The impact of additional pathology analysis on the diagnosis and management of soft tissue tumours: a 10-year,retrospective study

In order to characterise soft tissue tumours, pathologists often utilise specialised additional tests, or may seek opinions from subspecialist pathologists due to rarity or complex morphology. Additionally, further review may be sought by subspecialist sarcoma pathologists, such as those at our tertiary referral centre in Sydney, Australia. The aim of this study was to examine the impact on diagnosis and management of this external review, following diagnosis at a specialised sarcoma unit. We collated the results of all additional external ancillary tests and specialist reviews over a 10-year period and characterised the impact on the preliminary diagnosis as 'confirmed', 'new' or 'no clear diagnosis'. We subsequently noted whether the additional findings resulted in a clinically significant change in management. Of the 136 cases sent away, 103 patients had their initial diagnosis confirmed, 29 patients received a new diagnosis and, for four patients, the diagnosis remained uncertain. Nine of the 29 patients receiving a new diagnosis had their management altered. This study demonstrated that within our specialised sarcoma unit, the majority of diagnoses provided by our specialist pathologists are confirmed on additional external testing and review, but external review does provide additional assurance and benefit to the patient.

Patterns of care of superficial soft tissue sarcomas: it is not always just a lump

AIM

Superficial soft tissue sarcomas (S-STS) are generally considered low-risk tumors and have an excellent prognosis when treated with appropriate surgery and adjuvant therapy. However, they are often misdiagnosed then mistreated, leading to significant morbidity. This study aims to examine the patterns of care and outcomes of patients with S-STS, comparing those initially managed through sarcoma units versus elsewhere.

METHODS

Patients with S-STS from Prince of Wales Hospital in NSW (1995-2013) and Peter MacCallum Cancer Centre in Victoria (2009-2013) were identified from a national sarcoma database. Baseline variables, treatment and disease outcomes were recorded. Statistical tests performed included univariate and multivariate analyses, chi-square tests, as well as the Kaplan-Meier method for 5-year local recurrence and survival rates.

RESULTS

Eighty-nine patients were identified, with 35% initially managed at a sarcoma unit and 65% elsewhere. Patients initially managed at sarcoma units had larger tumors (>5 cm 39% vs 17%; P  =  0.036) with a trend to higher grade (61% vs 48%; P = 0.39). Patients that were initially managed outside a sarcoma unit more often underwent open surgical biopsies (P < 0.0005), had multiple operations (P < 0.0005) and had higher rates of local recurrences (24% vs 6.5%, P  =  0.038). They also had lower 5-year local recurrence-free survival rates (P = 0.022), but had higher metastasis-free survival (P = 0.014). On multivariate analysis, only larger STS size and male gender predicted for poorer metastasis-free survival (P = 0.042 and 0.018, respectively).

CONCLUSION

Patients with S-STS initially managed outside specialized sarcoma units undergo more operations, with risk of greater morbidity, and have greater risk of local recurrence.

Comparative psychophysical evaluation in cochlear implantation: electrical and magnetic stimulation

Transtympanic electrical stimulation, either in the form of round window or promontory placement of electrode prior to cochlear implantation is an accepted and commonly used psychophysical tool. Certain response parameters have been identified as predictors of outcome. This study compared the subjective auditory responses generated by promontory electrical stimulation (PES) with those from two noninvasive modalities, namely peritympanic electrical stimulation (PTES) and transcranial magnetic stimulation (TMS). Ten postlingually deafened adult cochlear implant candidates were studied. Standard psychophysical parameters were obtained from patients undergoing PES and PTES. A more subjective form of evaluation was conducted for TMS. Subsequently, nine patients received the multichannel Nucleus (Cochlear Corp., Denver, CO, U.S.A.) implant and one patient a Clarion (Advanced Bionics, Sylmar, CA, U.S.A.) implant. Compared with PES. PTES elicited increased threshold responses with similar dynamic ranges between 50 and 400 Hz of stimulation. The differences were, by and large, insignificant. PTES appeared to be a useful alternative in selected individuals owing to its noninvasiveness. TMS, on the other hand, was incapable of clearly inducing auditory percepts. It also produced concomitant facial and trigeminal stimulation, limiting its potential use as a prognostic tool.