The value of expert second opinion in diagnosis of soft tissue sarcomas.
BACKGROUND
Soft tissue sarcomas represent a heterogeneous group of tumours with a wide range of clinical behaviour. Exact determination of diagnosis and prognosis is critical in order to guide surgical decisions and provide systemic therapy or radiation for patients. The value of consultative second opinions has been proven for general surgical pathology; some studies suggest an even higher value for the soft tissue tumour specimens in particular.


METHODS
We reviewed 603 patients who were operated on at our institution with the diagnosis of soft tissue sarcoma and aggressive fibromatosis; we focused on mismatches in primary and definite tumour-entity and -grading with respect to the diagnosing institution and the primary surgical procedure.


RESULTS
We found concordant primary diagnosis in 28.3% for pathologists in private clinics, 29.6% for hospital pathologists, 36.8% for academic medical centres (university hospitals) and 70.5% for the Department of Pathology at our institution. An improvement in diagnosis or confirmation of the correct primary diagnosis by the second opinion was seen in 73.1% of the patients; in 2.5%, the second opinion was false.


CONCLUSIONS
For accurate determination of prognosis and to provide optimal therapeutic decisions we consider expert second opinion essential for optimal treatment of soft tissue sarcomas.
Lehnhardt
Marcus
M
Department of Plastic Surgery, Burn Center, Hand Surgery, Sarcoma Reference Center, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany. Marcus.Lehnhardt@rub.de
Daigeler
Adrien
A
Hauser
Joerg
J
Puls
Alexander
A
Soimaru
Christian
C
Kuhnen
Cornelius
C
Steinau
Hans Ulrich
HU
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005104:Expert Testimony; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis* / Q000473:pathology