title: Sarcoma: concordance between initial diagnosis and centralized expert review in a population-based study within three European regions.
abstract: BACKGROUND
  Sarcomas represent a heterogeneous group of tumors. Accurate determination of histological diagnosis and prognostic factors is critical for the delineation of treatment strategies. The contribution of second opinion (SO) to improve diagnostic accuracy has been suggested for sarcoma but has never been established in population-based studies.
  
  
  METHODS
  Histological data of patients diagnosed with sarcoma in Rhone-Alpes (France), Veneto (Italy) and Aquitaine (France) over a 2-year period were collected. Initial diagnoses were systematically compared with SO from regional and national experts.
  
  
  RESULTS
  Of 2016 selected patients, 1463 (73%) matched the inclusion criteria and were analyzed. Full concordance between primary diagnosis and SO (the first pathologist and the expert reached identical conclusions) was observed in 824 (56%) cases, partial concordance (identical diagnosis of connective tumor but different grade or histological subtype) in 518 (35%) cases and complete discordance (benign versus malignant, different histological type or invalidation of the diagnosis of sarcoma) in 121 (8%) cases. The major discrepancies were related to histological grade (n = 274, 43%), histological type (n = 144, 24%), subtype (n = 18, 3%) and grade plus subtype or grade plus histological type (n = 178, 29%).
  
  
  CONCLUSIONS
  More than 40% of first histological diagnoses were modified at second reading, possibly resulting in different treatment decisions.
authors.affiliation: University Lyon, EAM 4129 Health Individual Society, Hôtel Dieu, Lyon; Centre Léon Bérard, Lyon, France. Electronic address: isabelle.ray-coquard@lyon.unicancer.fr.
authors.forename: I
authors.initials: I
authors.lastname: Ray-Coquard
authors.affiliation: Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Montesco
authors.affiliation: University Bordeaux Segalen; INSERM U916, Bordeaux, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Coindre
authors.affiliation: General Hospital of Treviso, Italy.
authors.forename: A P
authors.initials: AP
authors.lastname: Dei Tos
authors.affiliation: University Lyon, EAM 4129 Health Individual Society, Hôtel Dieu, Lyon; Centre Léon Bérard, Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Lurkin
authors.affiliation: Centre Léon Bérard, Lyon, France.
authors.forename: D
authors.initials: D
authors.lastname: Ranchère-Vince
authors.affiliation: Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Vecchiato
authors.affiliation: Centre Léon Bérard, Lyon, France.
authors.forename: A V
authors.initials: AV
authors.lastname: Decouvelaere
authors.affiliation: University Bordeaux Segalen; INSERM U916, Bordeaux, France; INSERM CIC-EC7 and Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux.
authors.forename: S
authors.initials: S
authors.lastname: Mathoulin-Pélissier
authors.affiliation: INSERM CIC-EC7 and Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux.
authors.forename: S
authors.initials: S
authors.lastname: Albert
authors.affiliation: Centre Léon Bérard, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Cousin
authors.affiliation: Merck Serono, Lyon, France.
authors.forename: D
authors.initials: D
authors.lastname: Cellier
authors.affiliation: General Hospital of Treviso, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Toffolatti
authors.affiliation: Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy; University of Padova, Italy.
authors.forename: C R
authors.initials: CR
authors.lastname: Rossi
authors.affiliation: Centre Léon Bérard, Lyon, France; NSERM U590 Cytokine and Cancer, Centre Léon Bérard, Lyon, France.
authors.forename: J Y
authors.initials: JY
authors.lastname: Blay
mesh_terms: D000008:Abdominal Neoplasms / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D005602:France; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011153:Population; D012017:Referral and Consultation; D012509:Sarcoma / Q000175:diagnosis*; D055815:Young Adult