Nantes University, Nantes University Hospital (CHU Nantes), Orthopedic and Traumatological Surgical Clinic, Nantes, France; CRCI2NA (Center for Cancer Research and Immunology Nantes-Angers), INSERM, UMR 1307, CNRS UMR 6075-Team 9 CHILD (CHromatin and Transcriptional Deregulation in Pediatric Bone Sarcoma), Nantes University, Nantes, France.
Nantes University, Nantes University Hospital (CHU Nantes), Orthopedic and Traumatological Surgical Clinic, Nantes, France.
Eur J Surg Oncol. 2024 Jun;50(6):108271. doi: 10.1016/j.ejso.2024.108271. Epub 2024 Mar 18.
Primary bone tumors encompass a range of rare and diverse lesions. Pathological diagnosis poses significant challenges, with histological discrepancies extensively studied in soft tissue sarcomas but lacking specific investigation in bone lesions. This study aimed to determine the rate of major diagnostic discrepancies in primary bone tumors, assessing whether initial histological analysis within an expert referral center network reduces this rate and final diagnostic delay. Additionally, we examined the impact of mandatory systematic re-reading by expert pathologists on diagnostic variation and readjustment.
Our study cohort comprised patients with primary bone tumors, drawn from the national prospective French sarcoma network database. A total of 1075 patients were included from 2018 to 2019.
The cohort exhibited a major discrepancy rate of 24%. Within the expert referral centers network, 49 cases (7%) showed major diagnostic discrepancies in the initial analysis, compared to 207 cases (57%) outside the network (p < 0.001). Regarding the final diagnostic delay, a mean of 2.8 weeks (±4.9) was observed within the network, contrasting with 6.5 weeks (±9.1) outside the network (p < 0.001). Systematic re-reading by an expert pathologist facilitated diagnosis readjustment in 75% of the 256 cases, with 68% of all diagnostic variations occurring preoperatively.
Early management within the expert network significantly reduced major diagnostic discrepancies and shortened the diagnosis delay by approximately a month. Expert pathologist systematic re-readings were responsible for diagnosis readjustments in three-quarters of cases, with two-thirds of all diagnostic variations occurring preoperatively, thereby mitigating the consequences of mistreatment.
原发性骨肿瘤包括一系列罕见且多样的病变。病理诊断具有挑战性，软组织肉瘤的组织学差异得到了广泛研究，但骨病变缺乏特定的研究。本研究旨在确定原发性骨肿瘤中主要诊断差异的发生率，评估在专家转诊中心网络内进行初始组织学分析是否会降低这种发生率和最终诊断延迟。此外，我们还研究了强制由专家病理学家进行系统重新阅读对诊断差异和调整的影响。
我们的研究队列包括来自全国前瞻性法国肉瘤网络数据库的原发性骨肿瘤患者。2018 年至 2019 年共纳入 1075 例患者。
该队列的主要差异率为 24%。在专家转诊中心网络内，49 例（7%）在初始分析中存在主要诊断差异，而网络外有 207 例（57%）（p<0.001）。关于最终诊断延迟，网络内的平均延迟为 2.8 周（±4.9），而网络外为 6.5 周（±9.1）（p<0.001）。专家病理学家的系统重新阅读有助于调整 256 例中的 75%的诊断，所有诊断差异中有 68%发生在术前。
在专家网络内进行早期管理可显著减少主要诊断差异，并将诊断延迟缩短约一个月。专家病理学家的系统重新阅读有助于调整 75%的病例的诊断，所有诊断差异中有三分之二发生在术前，从而减轻了治疗不当的后果。
