Trends in presentation of bone and soft tissue sarcomas over 25 years: little evidence of earlier diagnosis

Smith, G.; Johnson, Graham; Grimer, RJ; Wilson, Scott B.

doi:10.1308/147870811x13137608455055

Cited by 53 publications

(43 citation statements)

References 17 publications

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“…This factor can cause difficulties in detection since a STS lying deep has hardly any symptoms. 6,11 The results of our dataset match with this observation as the majority of malignancies were situated deep while benign lesions were more likely to be located subcutaneously.…”

Section: Depthsupporting

confidence: 83%

“…This is a little less than the usual size for STS at initial presentation over the past 25 years. 6 Nevertheless, while benign soft tissue tumours are approximately 5cm in size, sarcomas are most often clearly positive for the parameter 'size >5cm'. As size correlates directly with chances of survival for patients with STS, it is crucial to diagnose them at an early stage.…”

Section: Sizementioning

confidence: 99%

“…4,5 Metastasis free patients have a better prognosis than patients with tumour spread at diagnosis and the age of the patients also influences overall survival rates, with better outcome in younger individuals. 6,7 Furthermore, elevated levels of Creactive protein measured prior to treatment indicate a poor prognosis. 8 Previous studies have challenged the effectiveness of the two-week wait system as the average size of the STS at time of diagnosis has not changed significantly since the introduction of the guidelines in 2000.…”

mentioning

confidence: 99%

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Evaluating the British sarcoma referral form

Smolle

Leithner

Grimer

2015

annals

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INTRODUCTION This study investigated the accuracy of general practitioner (GP) referrals under the two-week wait pathway for soft tissue sarcomas and whether the current National Institute for Health and Care Excellence criteria should be refined. METHODS All patients referred under the two-week wait system to one centre over the course of one year were reviewed. Comparison was made between the criteria identified by the GP and those confirmed by the centre to assess the accuracy of the referrals, and to identify what criteria predicted malignancy. RESULTS Overall, 135 patients were referred to our unit with a mean age of 56.4 years. Of these, 45 (33%) were found to have a malignant tumour. Factors identified by the GP were accurate in 74% of cases. The best predictor of malignancy was 'size >5cm' (76% sensitivity) while 'pain' was the least useful (27% sensitivity). Lowering the threshold for concern to a size of >4cm increased sensitivity to 89%. Although 106 patients had undergone some form of imaging prior to referral, this did not increase the likelihood of malignancy being detected. The combination of factors most likely to predict malignancy was a size of >5cm, increase in size, deep location and no pain (10 out of 13 referrals, 77% accuracy). CONCLUSIONS Based on the results of this study, we recommend an adaption of the existing features for concern. The new feature for concern should be 'size >4cm' and the factor 'pain' should be removed from the urgent referral form.

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Section: Depthsupporting

confidence: 83%

Section: Sizementioning

confidence: 99%

mentioning

confidence: 99%

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Evaluating the British sarcoma referral form

Smolle

Leithner

Grimer

2015

annals

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“…Diagnostic delay is thought to contribute to this. Sarcomas are diagnosed later in the UK patients, and are larger at the time of biopsy, even after new cancer referral guidelines from 2000 12. The time from first symptom to diagnosis in Ewing sarcoma is one of the longest of all paediatric tumours, with a median time of 3–6 months and case reports of tumours that were missed on imaging or pathology up to 3 years earlier 13–15…”

Section: Discussionmentioning

confidence: 99%

Navigating chronic pain: how taking a few wrong turns can miss sinister pathology

Turnbull¹,

Dodds²,

Wainwright³

et al. 2017

Arch Dis Child Educ Pract Ed

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Bone sarcomas are rare in childhood, and their presentation can often mimic more benign complaints or chronic musculoskeletal pain. Ewing sarcomas in particular are often diagnosed after a significant delay from the onset of symptoms. At a population level, a long diagnostic delay is not necessarily associated with worse survival , as tumours that display slow growth also tend to be less aggressive. For any specific individual however, a delayed diagnosis can result in a larger tumour that is more difficult to treat. We explore a case of Ewing sarcoma and discuss how the presenting features, approach to imaging and the role of clinician cognitive bias may have led to diagnostic delay.Ewing sarcoma is treated with chemotherapy and surgery and/or radiotherapy based on the initial site of disease, size of tumour and response to initial treatment. With current UK treatments, overall survival is approximately 70% for localised tumours and up to 20% in those with metastatic disease. Bone sarcomas usually present with deep-seated mechanical bone pain akin to toothache. The pain can be intermittent over the course of days or weeks, but pain occurring at night should be considered a red flag. Swelling may also present. On plain X-ray, bone sarcomas can demonstrate areas of bone destruction, new bone formation, periosteal inflammation and soft tissue swelling, but in some cases the changes are very subtle. Persistent unexplained symptoms require MRI to exclude tumours and detect potential benign causes that are amenable to treatment.

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“…Previous studies have also found the presence of pain to be an unreliable indicator of malignancy. 10,20 Current guidelines for referral include size >5 cm, increasing in size, deep to fascia, painful and recurrence after previous excision. 11,12 We found STL depth to be a second-degree associate in our study.…”

Section: Discussionmentioning

confidence: 99%