University Lyon, EAM 4129 Health Individual Society, Hôtel Dieu, Lyon; Centre Léon Bérard, Lyon, France.
Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy.
Ann Oncol. 2012 Sep;23(9):2442-2449. doi: 10.1093/annonc/mdr610. Epub 2012 Feb 13.
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.
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.
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%).
More than 40% of first histological diagnoses were modified at second reading, possibly resulting in different treatment decisions.
肉瘤是一组异质性肿瘤。准确确定组织学诊断和预后因素对于制定治疗策略至关重要。已经有人建议第二意见（SO）有助于提高肉瘤的诊断准确性，但尚未在基于人群的研究中得到证实。
在 2 年的时间里，收集了罗纳-阿尔卑斯大区（法国）、威尼托大区（意大利）和阿基坦大区（法国）诊断为肉瘤的患者的组织学数据。对初始诊断进行了系统比较，以确定与区域和国家专家的 SO 是否一致。
在 2016 名入选患者中，有 1463 名（73%）符合纳入标准并进行了分析。在 824 例（56%）病例中，主要诊断与 SO（第一病理学家和专家得出了相同的结论）完全一致，518 例（35%）部分一致（结缔组织肿瘤的相同诊断，但不同的分级或组织学亚型），121 例（8%）完全不一致（良性与恶性、不同的组织学类型或取消肉瘤的诊断）。主要差异与组织学分级（n = 274，43%）、组织学类型（n = 144，24%）、亚型（n = 18，3%）以及分级加亚型或分级加组织学类型（n = 178，29%）有关。
超过 40%的首次组织学诊断在第二次阅读时被修改，这可能导致不同的治疗决策。
