Abstract
Introduction
In this retrospective study, we evaluated to what extent diagnostic delays impact prognosis in osteosarcoma.
Materials and methods
The authors identified 26 osteosarcoma patients who had undergone inappropriate procedure-associated diagnostic delays of more than 45 days after surgery, calculated overall survival rates, and analyzed clinicopathologic characteristics.
Results
Initial clinical impressions were of a benign bone tumor in 15 patients, fracture in 8, and infection in 3. After initial inappropriate procedures, primary surgeons failed to send a tissue sample to a pathologist for definite diagnosis in 12 cases, and pathologists made incorrect diagnoses in the other 14. The average doctor-associated diagnostic delay after inappropriate surgery for these 26 patients was 10.5 months. Following referral to our institute, 22 underwent both surgery and chemotherapy and the remaining 4 patients underwent chemotherapy only. Four of the 26 patients were alive at last follow-ups. Estimated 5- and 10-year overall survival rates were 26 and 10%, respectively.
Conclusions
The present study shows that doctor-associated diagnostic delay superimposed on an inappropriate primary procedure has a significant detrimental effect on overall survival in osteosarcoma. This study demonstrates that surgeons and pathologists should spare no effort to minimize diagnostic errors and delays.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Brouns F, Stas M, De Wever I (2003) Delay in diagnosis of soft tissue sarcomas. Eur J Surg Oncol 29(5):440–445. doi:10.1016/S0748-7983(03)00006-4
Clark MA, Thomas JM (2005) Delay in referral to a specialist soft-tissue sarcoma unit. Eur J Surg Oncol 31(4):443–448. doi:10.1016/j.ejso.2004.11.016
Rougraff BT, Davis K, Lawrence J (2007) Does length of symptoms before diagnosis of sarcoma affect patient survival? Clin Orthop Relat Res 462:181–189. doi:10.1097/BLO.0b013e3180f62608
Saithna A, Pynsent PB, Grimer RJ (2008) Retrospective analysis of the impact of symptom duration on prognosis in soft tissue sarcoma. Int Orthop 32(3):381–384. doi:10.1007/s00264-007-0319-8
Murphy WA Jr (1991) Imaging bone tumors in the 1990s. Cancer 67(4 Suppl):1169–1176. doi:10.1002/1097-0142(19910215)67:4+<1169::AID-CNCR2820671511>3.0.CO;2-A
Ayerza MA, Muscolo DL, Aponte-Tinao LA, Farfalli G (2006) Effect of erroneous surgical procedures on recurrence and survival rates for patients with osteosarcoma. Clin Orthop Relat Res 452:231–235. doi:10.1097/01.blo.0000229314.58878.88
Jeon DG, Lee SY, Kim JW (2006) Bone primary sarcomas undergone unplanned intralesional procedures—the possibility of limb salvage and their oncologic results. J Surg Oncol 94(7):592–598. doi:10.1002/jso.20607
Kim MS, Cho WH, Song WS, Lee SY, Jeon DG (2007) time dependency of prognostic factors in patients with stage II osteosarcomas. Clin Orthop Relat Res 463:157–165
Gurney JG, Severson RK, Davis S, Robison LL (1995) Incidence of cancer in children in the United States. Sex-, race-, and 1-year age-specific rates by histologic type. Cancer 75(8):2186–2195. doi:10.1002/1097-0142(19950415)75:8<2186::AID-CNCR2820750825>3.0.CO;2-F
National Comprehensive Cancer Network (2008) NCCN clinical practice guidelines in oncology: bone cancer, V.1.2009. Available at http://www.nccn.org/professionals/physician_gls/PDF/bone.pdf. Accessed 2 Dec 2008
Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, Kotz R, Salzer-Kuntschik M, Werner M, Winkelmann W, Zoubek A, Jurgens H, Winkler K (2002) Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1, 702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 20(3):776–790. doi:10.1200/JCO.20.3.776
Meyers PA, Gorlick R (1997) Osteosarcoma. Pediatr Clin North Am 44(4):973–989. doi:10.1016/S0031-3955(05)70540-X
Troxel DB (2006) Medicolegal aspects of error in pathology. Arch Pathol Lab Med 130(5):617–619
Salzer-Kuntschik M (1996) Pitfalls and typical false interpretations in bone tumors. From the viewpoint of long-term consultation. Pathologe 17(1):1–5. doi:10.1007/s002920050128
Wakely SL, Baxendine-Jones JA, Gallagher PJ, Mullee M, Pickering R (1998) Aberrant diagnoses by individual surgical pathologists. Am J Surg Pathol 22(1):77–82. doi:10.1097/00000478-199801000-00010
Renshaw AA (2001) Measuring and reporting errors in surgical pathology. Lessons from gynecologic cytology. Am J Clin Pathol 115(3):338–341. doi:10.1309/M2XP-3YJA-V6E2-QD9P
Acknowledgments
Each author certifies that he has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his institution has approved or waived approval for the human protocol for their investigation, and that all investigations conformed to the ethical principles of research.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kim, M.S., Lee, SY., Cho, W.H. et al. Prognostic effects of doctor-associated diagnostic delays in osteosarcoma. Arch Orthop Trauma Surg 129, 1421–1425 (2009). https://doi.org/10.1007/s00402-009-0851-7
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-009-0851-7