三级肉瘤中心专家二次会诊病例的诊断差异
Diagnostic Differences in Expert Second-Opinion Consultation Cases at a Tertiary Sarcoma Center.
作者信息
Rupani Asha, Hallin Magnus, Jones Robin L, Fisher Cyril, Thway Khin
机构信息
Sarcoma Unit, Royal Marsden Hospital, London SW3 6JJ, UK.
The Institute of Cancer Research, London SW3 6JB, UK.
出版信息
Sarcoma. 2020 Sep 29;2020:9810170. doi: 10.1155/2020/9810170. eCollection 2020.
Soft tissue tumors are diagnostically challenging, and it is recommended that these are reported or reviewed by specialist soft tissue pathologists. We present our experience with second-opinion (consultation) cases in a specialist tertiary sarcoma center. The aim of this study was to determine areas of diagnostic difficulty in soft tissue pathology. We assessed 581 second-opinion cases which were reviewed by two experienced pathologists in a period of one year. There was 62% concordance between the original and the second-opinion diagnosis, with diagnostic discrepancy in 38%. The largest group of soft tissue neoplasms received for second opinion was fibroblastic/myofibroblastic tumors, and most major diagnostic problems were encountered in adipocytic and so-called "fibrohistiocytic" tumors. Major diagnostic errors impacting management were found in 148 cases (25%). Morphologic assessment of tumors, judicious use of molecular techniques, newer immunostains and their interpretation, along with importance of knowledge of rarer entities were found to be most useful in avoiding errors.
软组织肿瘤的诊断具有挑战性，建议由专业的软组织病理学家进行报告或复查。我们介绍了在一家专业的三级肉瘤中心进行二次诊断（会诊）病例的经验。本研究的目的是确定软组织病理学中诊断困难的领域。我们评估了581例二次诊断病例，这些病例在一年内由两位经验丰富的病理学家进行了复查。原诊断与二次诊断之间的一致性为62%，诊断差异为38%。接受二次诊断的最大软组织肿瘤组是成纤维细胞/肌成纤维细胞肿瘤，大多数主要诊断问题出现在脂肪细胞性肿瘤和所谓的“纤维组织细胞性”肿瘤中。在148例病例（25%）中发现了影响治疗的主要诊断错误。发现肿瘤的形态学评估、明智地使用分子技术、更新的免疫染色及其解读，以及了解罕见实体的重要性对于避免错误最为有用。
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