Prevalence of Soft Tissue and Bone Tumor Diagnostic Discrepancies from Initial to Referral Sarcoma Center

Khomsit  Thongthammachat; Sorranart  Muangsomboon; Akarin  Nimmannit; Charuwan  Akewanlop; Chandhanarat  Chandhanayingyong; Rapin  Phimolsarnti; Jomjit Chantharasamee

doi:10.33192/smj.v77i3.270439

Authors

Khomsit Thongthammachat Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
Sorranart Muangsomboon Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Akarin Nimmannit Department of Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Charuwan Akewanlop Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Chandhanarat Chandhanayingyong Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Rapin Phimolsarnti Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Jomjit Chantharasamee Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v77i3.270439

Keywords:

Concordance evaluation, histological review, medical decision, sarcoma

Abstract

Objective: Diagnosing sarcoma can be challenging. This study evaluates pathological reviews of all sarcoma cases diagnosed at Siriraj Hospital, comparing initial diagnoses with those confirmed by a dedicated sarcoma pathologist

Materials and Methods: Histopathological data from sarcoma patients at Siriraj Hospital were collected over five years. Initial diagnoses were compared to those determined by specialized sarcoma pathologists.

Results: Among the 185 patients, 107 (57%) met the inclusion criteria and were then analyzed. Full concordance (perfect agreement between initial and sarcoma specialized pathologist) was observed in 28 (26.1%) cases, partial concordance (identical diagnosis with differences in classification and / or histopathological subtype differences) in 18 (16.8%) cases, and zero concordance (benign to malignant or vice versa, different histopathological type or invalidation of sarcoma diagnosis) in 61 (57%) cases. The rate of complete concordance was significantly higher in cases with initial complete immunohistochemical (IHC) studies (HR 4.17 and 95% CI 1.43-12.12; p = 0.009), tumors size 100 mm or more (HR 0.32 and 95% CI 0.10-0.99; p = 0.04) and younger than 18 years (HR 5.48, 95% CI 1.49-20; p = 0.01). The main discrepancies were histopathological type (n = 53, 49.5%), subtype (n = 8, 7.5%) and grade plus subtype (n = 4, 3.7%). The mean duration from diagnosis to treatment was 68 days (range: 0-272).

Conclusion: The second opinion modified 73.8% of the initial diagnoses. However, no significant association was found between concordance of diagnosis and time to treatment initiation. Second opinion improves diagnostic accuracy and potentially enhance patient care.

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