Alarm symptoms of soft-tissue and bone sarcoma in patients referred to a specialist center

Figures & data

Table 1. Patient and tumor characteristics for the 1,126 patients included in the study population

	Sarcoma	Other
	Soft		Soft
	tissue (%)	Bone (%)	tissue (%)	Bone (%)
Sex
Male	101 (58)	43 (51)	258 (49)	178 (53)
Female	73 (42)	41 (49)	274 (52)	158 (47)
Age
< 20	6 (3)	15 (18)	46 (9)	89 (27)
20–39	26 (15)	22 (26)	95 (18)	53 (16)
40–59	46 (26)	31 (37)	184 (35)	80 (24)
≥ 60	96 (55)	16 (19)	207 (39)	114 (34)
Referral year
2007	48 (28)	12 (14)	137 (26)	81 (24)
2008	35 (20)	22 (26)	106 (20)	60 (18)
2009	46 (26)	18 (21)	141 (27)	88 (26)
2010	45 (26)	32 (38)	148 (28)	107 (32)
Duration of symptoms
≤ 1 year	121 (70)	61 (73)	299 (56)	229 (68)
> 1 year	37 (21)	12 (14)	139 (26)	43 (13)
Missing data	16 (9)	11 (13)	94 (18)	64 (19)
Tumor diameter
< 5 cm	68 (39)	26 (31)	251 (47)	156 (46)
≥ 5 cm	98 (56)	54 (64)	267 (50)	115 (34)
Missing	8 (5)	4 (5)	14 (3)	65 (19)
Histological grade ^a
Benign	-	-	364 (68)	182 (54)
Low	57 (33)	21 (25)	-	-
High	117 (67)	63 (75)	-	-
No biopsy	-	-	168 (32)	154 (46)
Tumor depth ^b
Superficial	63 (36)	-	182 (34)	-
Deep	109 (63)	-	350 (66)	-
Missing data	2 (1)	-	-	-
Total	174 (100)	84 (100)	532 (100)	336 (100)

^a Low: Trojani grade 1; High: Trojani grade 2–3

^b Evaluated after imaging, clinical examination, and/or surgical removal. Not necessarily a presenting symptom.

Table 2. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for sarcomas with single symptoms and combinations of symptoms and signs that have been defined as inclusion criteria for soft-tissue tumors in the Cancer Patient Pathway, in suspected sarcoma patients

	Soft-tissue tumors (n = 706)
	Sarcoma	Non-sarcoma	Sensitivity	Specificity	PPV	NPV
Symptom ^a Present	(n = 174)	(n = 532)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)
	+	–	+	–
1	78	96	233	299	45 (37–53)	56 (52–61)	25 (20–30)	76 (71–80)
2	76	98	293	239	44 (36–51)	45 (41–49)	21 (17–25)	71 (66–76)
3	50	124	164	368	29 (22–36)	69 (65–73)	23 (18–30)	75 (71–79)
1 + 2	36	138	91	441	21 (15–28)	83 (79–86)	28 (21–37)	76 (73–80)
2 + 3	5	169	34	498	3 (1–7)	94 (91–96)	13 (4–27)	75 (71–78)
1 + 3	6	168	31	501	3 (1–7)	94 (92–96)	16 (6–32)	75 (71–78)
1 + 2 + 3	26	148	37	495	15 (10–21)	93 (91–95)	41 (29–54)	77 (74–80)

^a Symptom 1: soft-tissue tumor > 5 cm; symptom 2: soft-tissue tumor on or under the fascia; symptom 3: fast-growing soft-tissue tumor.

Table 3. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for sarcomas with single symptoms and combinations of symptoms and signs that have been defined as inclusion criteria for bone tumors in the Cancer Patient Pathway, in suspected sarcoma patients

	Bone tumors (n = 420)
	Sarcoma	Non-sarcoma	Sensitivity	Specificity	PPV	NPV
Symptom ^aPresent	(n = 84)	(n = 336)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)
	+	–	+	–
4	12	72	44	292	14 (8–24)	87 (83–90)	21 (12–34)	80 (76–84)
5	69	15	237	99	82 (72–90)	30 (25–35)	23 (18–28)	87 (79–92)
4 + 5	8	76	14	322	9 (4–18)	96 (93–98)	36 (17–59)	81 (77–85)

^a Symptom 4: palpable bone tumor; symptom 5: deep persisting bone pains.