Abstract
Introduction
General Practitioners will be confronted with a sarcoma rarely in their working lives. Most will never see a bone sarcoma although most will see at least one soft tissue sarcoma. Guidelines designed to lead to earlier diagnosis of the most common cancers were introduced by NICE in 2000 and were updated in 2005, containing basic guidance on the earlier diagnosis of bone and soft tissue tumours. Referral criteria include: masses greater than 5cm in diameter, masses deep to fascia, masses which are fixed or immobile, masses which are painful, those which are increasing in size and recurrence after previous excision
Methods
We examined 350 General Practitioner referrals over the past 3 years to our service and examined the correlation between the above criteria and the likelihood of malignancy.
Results
33.3% of all tumours were malignant. The likelihood of a painful tumour proving malignant was 33.1% and therefore pain was not a valid predictor of malignancy (p = 0.86). Effectively, pain did not confer a relative risk. The likelihood of a growing tumour proving malignant was 38.5% and therefore increasing size is a predictor of malignancy (p = 0.03). Increasing size conferred a relative risk of 1.42 on a growing tumour. 67% of GP's said that they felt uncertain in determining whether a lesion was deep to fascia.
Discussion
Whilst the introduction of the NICE guidelines has provided a clearer indication for referral than existed previously, we did not find all the referral criteria to be of particular value. In particular, pain did not correlate strongly with the likelihood of a tumour proving malignant. Specifically, GPs need further education to improve their working knowledge of this rare disease.
