Abstract
Aim
Assess symptoms and diagnostic problems of chest wall chondrosarcoma and factors related to long doctor's delay.
Methods
The material included all 106 consecutive patients with chondrosarcoma of the chest wall diagnosed in Sweden 1980-2002. Pathological specimens were re-evaluated and graded by the Scandinavian Sarcoma Group pathology board. Files from the very first medical visit for symptoms related to the chondrosarcoma were traced and used to characterise the initial symptoms, calculate patient's and doctor's delay and to identify factors contributing to the delays
Results
The most prominent initial symptom was a palpable mass found in (73/106) 69 % of the patients at the first visit. A tumour was suspected at the first visit in 85 % of the patients. Patients delay was in median 3 (0-118) months and doctor's delay was 4 (0.1-190) months. Doctor's delay was > 6 months for 40 % of the patients. Patients with an initial plain chest radiograph interpreted as normal (34 patients), and/or normal or inconclusive results of a fine-needle aspiration biopsy had longer doctor's delay. Fine-needle aspiration biopsy done at non-specialty units resulted in only 26 % correct malignant diagnoses; at sarcoma centres 94 % were correctly diagnosed.
Only 57 % of the patients were operated at a sarcoma centre and 43 % at non-specialty hospitals. The local recurrence rate was 16 % and 57 %, respectively. The 10 years survival for patients treated at sarcoma centres was 75 % but only 59 % for those not referred.
Conclusion
Chest wall chondrosarcoma presents as a lump, usually painless. Plain chest radiographs and fine-needle aspiration, when done at non-specialty hospitals are often normal or inconclusive. The diagnostic difficulties led to long doctor's delay and to inadequate treatment leading to poor outcome. Patients should be referred to sarcoma centres for diagnosis and treatment.
