Division of Orthopedics, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
Acta Oncol. 2011 Apr;50(3):435-40. doi: 10.3109/0284186X.2010.486797. Epub 2010 Jun 15.
Bone sarcomas in Sweden are generally referred to a multidisciplinary team at specialized sarcoma centers. This practice is strictly followed for sarcomas of long bones, but not for chest wall chondrosarcomas. Delay in diagnosis and treatment is often considerable for bone sarcomas. This report focuses on the symptoms and diagnostic problems of chest wall chondrosarcoma and factors related to long doctor's delay.
The material included all 106 consecutive patients with chondrosarcoma of the chest wall diagnosed in Sweden 1980-2002. Pathological specimens were re-evaluated and graded by the Scandinavian Sarcoma Group pathology board. Files from the very first medical visit for symptoms related to the chondrosarcoma were traced and used to characterize the initial symptoms and calculate patient's and doctor's delay.
The most prominent initial symptom for the chest wall chondrosarcomas was a palpable mass found in 69% (73/106) of the patients at the first visit. Two-thirds of the patients experienced no local chest pain. A tumor was suspected at the first visit in 83% of the patients. Patients delay was median 3 (0-118) months and doctor's delay was 4.5 (0.1-197) months. Doctor's delay was >6 months for 40% of the patients. Patients with an initial plain chest radiograph interpreted as normal (35 patients), and/or normal or inconclusive results of a fine-needle aspiration biopsy had longer doctor's delay. Fine-needle aspiration cytology done at non-specialty units resulted in only 26% correct malignant diagnoses; at sarcoma centers 94% were correctly diagnosed. Long total delay was unfavorable. Patients who died from the chondrosarcoma had longer total delay (p<0.05).
Chest wall chondrosarcoma presents as a lump, usually painless. Plain chest radiographs and fine-needle aspiration cytology, when done at a non-specialty center, are often normal or inconclusive. Patients should be referred to sarcoma centers for diagnosis and treatment.
在瑞典，骨肉瘤通常会被转介到多学科专业肉瘤中心的团队进行治疗。这种治疗方法严格适用于长骨肉瘤，但不适用于胸壁软骨肉瘤。骨肉瘤的诊断和治疗常常会出现显著的延误。本报告重点关注胸壁软骨肉瘤的症状和诊断问题，以及与较长医生延迟相关的因素。
本材料纳入了 1980 年至 2002 年在瑞典诊断的 106 例连续胸壁软骨肉瘤患者。由斯堪的纳维亚肉瘤组病理委员会对病理标本进行重新评估和分级。追查与软骨肉瘤相关症状的首次就诊的病历，并用于描述初始症状和计算患者和医生的延迟。
胸壁软骨肉瘤最突出的初始症状是在首次就诊时，69%（73/106）的患者可触及肿块。三分之二的患者没有局部胸痛。83%的患者在首次就诊时怀疑患有肿瘤。患者的延迟中位数为 3（0-118）个月，医生的延迟为 4.5（0.1-197）个月。40%的患者医生的延迟超过 6 个月。对于初始胸部平片解读为正常（35 例）的患者和/或细针抽吸活检结果正常或不确定的患者，医生的延迟时间更长。在非专业单位进行的细针穿刺细胞学检查仅导致 26%的恶性诊断正确；在肉瘤中心，94%的诊断是正确的。总的延迟时间较长是不利的。死于软骨肉瘤的患者总延迟时间较长（p<0.05）。
胸壁软骨肉瘤表现为肿块，通常无疼痛。在非专业中心进行的胸部平片和细针穿刺细胞学检查通常为正常或不确定。患者应转介到肉瘤中心进行诊断和治疗。
