Assessing Unit Perspectives on Referrals to a Regional Bone and Soft Tissue Tumour Service

Pathologies of bone and soft tissues may be complex and heterogeneous; referral patterns influence service efficiency and workflow. This study quantifies regional evidence of referral volume, diagnostic outcomes, and pre-referral imaging pathways from the perspective of referring units.  All referrals to a tertiary United Kingdom Midlands National Health Service (NHS) bone and soft tissue service over a 10-year period were retrospectively assessed using a prospectively maintained institutional database. In total, 279 patients were referred for specialist assessment during the study period. Diagnoses were classified as provisional or final, with imaging modalities categorised as first-, second-, or third-line investigations prior to referral in accordance with the order in which they were performed.  True malignant bone tumours, as defined by histology, constituted a small proportion of referrals: seven patients (2.5%). Benign bone and soft tissue lesions represented a sizeable proportion of provisional diagnoses: 81 patients (29.0%). Metastatic disease and malignant bone tumours were provisionally diagnosed, more commonly than they were confirmed by specialist assessment: 84 patients (30.1%) provisionally referred, 35 patients (12.5%) confirmed following specialist review. Referral volumes varied across specialties and many patients underwent multiple imaging studies prior to referral. These findings provide baseline observational data from a single regional service and highlight the role of specialist bone and soft tissue tumour centres as important diagnostic triage and risk-stratification services within a landscape of heterogeneous pathology and referral pathways. The identification of malignant disease within a small subset of referrals reinforces the value of early specialist assessment for patients with suspected bone and soft tissue tumours.