(P 134) IMPACT OF THE PARTNERSHIP BETWEEN TERTIARY CENTERS AND NON-SARCOMA RADIOLOGY CENTERS.

Objective: Sarcomas are aggressive lesions requiring early management by a specialized multidisciplinary team. Due to their great variability in terms of affected tissue, location, size and evolution, their detection remains challenging. As part of the development of the Quebec Sarcoma Network, new referral algorithms have been established to facilitate the referral of patients to tertiary sarcoma treatment centers. As described in a previous study, the time between the first imaging and patient referral constituted around 37% of the total time between the onset of symptoms and the first consultation in a specialized center (mean delay of 66 weeks (median 22)). It was also observed that 60% of patients had to undergo an additional imaging investigation in a sarcoma center, due to insufficient or obsolete imaging. A plan to optimize the partnership with radiologists not specialized in sarcomas was therefore put in place. This study presents preliminary results of this partnership impact on the sarcoma care pathway.

Methods: This is a retrospective study of 100 consecutive consultations requested between October 14, 2022 and May 9, 2023. Local ERB approbation was obtained. The following exclusion criteria were applied: non-oncological cases, bone metastases, superficial lesions of less than 5 cm. Patients still under investigation were also excluded. Referral data was collected from medical records: type of and date of examination, final diagnosis, grade (categorized as benign or malignant), subtype (soft tissue or bone) and date of referral to a sarcoma center. Imaging reports were assessed whether or not a diagnosis was mentioned, and if a referral to a specialized sarcoma center was recommended. Time from imaging to referral is given as the mean number of weeks (min-max; SD), and other findings as frequency and percentages. The Man Whitney statistical test was used to compare delays for categorical data, to account for the non-normality of the data. Analyses comparing categorical data were performed using the chi-square test.

Results: There were 69 soft-tissue lesions (33 (48%) malignant, 36 (52%) benign) and 31 bone lesions (6 (20%) malignant, 25 (80%) benign) in the reviewed cohort. 78 patients had an MRI (74% for a soft-tissue lesion), of whom 35 (45%) included a specific diagnosis linked to a consultation in a sarcoma center, and 42 (54%) suggested a referral to a sarcoma center in the imaging report. Ultrasounds were performed for 52 patients, of whom 5 (10%) included a specific diagnosis and 1 (2%) suggested a referral to a sarcoma center. 35 patients (69% soft tissue) had a CT scan, of whom 13 (37%) had a specific diagnosis and 9 (26%) suggested a referral to a sarcoma center. Delay from imaging to referral for patients with a specific diagnosis in imaging report was 3 weeks (0-21; 4.9) versus 6.9 weeks (0-40; 8.9) (p=0.003) for those who did not have this information. Mean time for cases where the imaging report suggested referral to a sarcoma center was 3.8 weeks (0-21; 5.0) versus 6.6 (0-40; 9.3) (p=0.268) for those who did not receive this recommendation.

Conclusion: The radiologists' impact in the sarcoma diagnostic pathway is major. Incorporating an accurate diagnosis in imaging reports enables doctors and specialists to refer patients more efficiently to sarcoma centers. Clear referral recommendation to a specialized sarcoma center also helps to reduce referral times, although the results are not statistically significant. Optimizing radiologists' training, both on the sarcoma suspicion and on the importance of referring physicians to the appropriate resources, will significantly improve the sarcoma care pathway. Collaboration with radiologists could be achieved through teaching, institutional presentations, webinars, conference presentations - in short, make some noise!