Evaluating the British sarcoma referral form.
M A Smolle1, A Leithner1, R J Grimer2
1Medical University of Graz , Austria.
Annals of the Royal College of Surgeons of England
|August 15, 2015
Summary
General practitioner (GP) referrals for suspected soft tissue sarcomas can be improved. Lowering the size referral criterion to >4cm and removing "pain" significantly enhances malignancy detection accuracy.
Area of Science:
- Oncology
- Diagnostic Accuracy
- Healthcare Pathways
Background:
- Investigated the accuracy of general practitioner (GP) referrals for soft tissue sarcomas via the two-week wait pathway.
- Assessed the adequacy of current National Institute for Health and Care Excellence (NICE) referral criteria.
Purpose of the Study:
- To evaluate GP referral accuracy for soft tissue sarcomas.
- To determine if NICE criteria require refinement for improved diagnostic yield.
Main Methods:
- Reviewed 135 patients referred under the two-week wait system over one year.
- Compared GP-identified criteria against centre-confirmed findings to assess referral accuracy and identify malignancy predictors.
Main Results:
- 45% of referrals (33%) were malignant. GP factors were accurate in 74% of cases.
- Size >5cm was the best predictor (76% sensitivity); pain was least useful (27% sensitivity).
- Lowering the size threshold to >4cm increased sensitivity to 89%. Imaging did not improve detection rates.
Conclusions:
- Recommended adapting current soft tissue sarcoma referral criteria.
- Proposed 'size >4cm' as a new criterion and removing 'pain' from urgent referral forms.
