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The Diagnostic Value of Pathology Examination in Clinically Unsuspected Lipomatous Soft-tissue Tumors

Received: 7 September 2021     Accepted: 22 September 2021     Published: 30 September 2021
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Abstract

Soft-tissue tumors range from benign to malignant tumors. Although these tumors are frequently unsuspected during surgical excision, additional pathology examination is usually performed in the absence of national guidelines in combination with the fear of missing a malignant tumor. The aim of this study is to investigate if it is safe to refrain from routinely performing pathology examinations of soft-tissue tumors when they are clinically unsuspected to have malignant origins. Data from all routinely performed pathology examinations from patients with one or more clinically unsuspected resected soft-tissue tumors between January 2018 and January 2021 were retrospectively extracted from a merged prospectively maintained institutional database. The primary outcome was the overall rate of premalignant and malignant soft-tissue tumors. Secondary outcomes included specific patient and tumor characteristics in patients with premalignant or malignant soft-tissue tumors and the healthcare costs associated with the performed pathology examinations. In this study, 1,035 resected soft-tissue tumors from 823 patients were analyzed. In total, 1,033 tumors (99.8%) turned out to be benign during the pathology examination, and the remaining two tumors (0.2%) were intermediate soft-tissue tumors without clinical consequences. Both intermediate soft-tissue tumors were larger than 10 cm during clinical examination and were larger than 5 cm during the final pathology examination. The estimated costs spent to perform these pathology examinations were €44,009. Refraining from pathology examination in unsuspected soft-tissue tumors smaller than 5 cm seems to be safe, as no malignant tumor was found in this large cohort of patients. In addition, a cost reduction of €11,000 per year can be achieved by refraining from pathology examinations in this specific group of small non-suspected soft-tissue tumors.

Published in Journal of Surgery (Volume 9, Issue 5)
DOI 10.11648/j.js.20210905.14
Page(s) 233-237
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Soft-tissue Tumors, Pathologic Examination, Healthcare Costs

References
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[2] El Ouni F, Jemni H, Trabelsi A, Ben Maitig M, Arifa N, Ben Rhouma K, et al. Liposarcoma of the extremities: MR imaging features and their correlation with pathologic data. Orthop Traumatol Surg Res 2010; 96: 876–83.
[3] Toirkens J, De Schepper A, Vanhoenacker F, Van Dyck, et al. A comparison between histopathology and findings on magnetic resonance imaging of subcutaneous lipomatous soft-tissue tumors. Insights Imaging 2011; 2: 599-607.
[4] Brisson M, Kashima T, Delaney D, Tirabosco R, Clarke A, Cro S, et al. MRI characteristics of lipoma and atypical lipomatous tumour/well-differentiated liposarcoma: retrospective comparison with histology and MDM2 gene amplification. Skeletal Radiol 2013; 42: 635–47.
[5] Nagano S, Yokouchi M, Setoguchi T, Ishidou Y, Sasaki H, Shimada H, et al. Differentiation of lipoma and atypical lipomatous tumour by a scoring system: implication of increased vascularity on pathogenesis of liposarcoma. BMC Musculoskelet Disord 2015; 16: 36.
[6] Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al. The Clavien−Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250: 187–196.
[7] McClintock NC, Satyananda V, Dauphine C, Hari DM, Chen KT, Ozao-Choy JJ. Lipomatous Soft Tissue Masses: Challenging the Paradigm of Routine Preoperative Biopsy. Journal of Surgical Research 2020; 247: 103-107.
[8] Bird JE, Morse LJ, Feng L, Wang WL, Lin PP, Moon BS, Lazar AJ, Satcher RL, Madewell JE, Lewis VO. Non-Radiographic Risk Factors Differentiating Atypical Lipomatous Tumors from Lipomas. Oncol. 2016; 6: 197.
[9] Fisher SB, Baxter KJ, Staly CA, Fister KE, Monson DK, Murray DR, Oskouei SV, Weiss SW, Kooby DAA, Maithel SK, Delman KA. The General Surgeon’s Quandary: Atypical Lipomatous Tumor vs Lipoma, Who Needs a Surgical Oncologist? J Am Coll Surg. 2013; 217 (5): 881-8.
[10] Myhre-Jensen O. A consecutive 7-year series of 1331 benign soft tissue tumours. Clinicopathologic data. Comparison with sarcomas. Acta Orthop Scand. 1981; 52 (3): 287-93.
[11] Cooper CS, Stratton MR. Soft tissue tumors: the genetic basis of development. Carcinogenesis. 1991; 12 (2): 155-65.
[12] Fornage BD. Soft tissues massas: the underutilization of sonography. Semin Musculoskelet Radiol. 1999; 3 (2): 115-33.
[13] Ma LD. MRI of muscoskeletal tumors: skeletal and soft tissue masses. Curr Probl Diagn Radiol. 1999; 28 (2): 29-62.
[14] Sundaram M. MRI of soft tissue tumors: an overview. Semin Muscoloskelet Radiol. 1999; 3 (1): 15-20.
[15] Petterson H, et al. Primary musculoskeletal tumors: examination with MRI compared with conventional modalities. Radiology. 1987; 164 (1): 237-41.
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    Marije Zwakman, Judith Eleonora Katharina Regina Hentzen, Agnes Marije Hoogland, José van der Starre-Gaal, Engelbertus Gerardus Johannes Maria Pierik, et al. (2021). The Diagnostic Value of Pathology Examination in Clinically Unsuspected Lipomatous Soft-tissue Tumors. Journal of Surgery, 9(5), 233-237. https://doi.org/10.11648/j.js.20210905.14

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    ACS Style

    Marije Zwakman; Judith Eleonora Katharina Regina Hentzen; Agnes Marije Hoogland; José van der Starre-Gaal; Engelbertus Gerardus Johannes Maria Pierik, et al. The Diagnostic Value of Pathology Examination in Clinically Unsuspected Lipomatous Soft-tissue Tumors. J. Surg. 2021, 9(5), 233-237. doi: 10.11648/j.js.20210905.14

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    AMA Style

    Marije Zwakman, Judith Eleonora Katharina Regina Hentzen, Agnes Marije Hoogland, José van der Starre-Gaal, Engelbertus Gerardus Johannes Maria Pierik, et al. The Diagnostic Value of Pathology Examination in Clinically Unsuspected Lipomatous Soft-tissue Tumors. J Surg. 2021;9(5):233-237. doi: 10.11648/j.js.20210905.14

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  • @article{10.11648/j.js.20210905.14,
      author = {Marije Zwakman and Judith Eleonora Katharina Regina Hentzen and Agnes Marije Hoogland and José van der Starre-Gaal and Engelbertus Gerardus Johannes Maria Pierik and Anne Brecht Francken},
      title = {The Diagnostic Value of Pathology Examination in Clinically Unsuspected Lipomatous Soft-tissue Tumors},
      journal = {Journal of Surgery},
      volume = {9},
      number = {5},
      pages = {233-237},
      doi = {10.11648/j.js.20210905.14},
      url = {https://doi.org/10.11648/j.js.20210905.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210905.14},
      abstract = {Soft-tissue tumors range from benign to malignant tumors. Although these tumors are frequently unsuspected during surgical excision, additional pathology examination is usually performed in the absence of national guidelines in combination with the fear of missing a malignant tumor. The aim of this study is to investigate if it is safe to refrain from routinely performing pathology examinations of soft-tissue tumors when they are clinically unsuspected to have malignant origins. Data from all routinely performed pathology examinations from patients with one or more clinically unsuspected resected soft-tissue tumors between January 2018 and January 2021 were retrospectively extracted from a merged prospectively maintained institutional database. The primary outcome was the overall rate of premalignant and malignant soft-tissue tumors. Secondary outcomes included specific patient and tumor characteristics in patients with premalignant or malignant soft-tissue tumors and the healthcare costs associated with the performed pathology examinations. In this study, 1,035 resected soft-tissue tumors from 823 patients were analyzed. In total, 1,033 tumors (99.8%) turned out to be benign during the pathology examination, and the remaining two tumors (0.2%) were intermediate soft-tissue tumors without clinical consequences. Both intermediate soft-tissue tumors were larger than 10 cm during clinical examination and were larger than 5 cm during the final pathology examination. The estimated costs spent to perform these pathology examinations were €44,009. Refraining from pathology examination in unsuspected soft-tissue tumors smaller than 5 cm seems to be safe, as no malignant tumor was found in this large cohort of patients. In addition, a cost reduction of €11,000 per year can be achieved by refraining from pathology examinations in this specific group of small non-suspected soft-tissue tumors.},
     year = {2021}
    }
    

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    T1  - The Diagnostic Value of Pathology Examination in Clinically Unsuspected Lipomatous Soft-tissue Tumors
    AU  - Marije Zwakman
    AU  - Judith Eleonora Katharina Regina Hentzen
    AU  - Agnes Marije Hoogland
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    AU  - Engelbertus Gerardus Johannes Maria Pierik
    AU  - Anne Brecht Francken
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    JO  - Journal of Surgery
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    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20210905.14
    AB  - Soft-tissue tumors range from benign to malignant tumors. Although these tumors are frequently unsuspected during surgical excision, additional pathology examination is usually performed in the absence of national guidelines in combination with the fear of missing a malignant tumor. The aim of this study is to investigate if it is safe to refrain from routinely performing pathology examinations of soft-tissue tumors when they are clinically unsuspected to have malignant origins. Data from all routinely performed pathology examinations from patients with one or more clinically unsuspected resected soft-tissue tumors between January 2018 and January 2021 were retrospectively extracted from a merged prospectively maintained institutional database. The primary outcome was the overall rate of premalignant and malignant soft-tissue tumors. Secondary outcomes included specific patient and tumor characteristics in patients with premalignant or malignant soft-tissue tumors and the healthcare costs associated with the performed pathology examinations. In this study, 1,035 resected soft-tissue tumors from 823 patients were analyzed. In total, 1,033 tumors (99.8%) turned out to be benign during the pathology examination, and the remaining two tumors (0.2%) were intermediate soft-tissue tumors without clinical consequences. Both intermediate soft-tissue tumors were larger than 10 cm during clinical examination and were larger than 5 cm during the final pathology examination. The estimated costs spent to perform these pathology examinations were €44,009. Refraining from pathology examination in unsuspected soft-tissue tumors smaller than 5 cm seems to be safe, as no malignant tumor was found in this large cohort of patients. In addition, a cost reduction of €11,000 per year can be achieved by refraining from pathology examinations in this specific group of small non-suspected soft-tissue tumors.
    VL  - 9
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Author Information
  • Department of Surgery, ISALA, Zwolle, The Netherlands

  • Department of Surgery, ISALA, Zwolle, The Netherlands

  • Department of Pathology, ISALA, Zwolle, The Netherlands

  • Department of Pathology, ISALA, Zwolle, The Netherlands

  • Department of Surgery, ISALA, Zwolle, The Netherlands

  • Department of Surgery, ISALA, Zwolle, The Netherlands

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