A Daily Diagnostic Multidisciplinary Meeting to Reduce Time to Definitive Diagnosis in the Context of Primary Bone and Soft Tissue Sarcoma

Figures & data

Figure 1 A depiction of the referral process in 2015 before the introduction of the DMDT; illustrating the steps taken to appropriately triage the referral before making the first management decision.

Abbreviation: MDT, multidisciplinary team meeting.

Figure 2 A depiction of the referral process in 2018 after the introduction of the DMDT; illustrating the steps taken to appropriately triage the referral and make a first management decision.

Abbreviations: MDT, multidisciplinary team meeting; CNS, clinical nurse specialist; DMDT, diagnostic multidisciplinary team meeting.

Table 1 Demographic Data for the 2015 and 2018 Cohorts

	2015, N = 101	2018, N = 135
Age	95 Adults^(94%) 6 Children^(6%)	116 Adults^(86%) 19 Children^(14%)
Gender	47 Females^(46%) 54 Males^(54%)	67 Females^(50%) 68 Males^(50%)
Type of Referral	34 2WW^(34%) 63 Routine^(62%) 4 Urgent^(4%)	29 2WW^(21%) 100 Routine^(74%) 6 Urgent^(4%)
Referrer	69 Other Hospital Consultant^(68%) 32 GP^(32%)	112 Other Hospital Consultant^(83%) 22 GP^(16%) 1 Allied Healthcare Professional^(1%)
Pathway Used	29 Suspected Primary Bone Sarcoma^(29%)	33 Suspected Primary Bone Sarcoma^(24%)
	46 Suspected Primary Soft Tissue Sarcoma^(46%)	53 Suspected Primary Soft Tissue Sarcoma^(40%)
	26 Other Bone Pathology^(25%)	49 Other Bone Pathology^(36%)
Definitive Diagnosis	4 Primary Bone Sarcoma^(4%)	3 Primary Bone Sarcoma^(2%)
	12 Primary Soft Tissue Sarcoma^(12%)	11 Primary Soft Tissue Sarcoma^(8%)
	3 Haematological Malignancy^(3%)	6 Haematological Malignancy^(4%)
	5 Metastatic Pathology^(5%)	21 Metastatic Pathology^(16%)
	77 Benign (bone and soft tissue) Pathology^(76%)	94 Benign (bone and soft tissue) Pathology^(69%)

Table 2 Provisional Diagnosis at DMDT Data (2018)

Group	Sub-Group	Number of Cases
Malignancy Likely (N = 30)	Sarcoma Malignancy (Bone/STS)	15
	Non-Sarcoma Malignancy (Metastatic Disease/Pathological Fracture)	15
Malignancy Possible (N = 34)	Sarcoma Malignancy (Bone/STS)	32
	Non-Sarcoma Malignancy (Metastatic Disease/Pathological Fracture)	2
Malignancy Unlikely (N = 27)
Malignancy Excluded (N = 44)

Table 3 Outcomes of First Management Decision (2015)

Clinic Only	18%	Clinic + Scan + Biopsy	1%
Biopsy Only	21%	Scan + Biopsy	10%
Scan Only	7%	Discharge	18%
Clinic + Scan	16%	Palliative	0%
Clinic + Biopsy	6%	Surgery	4%

Table 4 Outcomes of First Management Decision (2018)

Clinic Only	13%	Clinic + Scan + Biopsy	11%
Biopsy Only	3%	Scan + Biopsy	1.5%
Scan Only	1.5%	Discharge	24%
Clinic + Scan	19%	Palliative	1.5%
Clinic + Biopsy	24%	Surgery	1.5%