title: Alarm symptoms of soft-tissue and bone sarcoma in patients referred to a specialist center.
abstract: OBJECTIVE
  The Danish Cancer Patient Pathway for sarcoma defines a set of alarm symptoms as criteria for referral to a sarcoma center. This may exclude cancer patients without alarm symptoms, so we investigated the presence of alarm symptoms (defined as being indicative of a sarcoma) in patients who had been referred to the Aarhus Sarcoma Center.
  
  
  METHODS
  We reviewed the medical records of all 1,126 patients who had been referred, with suspected sarcoma, from other hospitals in the period 2007-2010 for information on symptoms, clinical findings, and diagnosis. Alarm symptoms were analyzed for predictive values in diagnosing sarcoma.
  
  
  RESULTS
  179 (69%) of 258 sarcoma patients were referred with alarm symptoms (soft-tissue tumor>5 cm or deep-seated, fast-growing soft-tissue tumor, palpable bone tumor, or deep persisting bone pain). The remaining 79 sarcomas were found accidentally. "Size over 5 cm" for soft-tissue tumors, and "deep persisting bone pain" for bone tumors had the highest sensitivity and positive predictive value. Of the 79 sarcoma patients who were referred without alarm symptoms, 7 were found accidentally on imaging, 5 were referred with suspected recurrence of a sarcoma, 64 were referred with a confirmed histological diagnosis, and 3 were referred for other reasons.
  
  
  CONCLUSIONS
  Defined alarm symptoms are predictive of sarcoma, but one-third of the patients were found accidentally. Further studies on presenting symptoms in primary care are needed to assess the true value of alarm symptoms.
authors.affiliation: Department of Experimental Clinical Oncology, Aarhus University Hospital.
authors.forename: Heidi B
authors.initials: HB
authors.lastname: Dyrop
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
authors.forename: Akmal
authors.initials: A
authors.lastname: Safwat
authors.forename: Katja
authors.initials: K
authors.lastname: Maretty-Nielsen
authors.forename: Bjarne H
authors.initials: BH
authors.lastname: Hansen
authors.forename: Peter H
authors.initials: PH
authors.lastname: Jørgensen
authors.forename: Thomas
authors.initials: T
authors.lastname: Baad-Hansen
authors.forename: Johnny
authors.initials: J
authors.lastname: Keller
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D019091:Critical Pathways / Q000706:statistics & numerical data; D003718:Denmark / Q000453:epidemiology; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D012516:Osteosarcoma / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012509:Sarcoma / Q000175:diagnosis* / Q000453:epidemiology; D012680:Sensitivity and Specificity; D012983:Soft Tissue Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult