Evaluation of Concordance between Initial Diagnosis and Central Pathology Review in a Comprehensive Series of Sarcoma Patients Diagnosed in 3 European Regions
AV Decouvelaere, A Lurkin, JM Coindre, MC Montesco, AP Dei Tos, CR Rossi, S Albert, I Ray-Coquard, JY Blay, D Ranchere-Vince. Centre Léon Bérard, Lyon, France; CONTICANET, Lyon, France; Institut Bergonié, Bordeaux, France; University of Padua, Padua, Italy; Hopital of Treviso, Treviso, Italy
Background: Sarcomas are tumors difficult to diagnose accurately. Over a one-year period, we have reviewed all sarcomas diagnosed within three European regions (Rhone-Alpes (RA) and Aquitaine (Aq) in France, Veneto (Ve) in Italy, representing 12 millions inhabitants). The goal of this work was to assess the similarity between initial diagnosis and expert review.
Design: All primary soft tissue and visceral sarcomas were separated into two main groups: cases sent for the systematic review (SR) induced by this study and cases sent spontaneously for second opinion (SO). Within each group, the initial diagnosis was compared with the corresponding expert opinion. The similarity of the two diagnoses was assessed according to 3 defined levels: (0) absolute mismatch: major difference between the two diagnoses e.g. sarcoma vs benign soft tissue tumor or non-sarcoma, or misidentification of the subtype of sarcoma potentially resulting in important therapeutic impact; (1) partial concordance: inconsistence with the grade or the sarcoma subtype without therapeutic consequence, and (2) absolute concordance: identical diagnoses.
Results: 765 cases were analyzed and corresponded to: 347 patients (45%) from RA, 172 patients (23%) from Aq, and 246 (32%) from Ve. SR represented 60% of the cases (RA=170/347, 49%; Aq=75/172, 44%; Ve=215/246, 87%) and SO the remaining 40% (RA=177/347, 51%; Aq=97/172, 56%; Ve=31/246, 13%). Within the SR group, the three types of concordance rates observed were: 7% (RA=10/170, 6%; Aq=6/75, 8%; Ve=14/215, 7%) of total discordance, 27% (RA=48/170, 28%; Aq=25/75, 33%; Ve=50/215, 23%) of partial concordance, and 66% (RA=112/170, 66%; Aq=44/75, 59%; Ve=151/215, 70%) of total concordance. Within the SO group, the first diagnosis assumption of the pathologist was arbitrarily set as the initial diagnosis to be compared with the expert SO. The total discordance rate reached 18% in this group (54/305).
Conclusions: The high rate of spontaneous SO (40%) shows that pathologists are aware of the difficulties they face to make reliable diagnosis in this complex pathology. The 7% total discordance rate within a group of patients that would not have benefited from any review without this study (SR), shows the necessity to extend the expert process.
Category: Bone & Soft Tissue
Monday, March 22, 2010 1:00 PM
Poster Session II # 6, Monday Afternoon