3.1 Diagnosis and staging

3.1 Diagnosis and staging

Diagnostic work-up should include:

  • history and examination
  • staging: local – MRI, thallium or PET scans; systemic – bone scan, PET/CT, CT chest
  • image-guided biopsy – percutaneous needle or open
  • examination of tumour tissue by histological, immuno-histochemical, molecular pathological and cytogenetic methods, as appropriate
  • lymph node biopsy (if functional imaging is positive or clinical examination suspicious).

The tumour should be staged on completion of investigations.

To confirm malignancy, and provide a histological diagnosis, biopsy should be performed after all imaging modalities have been completed and reviewed by the specialist. Image-guided needle core biopsy (NCB) is the preferred method, performed by a radiologist who is familiar with the issues of sarcoma biopsy in a specialist sarcoma unit setting with appropriate multidisciplinary input.

The histological diagnosis and determination of grade and subtype of sarcomas should be undertaken by an appropriately trained histopathologist. Histological diagnosis should be made according to the 2013 World Health Organization (WHO) classification (ESMO 2014b).

Timeframe for diagnosis

Timeframes should be informed by evidence-based guidelines (where they exist) while recognising that shorter timelines for appropriate consultations and treatment can reduce patient distress.

The following recommended timeframes are based on expert advice from the Sarcoma Working Group:2

  • Complete all investigations within two weeks of first specialist assessment.