Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Tokyo, Japan.
Rare Cancer Center, National Cancer Center, Tokyo, Japan.
Cancer Sci. 2024 Aug;115(8):2831-2838. doi: 10.1111/cas.16211. Epub 2024 May 19.
Histological diagnosis of sarcomas (malignant bone and soft tissue tumors) is challenging due to their rarity, morphological diversity, and constantly evolving diagnostic criteria. In this study, we aimed to assess the concordance in histological diagnosis of bone and soft tissue tumors between referring hospitals and a tertiary sarcoma center and analyzed the clinical impact of the diagnostic alteration. We analyzed 628 consecutively accessioned specimens from 624 patients who visited a specialized sarcoma center for treatment. The diagnoses at referring hospitals and those at the sarcoma center were compared and classified into four categories: agreed, disagreed, specified, and de-specified. Of the 628 specimens, the diagnoses agreed in 403 (64.2%) specimens, whereas some changes were made in 225 (35.8%) specimens: disagreed in 153 (24.3%), specified in 52 (8.3%), and de-specified in 20 (3.2%) cases. The benign/intermediate/malignant judgment changed for 92 cases (14.6%). The diagnostic change resulted in patient management modification in 91 cases (14.5%), including surgical and medical treatment changes. The main inferred reason for the diagnostic discrepancies was a different interpretation of morphological findings of the tumor, which accounted for 48.9% of the cases. This was followed by the unavailability of specialized immunohistochemical antibodies and the unavailability of genetic analysis. In summary, our study clarified the actual clinical impact of diagnostic discrepancy in bone and soft tissue tumors. This may underscore the value of pathology consultation, facilitating access to specialized diagnostic tools, and continued education. These measures are expected to improve diagnostic precision and ultimately benefit patients.
由于肉瘤（恶性骨和软组织肿瘤）罕见、形态多样且诊断标准不断演变，因此其组织学诊断具有挑战性。在这项研究中，我们旨在评估转诊医院和三级肉瘤中心之间骨和软组织肿瘤的组织学诊断一致性，并分析诊断改变的临床影响。我们分析了 624 名就诊于专门肉瘤中心治疗的患者的 628 例连续入组标本。比较转诊医院和肉瘤中心的诊断，并将其分为四类：一致、不一致、特指和非特指。在 628 例标本中，有 403 例（64.2%）的诊断结果一致，而有 225 例（35.8%）的诊断结果发生了变化：153 例（24.3%）不一致，52 例（8.3%）特指，20 例（3.2%）非特指。92 例（14.6%）的良/中/恶性判断发生了改变。诊断改变导致 91 例（14.5%）患者管理发生改变，包括手术和药物治疗的改变。诊断差异的主要推断原因是对肿瘤形态学发现的不同解释，占病例的 48.9%。其次是缺乏专门的免疫组织化学抗体和缺乏基因分析。总之，我们的研究阐明了骨和软组织肿瘤诊断差异的实际临床影响。这可能强调了病理咨询的价值，有助于获得专门的诊断工具和持续的教育。这些措施有望提高诊断的准确性，最终使患者受益。
