The value of a second expert opinion in histopathological diagnosis of bone and soft tissue sarcoma: a systematic review

Jennifer Vu; Claudia Petrucco; Cristina Vargas; Susie Bae; Richard Carey Smith; Jayesh Desai; Andrew Johnston; Marianne Phillips; Stephen Thompson; Smaro Lazarakis; Jasmine Mar; Angela M. Hong; Fiona Maclean

doi:10.1016/j.pathol.2025.09.005

The value of a second expert opinion in histopathological diagnosis of bone and soft tissue sarcoma: a systematic review

Jennifer Vu, Claudia Petrucco, Cristina Vargas, Susie Bae, Richard Carey Smith, Jayesh Desai, Andrew Johnston, Marianne Phillips, Stephen Thompson, Smaro Lazarakis, Jasmine Mar, Angela M. Hong^*, Fiona Maclean

^*Corresponding author for this work

Macquarie Medical School

Research output: Contribution to journal › Review article › peer-review

1 Citation (Scopus)

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Abstract

Accurate subtype diagnosis of sarcoma is crucial for optimal patient management, requiring integration of clinical, radiological, morphological, immunohistochemical, and molecular findings. This systematic review examines the value of expert second opinions in the histopathological diagnosis of bone and soft tissue sarcomas. The review was conducted using the population, intervention, comparison, and outcome model over a 32-year timeframe. Notably, five studies reported major discrepancy rates exceeding 20%, impacting patient management or prognosis. Given these findings, we recommend referring all suspected sarcoma cases to specialised sarcoma centres for expert second opinions to ensure accurate diagnosis and optimal care. While all studies broadly addressed diagnostic discrepancy during second opinion review, there were difficulties in comparing the data from various studies. These difficulties related to the lack of standardised definitions of what constitutes (1) a second opinion, (2) a specialist pathologist in sarcoma, and (3) a discordant diagnosis.

Original language	English
Pages (from-to)	1-7
Number of pages	7
Journal	Pathology
Volume	58
Issue number	1
Early online date	17 Nov 2025
DOIs	https://doi.org/10.1016/j.pathol.2025.09.005
Publication status	Published - Feb 2026

Bibliographical note

Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

bone tumour
sarcoma
second opinion
soft tissue tumour

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Publisher version (open access)Final published version, 1.03 MBLicence: CC BY

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title = "The value of a second expert opinion in histopathological diagnosis of bone and soft tissue sarcoma: a systematic review",

abstract = "Accurate subtype diagnosis of sarcoma is crucial for optimal patient management, requiring integration of clinical, radiological, morphological, immunohistochemical, and molecular findings. This systematic review examines the value of expert second opinions in the histopathological diagnosis of bone and soft tissue sarcomas. The review was conducted using the population, intervention, comparison, and outcome model over a 32-year timeframe. Notably, five studies reported major discrepancy rates exceeding 20\%, impacting patient management or prognosis. Given these findings, we recommend referring all suspected sarcoma cases to specialised sarcoma centres for expert second opinions to ensure accurate diagnosis and optimal care. While all studies broadly addressed diagnostic discrepancy during second opinion review, there were difficulties in comparing the data from various studies. These difficulties related to the lack of standardised definitions of what constitutes (1) a second opinion, (2) a specialist pathologist in sarcoma, and (3) a discordant diagnosis.",

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T1 - The value of a second expert opinion in histopathological diagnosis of bone and soft tissue sarcoma

T2 - a systematic review

AU - Vu, Jennifer

AU - Petrucco, Claudia

AU - Vargas, Cristina

AU - Bae, Susie

AU - Smith, Richard Carey

AU - Desai, Jayesh

AU - Johnston, Andrew

AU - Phillips, Marianne

AU - Thompson, Stephen

AU - Lazarakis, Smaro

AU - Mar, Jasmine

AU - Hong, Angela M.

AU - Maclean, Fiona

N1 - Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2026/2

Y1 - 2026/2

N2 - Accurate subtype diagnosis of sarcoma is crucial for optimal patient management, requiring integration of clinical, radiological, morphological, immunohistochemical, and molecular findings. This systematic review examines the value of expert second opinions in the histopathological diagnosis of bone and soft tissue sarcomas. The review was conducted using the population, intervention, comparison, and outcome model over a 32-year timeframe. Notably, five studies reported major discrepancy rates exceeding 20%, impacting patient management or prognosis. Given these findings, we recommend referring all suspected sarcoma cases to specialised sarcoma centres for expert second opinions to ensure accurate diagnosis and optimal care. While all studies broadly addressed diagnostic discrepancy during second opinion review, there were difficulties in comparing the data from various studies. These difficulties related to the lack of standardised definitions of what constitutes (1) a second opinion, (2) a specialist pathologist in sarcoma, and (3) a discordant diagnosis.

AB - Accurate subtype diagnosis of sarcoma is crucial for optimal patient management, requiring integration of clinical, radiological, morphological, immunohistochemical, and molecular findings. This systematic review examines the value of expert second opinions in the histopathological diagnosis of bone and soft tissue sarcomas. The review was conducted using the population, intervention, comparison, and outcome model over a 32-year timeframe. Notably, five studies reported major discrepancy rates exceeding 20%, impacting patient management or prognosis. Given these findings, we recommend referring all suspected sarcoma cases to specialised sarcoma centres for expert second opinions to ensure accurate diagnosis and optimal care. While all studies broadly addressed diagnostic discrepancy during second opinion review, there were difficulties in comparing the data from various studies. These difficulties related to the lack of standardised definitions of what constitutes (1) a second opinion, (2) a specialist pathologist in sarcoma, and (3) a discordant diagnosis.

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DO - 10.1016/j.pathol.2025.09.005

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SN - 0031-3025

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IS - 1

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The value of a second expert opinion in histopathological diagnosis of bone and soft tissue sarcoma: a systematic review

Abstract

Bibliographical note

Keywords

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