title: Soft tissue sarcomas: are current referral guidelines sufficient?
abstract: BACKGROUND
  To investigate the adequacy of current early referral guidelines for patients with extremity soft tissue sarcomas.
  
  
  METHODS
  365 patients with confirmed soft tissue sarcomas were evaluated. Data were collected prospectively and included the length of history and the presence of features in current guidelines suggestive of malignancy (pain, rapidity of growth, depth and tumour size). Statistical analysis included the t-test, ANOVA and the Chi test.
  
  
  RESULTS
  Deep tumours were the commonest (306 patients with deep tumours). Pain was the least consistent feature (176 patients with pain). 345 patients with one or more of the guideline features had an average history of 19.86 months, 238 of these were seen after more than 3 months.
  
  
  CONCLUSIONS
  Although the majority of soft tissue sarcomas in our patients had one or more of the clinical guideline features, there was still an unacceptable delay in referring these patients to a specialist unit. The referral guidelines should be modified with special emphasis on depth, which is the most sensitive, followed by size and a history of rapid growth. This combined with increased awareness of these guidelines and a well-advertised, open-access clinic linked to a specialist unit should allow for a more rapid evaluation of soft tissue tumours.
authors.affiliation: Department of Orthopaedics, Guy's Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hussein
authors.forename: M A
authors.initials: MA
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008131:London; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000592:standards*; D012509:Sarcoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D012983:Soft Tissue Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D013997:Time Factors