The impact of a Diagnostic Multidisciplinary Meeting on reducing diagnostic delays in musculoskeletal tumors

Abstract

Background/hypothesis: Sarcomas are rare, complex tumors whose therapeutic management is typically guided by multidisciplinary teams. Many patients with suspected musculoskeletal tumors are referred to expert centers for further evaluation. To optimize initial patient management and reduce diagnostic delays, the implementation of Diagnostic Multidisciplinary Team Meetings (DMDT) has been proposed. We hypothesize that this implementation contributes to optimizing the management of patients and conducted this study to answer the following questions: (1) Does the implementation of DMDT lead to a reduction in diagnostic delays in the management of musculoskeletal tumors at a tertiary referral center? (2) Does the prioritization of biopsy in 2022 allow a faster management of the most suspicious cases?

Materials and methods: We conducted a retrospective comparison of two patient cohorts referred to an expert center for suspected musculoskeletal tumors: one cohort recruited in 2017 (before DMDT implementation) and one another in 2022 (after DMDT implementation). Both cohorts were observed over a 6-month period, focusing specifically on diagnostic delays between referral and biopsy, as well as between referral and diagnosis. In 2022, we also examined the effect of urgency levels (rated from 1 to 3) on biopsy prioritization.

Results: Patient volume increased by 80.5% from 2017 (190 patients) to 2022 (343 patients). The implementation of DMDT resulted in a significant reduction in diagnostic delays. The "Referral-Diagnosis" delay decreased by 11 days, from 65 ± 51 days in 2017 to 54 ± 43 days in 2022 (p = 0.023). Similarly, the "Referral-Biopsy" delay decreased by 11 days, from 50 ± 37 days in 2017 to 39 ± 27 days in 2022 (p < 0.001). Delays were further reduced when biopsies were prioritized according to urgency: the "DMDT-Biopsy" delay was 12 days shorter for level 1 urgency (16 ± 18 days) compared to level 3 urgency (28 ± 17 days, p = 0.002).

Conclusion: The implementation of DMDT significantly reduced diagnostic delays, even with the increased patient volume at the tertiary referral center. Prioritization of biopsy procedures based on urgency levels was proven effective in expediting the diagnostic process, although further improvements are still required. DMDT demonstrated its value as a major tool for improving access to specialized care and optimizing the efficiency and reliability of the diagnostic pathway for musculoskeletal tumors.

Level of evidence: IV; Retrospective study.

Keywords: Diagnostic delay; Multidisciplinary meeting; Sarcoma.