Optimal clinical management of tenosynovial giant cell tumours: a UK perspective

Aims: Tenosynovial giant cell tumour (TGCT) management is variable across the UK. Our aim was to examine these differences in clinical practice and develop consensus statements regarding the management of TGCTs. Methods: A three-stage modified Delphi technique was conducted with surgical, clinical, and medical oncology experts from across the UK. Key areas of controversy were identified in a virtual meeting on 23 January 2025. This was followed by an online questionnaire that was iteratively refined, and a virtual consensus meeting on 2 September 2025, to discuss topics where agreement had not yet been reached. Results: This consensus developed a definition for unresectable TGCT and criteria for patient referral from TGCT local management to multidisciplinary team (MDT) review with access to current appropriate treatment options and further defined unresectable TGCT. Diffuse, recurrent, and/or unresectable TGCT, or those requiring complex procedures should be reviewed through a centralized MDT case review at a sarcoma centre, given the complex multidisciplinary nature of TGCT management. Conclusion: The clarification of classification of localized and diffuse TGCTs, and the definition of unresectable TGCTs, as well as standardizing the criteria for referral to a sarcoma MDT, will facilitate the improved management of TGCTs across the UK and address regional resource challenges.