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Discordance of histo-pathological diagnosis of patients with soft tissue sarcoma referred to tertiary care center. Rastogi,S., Aggarwal, A., Soti, K.,

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Presentation on theme: "Discordance of histo-pathological diagnosis of patients with soft tissue sarcoma referred to tertiary care center. Rastogi,S., Aggarwal, A., Soti, K.,"— Presentation transcript:

1 Discordance of histo-pathological diagnosis of patients with soft tissue sarcoma referred to tertiary care center. Rastogi,S., Aggarwal, A., Soti, K., Vanidassane, I., Sharma M. C, Yadav, A., Sharma, A., Kataria, B., Deo, SVS Sarcoma Medical Oncology Clinic , All India Institute of Medical Sciences , New Delhi Results Background Discrepancy (AIIMS vs outside) Discussion Pathology of soft tissue sarcoma (STS) is extremely intricate because of its rarity and heterogeneity. There is high (25-40%) discordance between general pathologist and Bone and soft tissue expert pathologists1 Developing countries like India need to set up specialist sarcoma units in tertiary care institute with dedicated pathologists 1. The discordance in STS pathology between specialized center and other referral centers is alarming in view of treatment implications and is higher than that reported in West. 1 FNAC is still used in some peripheral centers in India for diagnosis and should be discouraged. It is a matter of concern that less than one fourth reported cases from outside had documented grading. 4. The discordance is more in non extremity sarcoma which might be due to uncommon location for clinical suspicion of sarcoma. . Characteristics (n=149) Number (%) Median age (range) 40 years (14-77 years) Sex- -Male -Female 97 (65) 52 (35) Extent Non metastatic Metastatic 87 (58) 62 (42) Site Extremity Non extremity Retroperitoneal Head and neck Trunk Others 23 (15) 22 ( 15) 20 (13) 22 (22) Histoparhology subtype Synovial sarcoma MPNST Liposarcoma Soft tissue ewings sarcoma Leiomyosarcoma Pleomorphic undifferenttiated sarcoma 25 (17) 13 (9) (9) 12 (8) 61 (40) Grade was reported in 13% of outside reported cases Aim of study To study the discrepancy in histopathological diagnosis of STS cases registered in sarcoma medical oncology clinic at AIIMS compared to diagnosis at non specialised referral centres Major discrepancy details (n=36) Conclusion Similar to NICE guidelines 2, it is time that all STS patients in India be reviewed or diagnosed by Sarcoma specialist pathologist. There should be minimum standards for pathology reporting in STS 3 3. More and more specialized sarcoma units are needed in developing countries like India in order to streamline the management of this rare cancer subtype . Methodology Retrospective review of all STS patients registered in sarcoma medical oncology clinic, AIIMS from January 2016 to January 2017 General characteristics were studied for all registered patients Comparative study for pathology was done for patients only if histopathology was done outside our institute major discrepancy was defined as change leading to different treatment plan and minor discrepancy as change in grade/subtype not affecting further management plan. . Histopathological Reporting Type Number (%) - Presented directly to AIIMS without outside histopathology -Patients already with outside histopathological diagnosis -Patients in which comparison of outside and inside histopathology was possible * Histopathology could not be repeated (n=4) Data not available (n=1) 47 (31.5) 102 (68.4) 97 (65) References As per institutional protocol we get the pathology of all patients reviewed by our bone and soft tissue pathologists irrespective of being reported outside. We have two sarcoma pathologists at our institute and there is a weekly pathology meeting during which all difficult cases are discussed and are correlated with radiology. Factors affecting Major Discrepancy Khin Thway and Cyril Fisher, “Histopathological Diagnostic Discrepancies in Soft Tissue Tumours Referred to a Specialist Centre,” Sarcoma, vol. 2009, Article ID , 7 pages, 2009 2. Improving Outcomes for People with Sarcoma,” 3. National Comprehensive Cancer Network. Soft tissue sarcoma. Accessed on Pathology process in AIIMS Characteristic % of major discrepancy (p value) Type of outside hospital Private Public 35.7% 40% 0.867 Location of tumor Extremity Non extremity 19.4% 48% 0.005 Type of sample outside Biopsy FNAC 34.5% 53.8% 0.18 Age at presentation Less than or =40 years More than 40 years 41% 31% 0.32 Pathology outside N=97 N=97 74% SPSS 17 was used for statistical calculations. Univariate analysis for factors affecting major discrepancy was done by chi- square test. Statistical analysis 85%


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