Soft-tissue and bone sarcoma histopathology peer review: the frequency of disagreement in diagnosis and the need for second pathology opinions. The Southeastern Cancer Study Group experience.

Abstract

Histopathologic peer review of specimens from 216 consecutive patients with soft-tissue or bone sarcomas on Southeastern Cancer Study Group protocols was performed by a panel of three pathologists. Subtype of sarcoma, degree of confidence in diagnosis, and grade were compared with agreement or disagreement in pathologic opinion from the primary member institution v the pathology review panel. The most common soft-tissue sarcoma was leiomyosarcoma, followed by malignant fibrous histiocytoma, fibrosarcoma, liposarcoma, malignant schwannoma, and rhabdomyosarcoma. There was total agreement between the primary pathologist and reviewer in 66% of cases. However, 12 cases (6%) were considered on review to not be sarcomas. In 27% of cases the subtype of sarcoma was felt to be incorrect by reviewers. Discordant diagnoses were more common when the confidence of the pathologist was less and when the tumor was of higher grade. There was no improvement in frequency of agreement in the second half of the study, despite educational workshops. We conclude that histologic peer review is important in sarcoma studies and is essential in many patients with presumed sarcomas.

Sarcomas in north west England: I. Histopathological peer review

“…Nevertheless it is surprising that, in spite of seeing relatively large numbers of sarcomas over and above normal workload, such variation in diagnosis between panel members continued to occur and although no formal assessment of converging agreement with time was made, the general impression was that this did not take place. This impression is consistent with that of Presant et al (1986) who found no improvement in frequency of agreement in the course of the SEG study, in spite of educational workshops. The only conclusion which can be drawn from this is that second opinion is of vital importance in cases of presumed sarcomas, particularly for those cases e.g.…”

“…Presant et al (1986) reported the review of specimens from 216 consecutive patients with bone or soft tissue sarcomas entered into trials conducted by the Southeastern Cancer Study Group (SEG). Most cases were reviewed by one or two pathologists in addition to the original reviewer, and there was agreement between primary reviewer and panel in 66% cases.…”

“…The consequences of some of these problems are exemplified in the results of the peer review studies of sarcomas which have been undertaken (Baker et al, 1978;Presant et al, 1986;Newton et al, 1988;Shiraki et al, 1989;Alvegard & Berg, 1989). In these series histological sub-type of sarcoma was frequently changed on review and significant proportions of tumours were considered ineligible as sarcomas.…”

“…

The consequences of some of these problems are exemplified in the results of the peer review studies of sarcomas which have been undertaken (Baker et al, 1978;Presant et al, 1986;Newton et al, 1988;Shiraki et al, 1989;Alvegard & Berg, 1989). In these series histological sub-type of sarcoma was frequently changed on review and significant proportions of tumours were considered ineligible as sarcomas.

The study undertaken here was an attempt to define accurately the incidence of sub-types of sarcomas Grade of malignancy was not specified but in smooth muscle tumours where malignancy was equivocal, mitotic counts were performed using the criteria for malignancy recommeded by Enzinger and Weiss (1988).

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Sarcomas in north west England: III Survival

“…Added to this is the observation that histopathological review often results in change in diagnosis of sub-type and may even result in certain tumours being redesignated as non-sarcomas (Presant et al, 1986;Alvegard & Berg, 1989, El-Jabbour et al, 1990Agnarsson et al, 1991).…”