Histopathologic Diagnostic Agreement Study in Bone and Soft Tissue Tumors: The SELNET Sarcoma Network Experience

This study aims to assess the rate of histopathologic diagnostic discordances between the local reviewer in each country of the Sarcoma European and Latin-American Network (SELNET) consortium and expert soft tissue and bone pathologists present in the SELNET network and to evaluate the causes of discrepancies.

Histologic diagnosis at the local center of each country from the SELNET consortium and its relative agreement with the revised diagnosis of expert pathologists from the SELNET pathologist network were evaluated in 347 cases of bone or soft tissue tumors over 3 years.

Diagnostic concordance was observed in 296 cases (85.3% with a Cohen's κ = 0.84, P < .001), whereas in the remaining 51 cases (14.7%), diagnostic discordance was observed. In 19 of 51 cases, the discordance was considered major because it was related to a significant change in clinical management. Minor histologic discordances were observed in the remaining 32 cases. The most frequent reason for diagnostic discordances was incorrect morphologic interpretation and/or the unavailability of key diagnostic immunohistochemical markers (41.2%), or the unavailability of molecular testing to confirm morphologic and immunohistochemical data (21.6%). Incorrect interpretations of morphologic features alone occurred in 37.2% of cases.

A diagnostic agreement of 85.3% was obtained between the original diagnosis in each country of the SELNET consortium and the expert pathologist of the network. Morphologic assessment of tumors, the use of newer immunohistochemical markers, and molecular analysis on a limited number of cases were found to be useful in correcting discrepancies.