Diagnostic Delay in Soft Tissue Sarcomas: A Review

Abstract

BACKGROUND/OBJECTIVES: To review the problem of diagnostic delay in soft tissue sarcomas with the aim of identifying its causes and consequences, understanding how to clinically suspect and refer them, and evaluating the main limitations of the referral guidelines already in use. METHODS: A systematic review of the available literature was performed, focusing on the theoretical framework, the elements and time intervals to be considered, causes and consequences, "red flag" symptoms/signs, the main referral guidelines in use, their results, and the methods used to avoid excessive referrals. RESULTS: Diagnostic delay in soft tissue sarcomas is a frequent event that is poorly characterized and has important consequences, including prognostic, medico-legal and psycho-social effects. The common denominator is the lack of knowledge and awareness. Several referral guidelines have been described, and most of them are based on clinical data. Their results have been disappointing. Thus, it is necessary to implement new methods to improve their results and avoid the overload of pre-referral imaging systems, sarcoma diagnostic triage meetings, and telemedicine systems. CONCLUSIONS: Sarcoma units and health system leaders need to study this issue to determine the extent of the problem and its causes. Without this information, it is almost impossible to properly address the problem and take corrective actions. Early referral of suspected soft tissue sarcoma lesions, although desirable, is a complex issue due to the non-specificity of the symptoms. Existing clinical referral guidelines need to be modified to improve detection and conversion rates.