If your lump is bigger than a golf ball and growing, think Sarcoma

R. Nandra*, J. Forsberg, R. Grimer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Aim Only 1 in 100 of primary care consultations regarding new soft tissue lumps (STL) are malignant and are susceptible to a delay in diagnosis. We aimed to generate a Bayesian Belief Network to estimate the likelihood of malignancy in patients to facilitate the initial evaluation of a STL and improve timing and quality of referrals to specialist treatment centres. Methods We evaluated all patients referred with a new STL between 1996 and 2007. Variables investigated focused on patient factors, symptoms and STL characteristics. Relevant data was extracted and coded for statistical analysis. Results 3018 patients with a STL were assessed, of which 1563 (52%) were benign and 1455 (48%) malignant. The features most conditionally associated with the outcome of interest (Benign or Malignant) are referred to as first-degree associates, and are increasing size, age, size of the lump, and duration of symptoms, in that order. On cross validation, this model demonstrated an AUC of 0.77 (95%C.I. 0.75-0.79). Conclusions For the first time, we have described the hierarchal relationship between factors and created an aide memoire, larger than a golf ball and growing, to trigger referral to tertiary tumor units. Importantly, we found pain to be a poor discriminatory factor. We hope our findings will lead to greater awareness and earlier diagnosis of STL.

Original languageEnglish
Article number4077
Pages (from-to)1400-1405
Number of pages6
JournalEuropean Journal of Surgical Oncology
Issue number10
StatePublished - Oct 2015


  • Bayesian belief network
  • Golf ball
  • Nomogram
  • Sarcoma
  • Soft tissue lump


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