title: Characteristics of 64 sarcoma patients referred to a sarcoma center after unplanned excision.
abstract: METHODS
  Unplanned excision of sarcoma before referral to specialist centers can affect prognosis and surgical outcome. The diagnostic pathway of these patients is uncertain and needs to be reviewed. We aimed to describe patient and tumor characteristics, initial symptoms, initial and final diagnosis, and explore reasons for unplanned excision in this patient group. From a previous study on 258 sarcoma patients, we identified 64 patients referred after surgery. Medical records were reviewed.
  
  
  RESULTS
  The majority were soft tissue sarcomas, most often with thoracic location. Leiomyosarcoma was the most frequent final diagnosis, lipoma, and fibroma/dermatofibroma the most frequent initial diagnoses. Fifty percent were superficial small tumors, and 60.9% had not received diagnostic imaging before surgery. Fifty percent were referred from public surgical departments, and 1/3 from private specialists. Twenty-three patients had initial presence of alarm symptoms registered before surgery, the remaining 2/3 fell outside referral criteria or alarm symptoms were not discovered.
  
  
  CONCLUSIONS
  Patients referred after unplanned excision often have small superficial tumors and the majority fall outside of defined referral criteria. Referral criteria are not a guarantee for detection of all sarcomas and surgeons should always be aware of the possibility of malignancy when removing a tumor.
authors.affiliation: Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus C, Denmark.|Department of Orthopedics, Sarcoma Center of Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Heidi Buvarp
authors.initials: HB
authors.lastname: Dyrop
authors.affiliation: Department of Oncology, Sarcoma Center of Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Akmal
authors.initials: A
authors.lastname: Safwat
authors.affiliation: The Research Unit for General Practice, Aarhus University, Aarhus C, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
authors.affiliation: Department of Pathology, Sarcoma Center of Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Katja
authors.initials: K
authors.lastname: Maretty-Kongstad
authors.affiliation: Department of Orthopedics, Sarcoma Center of Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Bjarne Hauge
authors.initials: BH
authors.lastname: Hansen
authors.affiliation: Department of Orthopedics, Sarcoma Center of Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Peter Holmberg
authors.initials: PH
authors.lastname: Jørgensen
authors.affiliation: Department of Orthopedics, Sarcoma Center of Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Baad-Hansen
authors.affiliation: Department of Orthopedics, Sarcoma Center of Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Johnny
authors.initials: J
authors.lastname: Keller
mesh_terms: D000328:Adult; D000368:Aged; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D011379:Prognosis; D012017:Referral and Consultation; D012509:Sarcoma / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*
keywords: alarm symptoms; cancer patient pathways; referral criteria; sarcoma; unplanned excision