title: Epidemiological evaluation of concordance between initial diagnosis and central pathology review in a comprehensive and prospective series of sarcoma patients in the Rhone-Alpes region.
abstract: BACKGROUND
  Sarcomas are rare malignant tumors. Accurate initial histological diagnosis is essential for adequate management. We prospectively assessed the medical management of all patients diagnosed with sarcoma in a European region over a one-year period to identify the quantity of first diagnosis compared to central expert review (CER).
  
  
  METHODS
  Histological data of all patients diagnosed with sarcoma in Rhone-Alpes between March 2005 and Feb 2006 were collected. Primary diagnoses were systematically compared with second opinion from regional and national experts.
  
  
  RESULTS
  Of 448 patients included, 366 (82%) matched the inclusion criteria and were analyzed. Of these, 199 (54%) had full concordance between primary diagnosis and second opinion (the first pathologist and the expert reached identical conclusions), 97 (27%) had partial concordance (identical diagnosis of conjonctive tumor but different grade or subtype), and 70 (19%) had complete discordance (different histological type or invalidation of the diagnosis of sarcoma). The major discrepancies were related to histological grade (n = 68, 19%), histological type (n = 39, 11%), subtype (n = 17, 5%), and grade plus subtype or grade plus histological type (n = 43, 12%).
  
  
  CONCLUSIONS
  Over 45% of first histological diagnoses were modified at second reading, possibly resulting in different treatment decisions. Systematic second expert opinion improves the quality of diagnosis and possibly the management of patients.
authors.affiliation: Centre Léon Bérard, Lyon, France. lurkin@lyon.fnclcc.fr
authors.forename: Antoine
authors.initials: A
authors.lastname: Lurkin
authors.forename: Francoise
authors.initials: F
authors.lastname: Ducimetière
authors.forename: Dominique Ranchère
authors.initials: DR
authors.lastname: Vince
authors.forename: Anne-Valérie
authors.initials: AV
authors.lastname: Decouvelaere
authors.forename: Dominic
authors.initials: D
authors.lastname: Cellier
authors.forename: François N
authors.initials: FN
authors.lastname: Gilly
authors.forename: Dimitri
authors.initials: D
authors.lastname: Salameire
authors.forename: Pierre
authors.initials: P
authors.lastname: Biron
authors.forename: Guy
authors.initials: G
authors.lastname: de Laroche
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Blay
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ray-Coquard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D055815:Young Adult
references.citation: Skeletal Radiol. 2000 May;29(5):249-58
references.pmid: 10883443
references.citation: J Clin Oncol. 1986 Nov;4(11):1658-61
references.pmid: 3772418
references.citation: Orthopedics. 2004 Feb;27(2):209-12
references.pmid: 14992389
references.citation: Ann Surg. 1995 Feb;221(2):185-95
references.pmid: 7857146
references.citation: Hum Pathol. 2002 Jan;33(1):111-5
references.pmid: 11823981
references.citation: Cancer. 1986 Jul 15;58(2):306-9
references.pmid: 3719523
references.citation: Cancer. 1989 Jul 15;64(2):484-90
references.pmid: 2736494
references.citation: J Clin Oncol. 1997 Jan;15(1):350-62
references.pmid: 8996162
references.citation: Eur J Cancer Prev. 1997 Oct;6(5):442-66
references.pmid: 9466116
references.citation: Ann Pathol. 1998 Dec;18(6):505-11
references.pmid: 10051921
references.citation: Ann Oncol. 2004 Feb;15(2):307-15
references.pmid: 14760127
references.citation: Ann Oncol. 2008 May;19 Suppl 2:ii89-93
references.pmid: 18456783
references.citation: Am J Clin Pathol. 2001 Oct;116(4):473-6
references.pmid: 11601130
references.citation: Arch Pediatr. 2006 Feb;13(2):121-9
references.pmid: 16376530
references.citation: Br J Cancer. 1991 Aug;64(2):315-20
references.pmid: 1892759
references.citation: Gynecol Oncol. 2000 Aug;78(2):166-70
references.pmid: 10926797
references.citation: Histopathology. 2003 Jul;43(1):1-16
references.pmid: 12823707
references.citation: Am J Clin Pathol. 1995 Nov;104(5):560-6
references.pmid: 7572817
references.citation: Adv Anat Pathol. 1998 Mar;5(2):67-85
references.pmid: 9868514
references.citation: Ann Pathol. 1985;5(2):95-9
references.pmid: 3840024
references.citation: Pathol Res Pract. 1988 Nov;183(6):698-705
references.pmid: 2851775
references.citation: Ann Oncol. 2012 Jan;23(1):159-166
references.pmid: 21415238
references.citation: Gan To Kagaku Ryoho. 2004 Sep;31(9):1340-5
references.pmid: 15446553
references.citation: Pediatr Blood Cancer. 2008 Jun;50(6):1213-20
references.pmid: 18300318
references.citation: Cancer. 1999 Dec 1;86(11):2426-35
references.pmid: 10590387
references.citation: Hum Pathol. 2000 May;31(5):532-8
references.pmid: 10836292
references.citation: Acta Orthop Scand Suppl. 1999 Jun;285:18-26
references.pmid: 10429617
references.citation: Verh Dtsch Ges Pathol. 1998;82:59-63
references.pmid: 10095417
references.citation: J Clin Oncol. 1996 Apr;14(4):1201-8
references.pmid: 8648375
references.citation: Crit Rev Oncol Hematol. 2002 Feb;41(2):157-67
references.pmid: 11856592
references.citation: Head Neck. 2002 Jul;24(7):684-93
references.pmid: 12112543
references.citation: J Surg Oncol. 2008 Jan 1;97(1):40-3
references.pmid: 17918224
references.citation: N Engl J Med. 2005 Aug 18;353(7):701-11
references.pmid: 16107623
references.citation: Am J Clin Pathol. 2000 Sep;114(3):329-35
references.pmid: 10989631