Primary bone tumors encompass a range of rare and diverse lesions. Pathological diagnosis poses significant challenges, with histological discrepancies extensively studied in soft tissue sarcomas but lacking specific investigation in bone lesions. This study aimed to determine the rate of major diagnostic discrepancies in primary bone tumors, assessing whether initial histological analysis within an expert referral center network reduces this rate and final diagnostic delay. Additionally, we examined the impact of mandatory systematic re-reading by expert pathologists on diagnostic variation and readjustment. Our study cohort comprised patients with primary bone tumors, drawn from the national prospective French sarcoma network database. A total of 1075 patients were included from 2018 to 2019. The cohort exhibited a major discrepancy rate of 24%. Within the expert referral centers network, 49 cases (7%) showed major diagnostic discrepancies in the initial analysis, compared to 207 cases (57%) outside the network (p < 0.001). Regarding the final diagnostic delay, a mean of 2.8 weeks (±4.9) was observed within the network, contrasting with 6.5 weeks (±9.1) outside the network (p < 0.001). Systematic re-reading by an expert pathologist facilitated diagnosis readjustment in 75% of the 256 cases, with 68% of all diagnostic variations occurring preoperatively. Early management within the expert network significantly reduced major diagnostic discrepancies and shortened the diagnosis delay by approximately a month. Expert pathologist systematic re-readings were responsible for diagnosis readjustments in three-quarters of cases, with two-thirds of all diagnostic variations occurring preoperatively, thereby mitigating the consequences of mistreatment.

中文翻译：

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肉瘤专家网络中诊断骨肿瘤的准确性提高并减少延迟：一项全国性研究

原发性骨肿瘤包括一系列罕见且多样的病变。病理诊断提出了重大挑战，软组织肉瘤的组织学差异被广泛研究，但缺乏对骨病变的具体研究。本研究旨在确定原发性骨肿瘤主要诊断差异的发生率，评估专家转诊中心网络内的初始组织学分析是否会降低该发生率和最终诊断延迟。此外，我们还研究了病理专家强制系统重读对诊断变异和重新调整的影响。我们的研究队列由原发性骨肿瘤患者组成，这些患者来自法国国家前瞻性肉瘤网络数据库。 2018 年至 2019 年共纳入 1075 名患者。该队列的主要差异率为 24%。在专家转诊中心网络内，49 例 (7%) 在初步分析中显示出重大诊断差异，而网络外则有 207 例 (57%) (p < 0.001)。关于最终诊断延迟，网络内观察到平均 2.8 周 (±4.9)，而网络外平均为 6.5 周 (±9.1) (p < 0.001)。病理学家专家的系统重读促进了 256 例病例中 75% 的诊断重新调整，其中 68% 的诊断变化发生在术前。专家网络内的早期管理显着减少了重大诊断差异，并将诊断延迟缩短了大约一个月。病理专家系统重读负责对四分之三的病例进行诊断重新调整，其中三分之二的诊断变化发生在术前，从而减轻了虐待的后果。