumours). Pain was the least consistent feature (176 patients with pain). 345 patients with one or more of the guideline features had an average history of 19.86 months, 238 of these were seen after more than 3 months.
Although the majority of soft tissue sarcomas in our patients had one or more of the clinical guideline features, there was still an unacceptable delay in referring these patients to a specialist unit. The referral guidelines should be modified with special emphasis on depth, which is the most sensitive, followed by size and a history of rapid growth. This combined with increased awareness of these guidelines and a well-advertised, open-access clinic linked to a specialist unit should allow for a more rapid evaluation of soft tissue tumours.
探讨当前肢体软组织肉瘤患者早期转诊指南的适用性。
对365例确诊为软组织肉瘤的患者进行评估。前瞻性收集数据，包括病史时长以及当前指南中提示恶性肿瘤的特征（疼痛、生长速度、深度和肿瘤大小）。统计分析包括t检验、方差分析和卡方检验。
深部肿瘤最为常见（306例深部肿瘤患者）。疼痛是最不一致的特征（176例有疼痛症状的患者）。345例具有一项或多项指南特征的患者平均病史为19.86个月，其中238例在3个月后才就诊。
尽管我们的患者中大多数软组织肉瘤具有一项或多项临床指南特征，但将这些患者转诊至专科单位仍存在不可接受的延迟。转诊指南应进行修订，特别强调深度，深度是最敏感的因素，其次是大小和快速生长史。这与对这些指南的更高认识以及与专科单位相关的宣传良好、开放就诊的诊所相结合，应能实现对软组织肿瘤更快速的评估。
