Epidemiological evaluation of concordance between initial diagnosis and central pathology review in a comprehensive and prospective series of sarcoma patients in the Rhone-Alpes region
1 Centre Léon Bérard, 28 rue Laennec - 69008 Lyon; France
2 INSERM EA 4129 « SIS », 28 rue Laennec - 69008 Lyon, France
3 ONCORA network, Réseau Oncologie Rhône-Alpes BIOPARC/ADENINE - 60 Avenue Rockefeller, 69373 LYON Cedex 08, France
4 CONCORDE network, Réseau Oncologie Rhône-Alpes BIOPARC/ADENINE - 60 Avenue Rockefeller, 69373 LYON Cedex 08, France
5 ARC'ALPIN network, Unité de Concertation et de Recherche pour le Traitement des Affections Cancéreuses, CHU A. Michallon BP217 38043 GRENOBLE, France
6 Institut de Cancerologie de la Loire, 108 Bis av. Albert Raimond 42270 Saint Priest en Jarez, France
7 Merck Serono, 37 rue Saint Romain - 69008 Lyon, France
8 INSERM U590 Cytokine et Cancer, 28 rue Laennec - 69008 Lyon, France
BMC Cancer 2010, 10:150 doi:10.1186/1471-2407-10-150Published: 19 April 2010
Sarcomas are rare malignant tumors. Accurate initial histological diagnosis is essential for adequate management. We prospectively assessed the medical management of all patients diagnosed with sarcoma in a European region over a one-year period to identify the quantity of first diagnosis compared to central expert review (CER).
Histological data of all patients diagnosed with sarcoma in Rhone-Alpes between March 2005 and Feb 2006 were collected. Primary diagnoses were systematically compared with second opinion from regional and national experts.
Of 448 patients included, 366 (82%) matched the inclusion criteria and were analyzed. Of these, 199 (54%) had full concordance between primary diagnosis and second opinion (the first pathologist and the expert reached identical conclusions), 97 (27%) had partial concordance (identical diagnosis of conjonctive tumor but different grade or subtype), and 70 (19%) had complete discordance (different histological type or invalidation of the diagnosis of sarcoma). The major discrepancies were related to histological grade (n = 68, 19%), histological type (n = 39, 11%), subtype (n = 17, 5%), and grade plus subtype or grade plus histological type (n = 43, 12%).
Over 45% of first histological diagnoses were modified at second reading, possibly resulting in different treatment decisions. Systematic second expert opinion improves the quality of diagnosis and possibly the management of patients.