The value of expert second opinion in diagnosis of soft tissue sarcomas
The value of expert second opinion in diagnosis of soft tissue sarcomas
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DOI：
10.1002/jso.20897
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发表时间：
2008-01-01
影响因子：
2.5
通讯作者：
Steinau, Hans Ulrich
中科院分区：
文献类型：
--
作者：
Lehnhardt, Marcus;Daigeler, Adrien;Steinau, Hans Ulrich
简介：软组织肉瘤代表一组具有广泛临床行为的异质性肿瘤。准确确定诊断和预后对于指导手术决策和为患者提供全身治疗或放射治疗至关重要。 9个咨询性第二意见对于普通外科病理学的价值已得到证实；一些研究表明，尤其是软组织肿瘤标本的价值更高。方法：我们回顾了 603 名在我们机构接受手术、诊断为软组织肉瘤和侵袭性纤维瘤病的患者；我们重点关注原发和明确的肿瘤实体和分级在诊断机构和主要手术程序方面的不匹配。结果：我们发现私人诊所病理学家的初步诊断一致率为 28.3%，医院病理学家为 29.6%，学术医疗中心（大学医院）为 36.8%，我们机构病理科为 70.5%。 73.1% 的患者的诊断有所改善或通过第二意见确认了正确的初步诊断； 2.5% 的第二意见是错误的。讨论：为了准确确定预后并提供最佳治疗决策，我们认为专家第二意见对于软组织肉瘤的最佳治疗至关重要。
Introduction: Soft tissue sarcomas represent a heterogenous group of tumours with a wide range of clinical behaviour. Exact determination of diagnosis and prognosis is critical in order to guide surgical decisions and provide systemic therapy or radiation for patients. The value of 9 consultative second opinions has been proven for general surgical pathology; some studies suggest an even higher value for the soft tissue tumour specimens in particular.Methods: We reviewed 603 patients who were operated on at our institution with the diagnosis of soft tissue sarcoma and aggressive fibromatosis; we focused on mismatches in primary and definite tumour-entity and -grading with respect to the diagnosing institution and the primary surgical procedure.Results: We found concordant primary diagnosis in 28.3% for pathologists in private clinics, 29.6% for hospital pathologists, 36.8% for academic medical centres (university hospitals) and 70.5% for the Department of Pathology at our institution. An improvement in diagnosis or confirmation of the correct primary diagnosis by the second opinion was seen in 73.1% of the patients; in 2.5%, the second opinion was false.Discussion: For accurate determination of prognosis and to provide optimal therapeutic decisions we consider expert second opinion essential for optimal treatment of soft tissue sarcomas.