Imaging investigations before referral to a sarcoma center delay the final diagnosis of musculoskeletal sarcoma

Abstract

Background and purposeThe use of point-of-care or local investigations before referral to specialist sarcoma centers as part of a fast-track diagnostic pathway varies, and may affect the time to diagnosis. We wanted to investigate differences in time intervals and proportion of malignancy in patients who were referred after initial diagnostic investigations were performed locally and in patients who were referred without these investigations.Patients and methodsWe included 545 consecutive patients who were referred to Aarhus Sarcoma Center for suspected musculoskeletal sarcoma. Data on time intervals and investigations performed were collected from questionnaires and patient records. Patients who were referred from outside Aarhus uptake area after initial MRI/CT or histology performed locally were compared with patients who were referred from Aarhus uptake area without these investigations.ResultsThe median total interval from first symptom to diagnosis was 166 days for outside patients referred with MRI/CT or histology, which was 91 (95% CI: 76–106) days longer than for local patients who were referred without MRI/CT or histology. Comparing the same groups, the median diagnostic interval was 41 (95% CI: 30–51) days longer for outside patients including both primary care and hospital intervals. Both the proportion of malignancies (38% vs. 14%) and the proportion of sarcomas (24% vs. 7%) were higher in the outside group referred with MRI/CT or histology than in the local group without MRI/CT or histology.InterpretationPre-referral investigations at a local hospital increased the diagnostic interval by at least 1 month for 50% of the patients, and the proportion of malignancy was more than doubled—to almost 40%. If investigations are to be performed before referral to a sarcoma center, they should be part of the fast-track pathway in order to ensure timely diagnosis.

Conformity to Clinical Practice Guidelines at Initial Management in Adult Soft Tissue and Visceral Tumors since the Implementation of the NetSarc Network in Eastern France

“…We noticed an improvement in referral to reference centers over time, from 24.2% of patients in 2010 to 55.6% in 2016. Many sarcoma specialists already warned physicians of the pitfalls of delayed referral, assessing the diagnostic pattern of patients regarding their first symptoms [2,8,[19][20][21][22][23][24]. The implementation of an expert network was one of the strategies proposed to improve efficient referral, avoid misdiagnosis, and organize a straightforward sequence of care.…”

Adult soft tissue sarcoma and time to treatment initiation: An analysis of the National Cancer Database

“…It is important to understand that delays in diagnosis are different than delays in treatment—where the latter is the time elapsed after a diagnosis is known to the time of treatment. Studies have sought to detect reasons for delayed referrals of patients to sarcoma specialists, though focusing on how these delays in diagnosis affect patient survival—not delays in treatment . Delays in diagnosis have been shown to be a major cause for malpractice litigation.…”

“…Current literature regarding time to definitive treatment of STS has mainly focused on delays in diagnosis . These studies have identified risk factors for delay in diagnosis and the effect it has on patient survival, though little progress has been made in shortening time to diagnosis .…”

Persistent Shoulder Pain in Young Male: Osteosarcoma

“…It noted that 179 (69%) of 258 sarcoma patients were referred with alarming symptoms, while the remaining 79 sarcoma patients who were referred without alarming symptoms. Of them, seven were found accidentally on imaging, five were referred with suspected recurrence of a sarcoma, 64 were referred with a confirmed histological diagnosis, and three were referred for other reasons [ 6 ]. It was also noted that the sending of histological samples by primary care doctors delays the patient referral and the diagnosis of osteosarcoma.…”