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Surgeon's treatment outcome prediction: accuracy and communication
Lisa Vlug1, Ellen C de Lange1, Anouk A Kruiswijk2
1Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
Summary
Preoperative margin prediction for soft tissue sarcomas (STS) has low accuracy for positive margins. Surgeons often express high confidence, limiting discussion of uncertainty, which can impact prognostic counseling for STS patients.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Informatics
Background:
- Clear surgical margins are critical for soft tissue sarcoma (STS) treatment and prognosis.
- Prognostic tools like the Personalized Sarcoma Care (PERSARC) app require preoperative margin estimates.
- The accuracy of these predictions and communication of uncertainty are not well understood.
Purpose of the Study:
- To evaluate the accuracy of preoperative margin predictions in STS patients.
- To assess how margin uncertainty is communicated during treatment consultations.
- To understand the impact of prediction accuracy on prognostic counseling.
Main Methods:
- Retrospective analysis of PERSARC app data and electronic patient records.
- Comparison of preoperative margin predictions with postoperative histopathology in 134 STS patients.
- Qualitative analysis of margin uncertainty communication in 37 patient consultations.
Main Results:
- Margin prediction accuracy for positive margins was low (2.3% sensitivity).
- Inaccurate predictions significantly altered PERSARC-based survival and recurrence estimations.
- Uncertainty regarding margins was infrequently discussed, often with high surgeon confidence.
Conclusions:
- Preoperative margin prediction in STS is unreliable for positive margins, with limited communication of uncertainty.
- Inaccurate predictions may affect prognostic counseling and patient expectations.
- Improved awareness of prediction limitations and transparent communication are needed for informed decision-making in STS care.
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