Background: Percutaneous biopsy is recommended before surgery for suspected retroperitoneal sarcoma (RPS) to confirm the histological diagnosis and guide surgical strategy. The present study aimed to establish the diagnostic accuracy of percutaneous core biopsy with respect to histological diagnosis and tumour grade. Methods: Data on patients with suspected RPS who underwent percutaneous biopsy followed by surgical resection between 2005 and 2016 at one of two tertiary European sarcoma units were reviewed. Histological tumour type and tumour grade on biopsy were correlated with postoperative histology to evaluate diagnostic accuracy. Results: A total of 239 patients underwent percutaneous core biopsy followed by surgical resection in Milan (163, 68⋅2 per cent) or Birmingham (76, 31⋅8 per cent). Diagnostic accuracy varied with histological diagnosis (P < 0⋅001), but demonstrated overall concordance with final pathology following resection in 67⋅2 per cent of biopsies ( = 0⋅606). The majority of discrepancies occurred in dedifferentiated liposarcoma (DDLPS), owing to under-recognition of dedifferentiation in this group. Concordance between pathology on biopsy and resection improved to 81⋅1 per cent when DDLPS and well differentiated liposarcoma were grouped together as liposarcoma. Grade on biopsy was concordant with grade on resection specimen in 60⋅4 per cent of tumours ( = 0⋅640). Diagnosis of high-grade tumours on biopsy had a high specificity (98 per cent), and moderate positive predictive value (85 per cent) and negative predictive value (78 per cent). Conclusion: A diagnosis of DDLPS or leiomyosarcoma on percutaneous biopsy is highly reliable.High-grade sarcomas can be identified with high specificity, which opens the door to a study on neoadjuvant therapy in these patients.
Patient outcomes following surgical resection of retroperitoneal sarcomas (RPSs) are variable and therefore predicting prognosis is challenging. The risk of recurrence varies according to several patient- tumour- and treatment-related characteristics, including histological subtype and tumour grade. In an era of increased movement towards individualised patient care, the ability to predict prognosis following surgery for RPS is essential. The accurate prediction of an individual patient's outcome is important to allow adequate patient counselling and to ensure the optimal therapeutic strategy is selected. The outcomes of patients who have undergone resection for RPS can be predicted using tools such as nomograms. Nomograms take into account the relative contribution of each variable by giving them different weights and then combining them. This review aims to discuss current staging systems available for RPS and to critically appraise predictive tools that are currently available for use in clinical practice.
Background In patients with retroperitoneal sarcoma (RPS), the incidence of recurrence after surgery remains high. Novel treatment approaches are needed. This retrospective study evaluated patients with primary, high‐risk RPS who received neoadjuvant systemic therapy followed by surgery to 1) determine the frequency and potential predictors of radiologic tumor responses and 2) assess clinical outcomes. Methods Clinicopathologic data were collected for eligible patients treated at 13 sarcoma referral centers from 2008 to 2018. Univariable and multivariable logistic models were performed to assess the association between clinical predictors and response. Overall survival (OS) and crude cumulative incidences of local recurrence and distant metastasis were compared. Results Data on 158 patients were analyzed. A median of 3 cycles of neoadjuvant systemic therapy (interquartile range, 2‐4 cycles) were given. The regimens were mostly anthracycline based; however, there was significant heterogeneity. No patients demonstrated a complete response, 37 (23%) demonstrated a partial response (PR), 88 (56%) demonstrated stable disease, and 33 (21%) demonstrated progressive disease (PD) according to the Response Evaluation Criteria in Solid Tumors, version 1.1. Only a higher number of cycles given was positively associated with PR (P = .005). All patients underwent complete resection, regardless of the tumor response. Overall, patients whose tumors demonstrated PD before surgery showed markedly worse OS (P = .005). An indication of a better clinical outcome was seen in specific regimens given for grade 3 dedifferentiated liposarcoma and leiomyosarcoma. Conclusions In patients with high‐risk RPS, the response to neoadjuvant systemic therapy is fair overall. Disease progression on therapy may be used to predict survival after surgery. Subtype‐specific regimens should be further validated.
Appearance-related concerns are common following burns. However, there is minimal research that has specifically investigated patients' reactions when they looked in the mirror for the first time following facial burns. The current study aimed to investigate patients' reactions and factors associated with distress. Burns patients (n=35) who had sustained facial injuries completed a questionnaire which examined their reactions when looking in the mirror for the first time. Data were collected between April and July 2013. Participants had sustained their burn injuries 12 months prior to participating, on average (ranging from one to 24 months). Forty seven percent (n=16) of patients were worried about looking for the first time, 55% (n=19) were concerned about what they would see, and 42% (n=14) held negative mental images about what their faces looked like before they looked. twenty seven percent (n=9) of patients initially avoided looking, 38% (n=13) tried to 'read' others' reactions to them to try to gauge what they looked like, and 73% (n=25) believed that it was important for them to look. Mean ratings suggested that patients found the experience moderately distressing. Patients most often found the experience less distressing compared to their expectations. Distress was related to feeling less prepared, more worried and increased negative mental images prior to looking. In conclusion, patients' reactions to looking in the mirror for the first time vary. Adequately preparing patients and investigating their expectations beforehand is crucial. The findings have a number of important implications for practice.
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