title: Prognostic effects of doctor-associated diagnostic delays in osteosarcoma.
abstract: BACKGROUND
  In this retrospective study, we evaluated to what extent diagnostic delays impact prognosis in osteosarcoma.
  
  
  METHODS
  The authors identified 26 osteosarcoma patients who had undergone inappropriate procedure-associated diagnostic delays of more than 45 days after surgery, calculated overall survival rates, and analyzed clinicopathologic characteristics.
  
  
  RESULTS
  Initial clinical impressions were of a benign bone tumor in 15 patients, fracture in 8, and infection in 3. After initial inappropriate procedures, primary surgeons failed to send a tissue sample to a pathologist for definite diagnosis in 12 cases, and pathologists made incorrect diagnoses in the other 14. The average doctor-associated diagnostic delay after inappropriate surgery for these 26 patients was 10.5 months. Following referral to our institute, 22 underwent both surgery and chemotherapy and the remaining 4 patients underwent chemotherapy only. Four of the 26 patients were alive at last follow-ups. Estimated 5- and 10-year overall survival rates were 26 and 10%, respectively.
  
  
  CONCLUSIONS
  The present study shows that doctor-associated diagnostic delay superimposed on an inappropriate primary procedure has a significant detrimental effect on overall survival in osteosarcoma. This study demonstrates that surgeons and pathologists should spare no effort to minimize diagnostic errors and delays.
authors.affiliation: Department of Pathology, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Min Suk
authors.initials: MS
authors.lastname: Kim
authors.forename: Soo-Yong
authors.initials: SY
authors.lastname: Lee
authors.forename: Wan Hyeong
authors.initials: WH
authors.lastname: Cho
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Song
authors.forename: Jae-Soo
authors.initials: JS
authors.lastname: Koh
authors.forename: Jun Ah
authors.initials: JA
authors.lastname: Lee
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Yoo
authors.forename: Duk Seop
authors.initials: DS
authors.lastname: Shin
authors.forename: Dae-Geun
authors.initials: DG
authors.lastname: Jeon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors