Kikuta Kazutaka, Nakayama Robert, Yamaguchi Sayaka, Nishiwaki Yuuji, Susa Michiro, Nishimoto Kazumasa, Horiuchi Keisuke, Nakamura Masaya, Matsumoto Morio, Morioka Hideo
Department of Orthopaedic Surgery, Keio University School of Medicine.
Division of Environmental and Occupational Health, Department of Social Medicine, Faculty of Medicine, Toho University, Japan.
Jpn J Clin Oncol. 2018 Feb 1;48(2):130-134. doi: 10.1093/jjco/hyx184.
Subcutaneous malignant tumors are often treated by non-specialized clinicians in musculoskeletal oncology. While the resection of subcutaneous tumors appears technically feasible, unplanned resection of malignant tumors can result in a devastating clinical outcome. The aim of this study was to evaluate the potential estrangement in the awareness of and the treatment strategy for the patients with subcutaneous soft tissue tumors between musculoskeletal oncologists and non-specialized clinicians.
A questionnaire probing the clinical assessment of subcutaneous tumors was sent to orthopedic surgeons, dermatologists, plastic surgeons, and general surgeons. Results of the questionnaire were statistically analyzed.
One hundred sixteen clinicians out of 150 responded to the questionnaire; the response rate was 77.3%. Among those, 46 clinicians had treated subcutaneous tumors. Thirty-nine of these 46 clinicians (27 musculoskeletal oncologists and 12 non-specialized clinicians) preoperatively performed enhanced MRI for diagnostic evaluation. Preoperative incisional biopsy to confirm the pathological diagnosis was performed by 36 of the 46 clinicians (29 musculoskeletal oncologists and seven non-specialized clinicians). These results indicate that musculoskeletal oncologists perform preoperative enhanced MRI (P = 0.08) and biopsy (P < 0.01) more frequently than non-specialized clinicians. The recognition rate of 'myxofibrosarcoma' was 60.8% among clinicians with an experience with sarcoma treatment (25 musculoskeletal oncologists and three non-specialized clinicians). The recognition rate of 'myxofibrosarcoma' between musculoskeletal oncologists and non-specialized clinicians was statistically significant (P < 0.01).
Preoperative evaluations for subcutaneous tumors are more often inappropriate in non-specialized clinicians than those who are. Therefore, it will be mandatory to raise the awareness of this condition to improve the clinical outcome of patients with subcutaneous tumors.
皮下恶性肿瘤常由肌肉骨骼肿瘤领域的非专科临床医生进行治疗。虽然皮下肿瘤的切除在技术上似乎可行，但恶性肿瘤的意外切除可能导致灾难性的临床后果。本研究的目的是评估肌肉骨骼肿瘤医生与非专科临床医生在皮下软组织肿瘤患者的认识和治疗策略方面可能存在的差异。
向骨科医生、皮肤科医生、整形外科医生和普通外科医生发送了一份关于皮下肿瘤临床评估的问卷。对问卷结果进行统计学分析。
150名临床医生中有116名回复了问卷，回复率为77.3%。其中，46名临床医生治疗过皮下肿瘤。这46名临床医生中有39名（27名肌肉骨骼肿瘤医生和12名非专科临床医生）术前进行了增强磁共振成像（MRI）以进行诊断评估。46名临床医生中有36名（29名肌肉骨骼肿瘤医生和7名非专科临床医生）进行了术前切开活检以确诊病理诊断。这些结果表明，肌肉骨骼肿瘤医生比非专科临床医生更频繁地进行术前增强MRI（P = 0.08）和活检（P < 0.01）。在有肉瘤治疗经验的临床医生（25名肌肉骨骼肿瘤医生和3名非专科临床医生）中，“黏液纤维肉瘤”的识别率为60.8%。肌肉骨骼肿瘤医生和非专科临床医生之间“黏液纤维肉瘤”的识别率具有统计学意义（P < 0.01）。
非专科临床医生对皮下肿瘤的术前评估比专科医生更常出现不恰当的情况。因此，提高对这种情况的认识对于改善皮下肿瘤患者的临床结局将是必不可少的。
