Contralateral Testicular Cancer in spite of TIN-Negative Double Biopsies and Interval Cisplatin Chemotherapy

Souchon, Rainer; U, Gertenbach; Kp, Dieckmann; Hahn, E W; Ruwe, M.; Stambolis, C; Loy,; Claßen, Johannes

doi:10.1007/s00066-006-1516-x

Cited by 23 publications

(15 citation statements)

References 29 publications

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“…So, rebiopsy appears feasible after an interval of 2 years [32]. However, close clinical observation is mandatory in the meantime because malignancy may arise at any time [33]. In regard to surgical technique, 2-site biopsies are more sensitive than single biopsies, particularly when focal or sporadic presence of TIN must be considered [12, 34].…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy Is of Limited Efficacy in the Control of Contralateral Testicular Intraepithelial Neoplasia in Patients with Testicular Germ Cell Cancer

Kleinschmidt

Dieckmann²,

Georgiew³

et al. 2009

Oncology

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Introduction: Testicular intraepithelial neoplasia (TIN, also called carcinoma in situ of the testis), the precursor of testicular germ cell tumors, will progress to invasive cancer unless appropriate treatment is instituted. Orchiectomy and local radiotherapy have been shown to eradicate TIN safely. The efficacy of chemotherapy is equivocal to date. Patients and Methods: Eleven patients with unilateral testicular cancer (5 pure seminoma, 6 nonseminoma) and biopsy-proven contralateral TIN underwent chemotherapy. Four patients received 2 courses of carboplatin single agent, 4 had 2 courses of platin, etoposide, bleomycin (PEB) treatment and 3 had a full 3-cycle treatment with PEB. Rebiopsy to look for persistent TIN was performed after a mean interval of 8.8 months (range 2–31). The patients were then followed clinically. Results: Five patients had persistent TIN upon rebiopsy. Each of the patients failing to chemotherapy had undergone 2 or 3 cycles of the PEB regimen, while 3 had received carboplatin treatment. Two of the patients with no TIN upon rebiopsy developed invasive testis cancer subsequently. In summary, 7 of 11 patients thus failed to chemotherapy (64%; exact 95% confidence interval 30.8–89.1%). Three of the patients had complete absence of spermatogenesis upon rebiopsy histologically, while the remaining cases showed various forms of spermatogenetic arrest. Three of the failing patients were rescued by local radiotherapy, 4 patients underwent partial orchidectomy followed by local radiotherapy. No relapse occurred thereafter. Conclusions: Chemotherapy was shown to be of only littleeffect in eradicating TIN. The failure rate of 64% is much higher than reported previously. As the majority of failing cases had received carboplatin single-agent therapy or adjuvant PEB therapy with 2 cycles, it may be speculated that the efficacy of chemotherapy regarding TIN clearance is dose dependent. Multidrug regimens appear to be more efficacious than single-agent therapy. As spermatogenesis is only incompletely eliminated by chemotherapy, it is postulated that chemotherapy does no more than temporarily suppress TIN, while only selected cases are cleared of the lesion. Practically, rebiopsy to look for retained TIN about 2 years after completion of chemotherapy is valuable.

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Section: Discussionmentioning

confidence: 99%

Chemotherapy Is of Limited Efficacy in the Control of Contralateral Testicular Intraepithelial Neoplasia in Patients with Testicular Germ Cell Cancer

Kleinschmidt

Dieckmann²,

Georgiew³

et al. 2009

Oncology

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“…Two-site biopsies have further improved the sensitivity of detection, but subsequent TGCTs in patients with 1 or 2 previous negative biopsies have been described. [37][38][39] Controversy still exists with regards to the type of patient who would benefit from testicular biopsy. Although most of the academic world recommends testicular biopsy in patients with unilateral TGCT and a risk factor for contralateral disease, certain centers in Germany and Denmark perform routine contralateral testicular biopsies on all patients with TGCT at the time of orchiectomy.…”

Section: Diagnosis Of Intratubular Germ Cell Neoplasiamentioning

confidence: 99%

Intratubular Germ Cell Neoplasia of the Testis, Bilateral Testicular Cancer, and Aberrant Histologies

Dhillon

Sexton

2015

Urologic Clinics of North America

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“…Nonetheless, even with this improved methodology, three false‐negative biopsies have been experienced in the 2 300‐patients‐series so far (Dieckmann KP & Loy V, unpublished), and sporadic cases with diagnostic failures have been reported, too (Dieckmann et al. , 2004; Souchon et al. , 2006).…”

Section: How Accurate Is Testicular Biopsy?mentioning

confidence: 99%

Testicular biopsy for early cancer detection – objectives, technique and controversies

et al. 2011

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This review highlights the usefulness of testicular biopsy for early detection of testicular germ cell tumour (GCT). GCT develops through a precursor stage, called testicular intraepithelial neoplasia (TIN; also called intratubular germ cell neoplasia or carcinoma in situ, CIS), which is present many years before invasive malignancy occurs. TIN/CIS is safely detected histologically. TIN is usually widely but non-randomly distributed within the testicle, thus, a biopsy of 3 mm size usually indicates the presence of TIN. Surgically, testicular biopsy should be performed at the cranial pole. Two-site biopsies provide an 18% diagnostic yield over single biopsy. Surgical complications occur in about 2.8%, most of which are managed conservatively. Serial scrotal imaging studies after biopsies revealed significant early changes. Eighteen months thereafter, less than 5% of cases have changes detectable. False-negative biopsies are extremely rare. Biopsy also provides information regarding spermatogenesis. In case of diagnosis of TIN, orchiectomy is rarely required. Low-dose radiotherapy eradicates TIN. In conclusion, testicular biopsy is useful in patients with unilateral GCT to explore the opposite testis, and in patients with retroperitoneal GCT to look for occult testicular primary. Further candidates for biopsy are selected patients with sonographic testicular microlithiasis. Despite its usefulness, the procedure has been implemented in clinical routine only in few countries thus far.

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Contralateral Testicular Cancer in spite of TIN-Negative Double Biopsies and Interval Cisplatin Chemotherapy

Cited by 23 publications

References 29 publications

Chemotherapy Is of Limited Efficacy in the Control of Contralateral Testicular Intraepithelial Neoplasia in Patients with Testicular Germ Cell Cancer

Chemotherapy Is of Limited Efficacy in the Control of Contralateral Testicular Intraepithelial Neoplasia in Patients with Testicular Germ Cell Cancer

Intratubular Germ Cell Neoplasia of the Testis, Bilateral Testicular Cancer, and Aberrant Histologies

Testicular biopsy for early cancer detection – objectives, technique and controversies

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