Diagnostic difficulties and delays with chest wall chondrosarcoma: a Swedish population based Scandinavian Sarcoma Group study of 106 patients.
BACKGROUND
Bone sarcomas in Sweden are generally referred to a multidisciplinary team at specialized sarcoma centers. This practice is strictly followed for sarcomas of long bones, but not for chest wall chondrosarcomas. Delay in diagnosis and treatment is often considerable for bone sarcomas. This report focuses on the symptoms and diagnostic problems of chest wall chondrosarcoma and factors related to long doctor's delay.


METHODS
The material included all 106 consecutive patients with chondrosarcoma of the chest wall diagnosed in Sweden 1980-2002. Pathological specimens were re-evaluated and graded by the Scandinavian Sarcoma Group pathology board. Files from the very first medical visit for symptoms related to the chondrosarcoma were traced and used to characterize the initial symptoms and calculate patient's and doctor's delay.


RESULTS
The most prominent initial symptom for the chest wall chondrosarcomas was a palpable mass found in 69% (73/106) of the patients at the first visit. Two-thirds of the patients experienced no local chest pain. A tumor was suspected at the first visit in 83% of the patients. Patients delay was median 3 (0-118) months and doctor's delay was 4.5 (0.1-197) months. Doctor's delay was >6 months for 40% of the patients. Patients with an initial plain chest radiograph interpreted as normal (35 patients), and/or normal or inconclusive results of a fine-needle aspiration biopsy had longer doctor's delay. Fine-needle aspiration cytology done at non-specialty units resulted in only 26% correct malignant diagnoses; at sarcoma centers 94% were correctly diagnosed. Long total delay was unfavorable. Patients who died from the chondrosarcoma had longer total delay (p<0.05).


CONCLUSIONS
Chest wall chondrosarcoma presents as a lump, usually painless. Plain chest radiographs and fine-needle aspiration cytology, when done at a non-specialty center, are often normal or inconclusive. Patients should be referred to sarcoma centers for diagnosis and treatment.
Widhe
Björn
B
Division of Orthopedics, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden. bjorn.widhe@ki.se
Bauer
Henrik C F
HC
D001859:Bone Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D002813:Chondrosarcoma / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D015331:Cohort Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011153:Population; D011639:Public Opinion; D012042:Registries; D012189:Retrospective Studies; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D013899:Thoracic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D035441:Thoracic Wall / Q000473:pathology*