title: A population-based study of the quality of care in the diagnosis of large (≥5 cm) soft tissue sarcomas.
abstract: OBJECTIVE
  The aim of this study was to assess preoperative biopsy utilization for patients with soft tissue sarcoma (STS) of ≥5 cm in size and whether or not preoperative biopsy was associated with fewer surgical procedures to adequately treat these tumors.
  
  
  METHODS
  We identified 899 patients from the Surveillance, Epidemiology, and End Results-Medicare database with a diagnosis of STS and who underwent surgical resection of their tumors between 1992 and 2006. We used diagnosis and procedure codes from claims data to identify which patients had a biopsy performed and the corresponding number of surgical procedures for each patient. Multivariate logistic regression analyses were carried out to assess the influence of patient, tumor, and sociodemographic characteristics on performance of biopsy and the likelihood of multiple STS operations.
  
  
  RESULTS
  Only 40.6% of patients with tumors of ≥5 cm in size underwent biopsy as part of initial management of their STS. In multivariate analysis, biopsy utilization varied significantly by sex, tumor size, grade, and geographic region. After adjusting for patient, tumor, and sociodemographic characteristics, receipt of a biopsy was the only factor significantly associated with reduced likelihood of multiple STS operations (odds ratio=0.34, 95% confidence interval, 0.24-0.49).
  
  
  CONCLUSIONS
  Preoperative biopsy utilization among Medicare beneficiaries undergoing surgery for STS of ≥5 cm in size is low. Performance of a biopsy for patients with soft tissue tumors of ≥5 cm in size is associated with a decreased likelihood of a patient undergoing multiple surgeries for treatment of STS.
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. aguadagnolo@gmail.com
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.forename: Gunar K
authors.initials: GK
authors.lastname: Zagars
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
authors.forename: Raphael E
authors.initials: RE
authors.lastname: Pollock
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Sharon
authors.initials: S
authors.lastname: Giordano
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: Ya-Chen Tina
authors.initials: YC
authors.lastname: Shih
mesh_terms: D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D011379:Prognosis; D011787:Quality of Health Care; D018426:SEER Program; D012509:Sarcoma / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D014481:United States / Q000453:epidemiology