Contralateral biopsies in patients with testicular germ cell tumours: patterns of care in Germany and recent data regarding prevalence and treatment of testicular intra‐epithelial neoplasia
Summary The precursor of testicular germ cell tumours (GCTs), called testicular intra‐epithelial neoplasia (TIN/CIS), is safely diagnosed immunohistologically. Testicular biopsy provides a valuable tool for early detection of GCTs in risk groups. Although this knowledge is undisputed, testicular bio...
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| description | Summary
The precursor of testicular germ cell tumours (GCTs), called testicular intra‐epithelial neoplasia (TIN/CIS), is safely diagnosed immunohistologically. Testicular biopsy provides a valuable tool for early detection of GCTs in risk groups. Although this knowledge is undisputed, testicular biopsies are utilized poorly. The patterns of care regarding the use of biopsies remain unknown. Uncertainty exists about the prevalence and specific treatment of TIN/CIS. We asked clinical urologists in Germany whether or not they employed contralateral biopsies in GCT patients. We evaluated the prevalence of contralateral TIN/CIS in a retrospective analysis of 780 consecutive GCT patients. All had contralateral double biopsies. Discordance of TIN/CIS findings among biopsy pairs as well as age, histology of the primary tumour and clinical stage was noted. Evaluation of data comprised descriptive statistical methods. To evaluate treatment options for TIN/CIS, we performed a literature search. 52.1% of German urologists always perform the biopsy, 17% do it mostly, 27.3% in select cases, 3.5% never. Curiously, there was a geographic north‐south gradient regarding biopsy use. Contralateral TIN/CIS was found in 5%. The median ages of patients with TIN/CIS and those without were 31.8 and 34.9 years respectively (p = 0.02). The discordance rate among biopsy pairs was of 33%. Two‐site biopsies provide a 17% gain in diagnostic sensitivity. Local radiotherapy with 20 Gy is the safest treatment of TIN/CIS failing in 2%. Chemotherapy has significantly lower efficacy. Contralateral testicular biopsies in GCT patients are well accepted among German urologists. The prevalence of contralateral TIN/CIS found in this series is in accordance with previous reports. Double biopsies should be the diagnostic standard because of their diagnostic superiority. Local radiotherapy with 20 Gy is the safest way of eradicating TIN/CIS. Failures occur in only 2%, usually many years after irradiation. Cisplatin‐based chemotherapy is dose dependent and less effective. |
| doi_str_mv | 10.1111/j.2047-2927.2014.00260.x |
| format | Article |
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The precursor of testicular germ cell tumours (GCTs), called testicular intra‐epithelial neoplasia (TIN/CIS), is safely diagnosed immunohistologically. Testicular biopsy provides a valuable tool for early detection of GCTs in risk groups. Although this knowledge is undisputed, testicular biopsies are utilized poorly. The patterns of care regarding the use of biopsies remain unknown. Uncertainty exists about the prevalence and specific treatment of TIN/CIS. We asked clinical urologists in Germany whether or not they employed contralateral biopsies in GCT patients. We evaluated the prevalence of contralateral TIN/CIS in a retrospective analysis of 780 consecutive GCT patients. All had contralateral double biopsies. Discordance of TIN/CIS findings among biopsy pairs as well as age, histology of the primary tumour and clinical stage was noted. Evaluation of data comprised descriptive statistical methods. To evaluate treatment options for TIN/CIS, we performed a literature search. 52.1% of German urologists always perform the biopsy, 17% do it mostly, 27.3% in select cases, 3.5% never. Curiously, there was a geographic north‐south gradient regarding biopsy use. Contralateral TIN/CIS was found in 5%. The median ages of patients with TIN/CIS and those without were 31.8 and 34.9 years respectively (p = 0.02). The discordance rate among biopsy pairs was of 33%. Two‐site biopsies provide a 17% gain in diagnostic sensitivity. Local radiotherapy with 20 Gy is the safest treatment of TIN/CIS failing in 2%. Chemotherapy has significantly lower efficacy. Contralateral testicular biopsies in GCT patients are well accepted among German urologists. The prevalence of contralateral TIN/CIS found in this series is in accordance with previous reports. Double biopsies should be the diagnostic standard because of their diagnostic superiority. Local radiotherapy with 20 Gy is the safest way of eradicating TIN/CIS. Failures occur in only 2%, usually many years after irradiation. Cisplatin‐based chemotherapy is dose dependent and less effective.</description><identifier>ISSN: 2047-2919</identifier><identifier>EISSN: 2047-2927</identifier><identifier>DOI: 10.1111/j.2047-2927.2014.00260.x</identifier><identifier>PMID: 25146646</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Biopsy - trends ; Carcinoma in Situ - epidemiology ; Carcinoma in Situ - pathology ; Carcinoma in Situ - therapy ; contralateral cancer ; germ cell tumour ; Germany - epidemiology ; Health Care Surveys ; Humans ; Male ; Middle Aged ; Neoplasms, Germ Cell and Embryonal - epidemiology ; Neoplasms, Germ Cell and Embryonal - pathology ; Neoplasms, Germ Cell and Embryonal - therapy ; Patient Selection ; Practice Patterns, Physicians' - trends ; Predictive Value of Tests ; Prevalence ; pre‐invasive cancer ; radiotherapy ; Reproducibility of Results ; Retrospective Studies ; Surveys and Questionnaires ; testicular biopsy ; Testicular Neoplasms - epidemiology ; Testicular Neoplasms - pathology ; Testicular Neoplasms - therapy ; Treatment Outcome ; Young Adult</subject><ispartof>Andrology (Oxford), 2015-01, Vol.3 (1), p.92-98</ispartof><rights>2014 American Society of Andrology and European Academy of Andrology</rights><rights>2014 American Society of Andrology and European Academy of Andrology.</rights><rights>Andrology © 2015 American Society of Andrology and European Academy of Andrology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4470-f984f707214f57424c39fa35ad3616b10637a2c2ab89f718761085f69428e99f3</citedby><cites>FETCH-LOGICAL-c4470-f984f707214f57424c39fa35ad3616b10637a2c2ab89f718761085f69428e99f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.2047-2927.2014.00260.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.2047-2927.2014.00260.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25146646$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ruf, C.G.</creatorcontrib><creatorcontrib>Gnoss, A.</creatorcontrib><creatorcontrib>Hartmann, M.</creatorcontrib><creatorcontrib>Matthies, C.</creatorcontrib><creatorcontrib>Anheuser, P.</creatorcontrib><creatorcontrib>Loy, V.</creatorcontrib><creatorcontrib>Pichlmeier, U.</creatorcontrib><creatorcontrib>Dieckmann, K.‐P.</creatorcontrib><title>Contralateral biopsies in patients with testicular germ cell tumours: patterns of care in Germany and recent data regarding prevalence and treatment of testicular intra‐epithelial neoplasia</title><title>Andrology (Oxford)</title><addtitle>Andrology</addtitle><description>Summary
The precursor of testicular germ cell tumours (GCTs), called testicular intra‐epithelial neoplasia (TIN/CIS), is safely diagnosed immunohistologically. Testicular biopsy provides a valuable tool for early detection of GCTs in risk groups. Although this knowledge is undisputed, testicular biopsies are utilized poorly. The patterns of care regarding the use of biopsies remain unknown. Uncertainty exists about the prevalence and specific treatment of TIN/CIS. We asked clinical urologists in Germany whether or not they employed contralateral biopsies in GCT patients. We evaluated the prevalence of contralateral TIN/CIS in a retrospective analysis of 780 consecutive GCT patients. All had contralateral double biopsies. Discordance of TIN/CIS findings among biopsy pairs as well as age, histology of the primary tumour and clinical stage was noted. Evaluation of data comprised descriptive statistical methods. To evaluate treatment options for TIN/CIS, we performed a literature search. 52.1% of German urologists always perform the biopsy, 17% do it mostly, 27.3% in select cases, 3.5% never. Curiously, there was a geographic north‐south gradient regarding biopsy use. Contralateral TIN/CIS was found in 5%. The median ages of patients with TIN/CIS and those without were 31.8 and 34.9 years respectively (p = 0.02). The discordance rate among biopsy pairs was of 33%. Two‐site biopsies provide a 17% gain in diagnostic sensitivity. Local radiotherapy with 20 Gy is the safest treatment of TIN/CIS failing in 2%. Chemotherapy has significantly lower efficacy. Contralateral testicular biopsies in GCT patients are well accepted among German urologists. The prevalence of contralateral TIN/CIS found in this series is in accordance with previous reports. Double biopsies should be the diagnostic standard because of their diagnostic superiority. Local radiotherapy with 20 Gy is the safest way of eradicating TIN/CIS. Failures occur in only 2%, usually many years after irradiation. Cisplatin‐based chemotherapy is dose dependent and less effective.</description><subject>Adult</subject><subject>Biopsy - trends</subject><subject>Carcinoma in Situ - epidemiology</subject><subject>Carcinoma in Situ - pathology</subject><subject>Carcinoma in Situ - therapy</subject><subject>contralateral cancer</subject><subject>germ cell tumour</subject><subject>Germany - epidemiology</subject><subject>Health Care Surveys</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasms, Germ Cell and Embryonal - epidemiology</subject><subject>Neoplasms, Germ Cell and Embryonal - pathology</subject><subject>Neoplasms, Germ Cell and Embryonal - therapy</subject><subject>Patient Selection</subject><subject>Practice Patterns, Physicians' - trends</subject><subject>Predictive Value of Tests</subject><subject>Prevalence</subject><subject>pre‐invasive cancer</subject><subject>radiotherapy</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Surveys and Questionnaires</subject><subject>testicular biopsy</subject><subject>Testicular Neoplasms - epidemiology</subject><subject>Testicular Neoplasms - pathology</subject><subject>Testicular Neoplasms - therapy</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>2047-2919</issn><issn>2047-2927</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkcGKFDEQhhtR3GXdV5CAFy8zJul00i14WEZdhUVB9BxqeqrHDN3pNknv7tx8BN_Id_FJrOysg3gyhKQgX_35qb8omOBLQevFbim5MgvZSEOVUEvOpebL2wfF6fHh4bEWzUlxHuOO06rzlo-LE1kJpbXSp8XP1ehTgB4S0snWbpyiw8icZxMkhz5FduPSV5YwJtfOPQS2xTCwFvuepXkY5xBfZpYEfGRjx1oImPsvCQO_Z-A3LGBLUmwDCajeQtg4v2VTwGvo0bd4B6WAkIbMkcpf_7ns8Nf3HziREewd-fQ4Tj1EB0-KRx30Ec_v77Piy9s3n1fvFlcfL9-vLq4WrVKGL7qmVp3hRgrVVUZJ1ZZNB2UFm1ILvRZclwZkK2FdN50RtdGC11WnGyVrbJquPCueH3SnMH6byZsdXMwzALIyRyt0VRuauKgIffYPuqMheXKXKaMpBCOIqg9UG8YYA3Z2Cm6AsLeC25yz3dkcoc1x2pyzvcvZ3lLr0_sP5vWAm2Pjn1QJeHUAblyP-_8WthcfXn-iqvwN4we6Yw</recordid><startdate>201501</startdate><enddate>201501</enddate><creator>Ruf, C.G.</creator><creator>Gnoss, A.</creator><creator>Hartmann, M.</creator><creator>Matthies, C.</creator><creator>Anheuser, P.</creator><creator>Loy, V.</creator><creator>Pichlmeier, U.</creator><creator>Dieckmann, K.‐P.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201501</creationdate><title>Contralateral biopsies in patients with testicular germ cell tumours: patterns of care in Germany and recent data regarding prevalence and treatment of testicular intra‐epithelial neoplasia</title><author>Ruf, C.G. ; Gnoss, A. ; Hartmann, M. ; Matthies, C. ; Anheuser, P. ; Loy, V. ; Pichlmeier, U. ; Dieckmann, K.‐P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4470-f984f707214f57424c39fa35ad3616b10637a2c2ab89f718761085f69428e99f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Biopsy - trends</topic><topic>Carcinoma in Situ - epidemiology</topic><topic>Carcinoma in Situ - pathology</topic><topic>Carcinoma in Situ - therapy</topic><topic>contralateral cancer</topic><topic>germ cell tumour</topic><topic>Germany - epidemiology</topic><topic>Health Care Surveys</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasms, Germ Cell and Embryonal - epidemiology</topic><topic>Neoplasms, Germ Cell and Embryonal - pathology</topic><topic>Neoplasms, Germ Cell and Embryonal - therapy</topic><topic>Patient Selection</topic><topic>Practice Patterns, Physicians' - trends</topic><topic>Predictive Value of Tests</topic><topic>Prevalence</topic><topic>pre‐invasive cancer</topic><topic>radiotherapy</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Surveys and Questionnaires</topic><topic>testicular biopsy</topic><topic>Testicular Neoplasms - epidemiology</topic><topic>Testicular Neoplasms - pathology</topic><topic>Testicular Neoplasms - therapy</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ruf, C.G.</creatorcontrib><creatorcontrib>Gnoss, A.</creatorcontrib><creatorcontrib>Hartmann, M.</creatorcontrib><creatorcontrib>Matthies, C.</creatorcontrib><creatorcontrib>Anheuser, P.</creatorcontrib><creatorcontrib>Loy, V.</creatorcontrib><creatorcontrib>Pichlmeier, U.</creatorcontrib><creatorcontrib>Dieckmann, K.‐P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Andrology (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ruf, C.G.</au><au>Gnoss, A.</au><au>Hartmann, M.</au><au>Matthies, C.</au><au>Anheuser, P.</au><au>Loy, V.</au><au>Pichlmeier, U.</au><au>Dieckmann, K.‐P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Contralateral biopsies in patients with testicular germ cell tumours: patterns of care in Germany and recent data regarding prevalence and treatment of testicular intra‐epithelial neoplasia</atitle><jtitle>Andrology (Oxford)</jtitle><addtitle>Andrology</addtitle><date>2015-01</date><risdate>2015</risdate><volume>3</volume><issue>1</issue><spage>92</spage><epage>98</epage><pages>92-98</pages><issn>2047-2919</issn><eissn>2047-2927</eissn><abstract>Summary
The precursor of testicular germ cell tumours (GCTs), called testicular intra‐epithelial neoplasia (TIN/CIS), is safely diagnosed immunohistologically. Testicular biopsy provides a valuable tool for early detection of GCTs in risk groups. Although this knowledge is undisputed, testicular biopsies are utilized poorly. The patterns of care regarding the use of biopsies remain unknown. Uncertainty exists about the prevalence and specific treatment of TIN/CIS. We asked clinical urologists in Germany whether or not they employed contralateral biopsies in GCT patients. We evaluated the prevalence of contralateral TIN/CIS in a retrospective analysis of 780 consecutive GCT patients. All had contralateral double biopsies. Discordance of TIN/CIS findings among biopsy pairs as well as age, histology of the primary tumour and clinical stage was noted. Evaluation of data comprised descriptive statistical methods. To evaluate treatment options for TIN/CIS, we performed a literature search. 52.1% of German urologists always perform the biopsy, 17% do it mostly, 27.3% in select cases, 3.5% never. Curiously, there was a geographic north‐south gradient regarding biopsy use. Contralateral TIN/CIS was found in 5%. The median ages of patients with TIN/CIS and those without were 31.8 and 34.9 years respectively (p = 0.02). The discordance rate among biopsy pairs was of 33%. Two‐site biopsies provide a 17% gain in diagnostic sensitivity. Local radiotherapy with 20 Gy is the safest treatment of TIN/CIS failing in 2%. Chemotherapy has significantly lower efficacy. Contralateral testicular biopsies in GCT patients are well accepted among German urologists. The prevalence of contralateral TIN/CIS found in this series is in accordance with previous reports. Double biopsies should be the diagnostic standard because of their diagnostic superiority. Local radiotherapy with 20 Gy is the safest way of eradicating TIN/CIS. Failures occur in only 2%, usually many years after irradiation. Cisplatin‐based chemotherapy is dose dependent and less effective.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>25146646</pmid><doi>10.1111/j.2047-2927.2014.00260.x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Biopsy - trends Carcinoma in Situ - epidemiology Carcinoma in Situ - pathology Carcinoma in Situ - therapy contralateral cancer germ cell tumour Germany - epidemiology Health Care Surveys Humans Male Middle Aged Neoplasms, Germ Cell and Embryonal - epidemiology Neoplasms, Germ Cell and Embryonal - pathology Neoplasms, Germ Cell and Embryonal - therapy Patient Selection Practice Patterns, Physicians' - trends Predictive Value of Tests Prevalence pre‐invasive cancer radiotherapy Reproducibility of Results Retrospective Studies Surveys and Questionnaires testicular biopsy Testicular Neoplasms - epidemiology Testicular Neoplasms - pathology Testicular Neoplasms - therapy Treatment Outcome Young Adult |
| title | Contralateral biopsies in patients with testicular germ cell tumours: patterns of care in Germany and recent data regarding prevalence and treatment of testicular intra‐epithelial neoplasia |
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