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Open Access Research article

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

Antoine Lurkin12*, Francoise Ducimetière12, Dominique Ranchère Vince1, Anne-Valérie Decouvelaere1, Dominic Cellier7, François N Gilly4, Dimitri Salameire5, Pierre Biron123, Guy de Laroche3456, Jean Yves Blay12345678 and Isabelle Ray-Coquard12

Author Affiliations

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

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BMC Cancer 2010, 10:150  doi:10.1186/1471-2407-10-150

Published: 19 April 2010

Abstract

Background

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).

Methods

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.

Results

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%).

Conclusions

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.