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

Marije Zwakman; Judith Eleonora Katharina Regina Hentzen; Agnes Marije Hoogland; José van der Starre-Gaal; Engelbertus Gerardus Johannes Maria Pierik; Anne Brecht Francken

doi:doi:10.11648/j.js.20210905.14

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

Marije Zwakman, Judith Eleonora Katharina Regina Hentzen, Agnes Marije Hoogland, José van der Starre-Gaal, Engelbertus Gerardus Johannes Maria Pierik, Anne Brecht Francken

Published in Journal of Surgery (Volume 9, Issue 5)

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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[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.
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[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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APA Style

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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TY  - JOUR
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
AU  - José van der Starre-Gaal
AU  - Engelbertus Gerardus Johannes Maria Pierik
AU  - Anne Brecht Francken
Y1  - 2021/09/30
PY  - 2021
N1  - https://doi.org/10.11648/j.js.20210905.14
DO  - 10.11648/j.js.20210905.14
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 233
EP  - 237
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
IS  - 5
ER  -

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Author Information

Marije Zwakman

Department of Surgery, ISALA, Zwolle, The Netherlands
Judith Eleonora Katharina Regina Hentzen

Department of Surgery, ISALA, Zwolle, The Netherlands
Agnes Marije Hoogland

Department of Pathology, ISALA, Zwolle, The Netherlands
José van der Starre-Gaal

Department of Pathology, ISALA, Zwolle, The Netherlands
Engelbertus Gerardus Johannes Maria Pierik

Department of Surgery, ISALA, Zwolle, The Netherlands
Anne Brecht Francken

Department of Surgery, ISALA, Zwolle, The Netherlands

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APA Style

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}
}

Copy | Download

TY  - JOUR
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
AU  - José van der Starre-Gaal
AU  - Engelbertus Gerardus Johannes Maria Pierik
AU  - Anne Brecht Francken
Y1  - 2021/09/30
PY  - 2021
N1  - https://doi.org/10.11648/j.js.20210905.14
DO  - 10.11648/j.js.20210905.14
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 233
EP  - 237
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
IS  - 5
ER  -

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