The cost-saving effect of centralized histological reviews with soft tissue and visceral sarcomas, GIST, and desmoid tumors: The experiences of the pathologists of the French Sarcoma Group

Abstract

ObjectiveThis study examined the types of discordance occurring in the diagnosis of soft tissue and visceral sarcomas, gastrointestinal stromal tumors (GIST), and desmoid tumors, as well as the economic impact of diagnostic discrepancies.MethodsWe carried out a retrospective, multicenter analysis using prospectively implemented databases performed on a cohort of patients within the French RRePS network in 2010. Diagnoses were deemed to be discordant based on the 2013 World Health Organization (WHO) classification. Predictive factors of discordant diagnoses were explored. A decision tree was used to assess the expected costs of two strategies of disease management: one based on revised diagnoses after centralized histological review (option 1), the other on diagnoses without centralized review (option 2). Both were defined based on the patient and the disease characteristics, according to national or international guidelines. The time horizon was 12 months and the perspective of the French National Health Insurance (NHI) was retained. Costs were expressed in Euros for 2013. Sensitivity analyses were performed using low and high scenarios that included ± 20% estimates for cost.ResultsA total of 2,425 patients were included. Three hundred forty-one patients (14%) had received discordant diagnoses. These discordances were determined to mainly be benign tumors diagnosed as sarcomas (n = 124), or non-sarcoma malignant tumors diagnosed as sarcomas (n = 77). The probability of discordance was higher for a final diagnosis of desmoid tumors when compared to liposarcomas (odds ratio = 5.1; 95%CI [2.6–10.4]). The expected costs per patient for the base-case analysis (low- and high-case scenarios) amounted to €8,791 (€7,033 and €10,549, respectively) for option 1 and €8,904 (€7,057 and €10,750, respectively) for option 2.ConclusionsOur findings highlight misdiagnoses of sarcomas, which were found to most often be confused with benign tumors. Centralized histological reviews are likely to provide cost-savings for the French NHI.

Adherence to the guidelines and the pathological diagnosis of high-risk gastrointestinal stromal tumors in the real world

“…Contrary to soft tissue sarcomas, GISTs may not show such a high major discordance rate; for GISTs, the diagnostic criteria are indicated by the guidelines [6][7][8]19]. Our major discordance rate for high-risk GISTs (3.6%) appears to be better than that in European reports, in which pathological concordance according to the tumor category is 90.6% and 87.0% for GISTs and soft tissue sarcomas, respectively [5,20]. Our study indicates that key factors of concordance may include positive KIT and DOG1 staining and genotyping and that special care may be required for extragastrointestinal GISTs.…”

Diagnostic Differences in Expert Second-Opinion Consultation Cases at a Tertiary Sarcoma Center

“…As sarcomas comprise only 1% of all adult cancers, even experienced general pathologists see insufficient numbers to gain familiarity or expertise. The error rate in histopathological diagnosis of soft tissue sarcomas in the recent literature is between 14% and 47%, which reiterates the importance of obtaining further opinion from a specialist soft tissue pathologist for these neoplasms [ 6 – 9 ].…”

“…In a more recent study from France, Perrier et al reported a discrepancy rate of 14%, with higher probability of discordance for a final diagnosis of desmoid tumors in comparison to liposarcomas [ 9 ]. They performed a cost analysis and found that centralized histologic reviews are likely to provide cost savings compared to the cost of additional treatment in case of a wrong diagnosis.…”

“…Second-opinion cases are distinct from referrals as they are usually sought directly by general pathologists for rarer and diagnostically challenging cases. Our center has previously audited diagnostic discrepancy rates and causes for referred cases of soft tissue neoplasms [ 4 , 5 ], but there are few studies assessing diagnostic discrepancies for second-opinion cases in soft tissue pathology [ 6 – 9 ]. This is important, particularly now in an era where there is widespread routine use of ancillary molecular diagnostic modalities and immunohistochemical assays that can serve as correlates of molecular genetic alterations [ 10 – 12 ].…”

Nationwide central diagnosis review for childhood solid tumors: From concept to realization of an Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) integrated project

“…Doing a second routine review of pathologic material is time‐consuming, and its value and utility is questioned by hospitals. However, a second pathologic review could lower overall care costs by preventing inappropriate therapy (both over‐ and undertreatment), especially when pathologists with subspecialty expertise are responsible for a second review of rare tumors . This subject should be better defined at national level by appropriate regulation/legislative support making CPR mandatory, and better defining the terms of responsibility of both reviewers and local pathologists.…”