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J C de Waal

Publications and source records attributed to J C de Waal.

8 recordsLinked to original sources
PubMed2006

[Scope and limitations of diagnostics in breast disease--focussing on large core biopsy].

Percutaneous high speed large core biopsy (LCB) using a 14-gauge-needle, supported by sonographic procedures, is a safe and reliable method for the diagnosis of benign and malignant breast lesions in daily practice. All malignant diagnoses (B5)--comprising 44 % (267/604) of cases--were confirmed by subsequent surgical biopsy. This indicates a positive predictive value of 100 %. Evidence for uncertain dignity in LCB (categories B3 and B4) was found in 3 % of our cases (20/604), requiring open breast surgery for further clarification. This is strongly supported by the fact that 22 % of B3 and 82 % of B4 cases were identified as carcinomas in subsequent surgery. In 9 % of our cases (53/604), histology was only questionably representative (category B1) without cancer in the follow-up. In the B2-category--which comprised nearly 44 % of all cases (n = 263)--the positive predictive value ranged at 2 %. For clinical investigation, mammography, breast ultrasound and LCB the sensitivity were at 79 %, 92 %, 92 % and 98 %, respectively. The specificity of clinical findings, mammography, breast ultrasound and LCB ranged at 88 %, 67 %, 79 % and 99 %, respectively. The combination of the 3 methods: clinical findings, mammography and breast ultrasound (leading to a "total diagnostic score" provided a sensitivity and specificity of 97 % and 52 %. LCB revealed an excellent specificity of 99 %. Therefore, large core biopsy takes up a definite and reliable place in procedures of breast diagnostics, thereby preventing a high number of unnecessary open surgical interventions.

Adolescent↗
PubMed1988

[A tumor after-care schedule: information content--use--optimization].

Follow-up schedules for cancer patients define standards for post treatment care. They give informations about (1) the group of patients at risk, (2) the location of metastasis, (3) the adequate diagnostic procedures, (4) the frequency of examinations, and (5) the overall duration of follow-up. Such recommendations are a concise compilation of knowledge about the course of the disease, the tumor growth kinetics, and characteristics of the diagnostic tests. The validity of routine follow-up schedules will be discussed and explained using data about liver metastases in breast cancer patients. Simple calculations and simulations about the frequency of metastatic events demonstrate that strategies oriented on prognosis should be mandatory. The frequency of the detection of secondary cancers, the therapeutic possibilities etc. should define limits for the search of metastases. The effectiveness of follow-up programs must be evaluated just as the screening for the detection of early cancers in order to optimize the cost-benefit-relations.

Aftercare↗
PubMed1987

[Value of palpation and mammography in primary breast cancer. A retrospective study 1973-1982].

The value of palpation findings and mammography in 596 patients with primary breast cancer was investigated. The most frequent symptom (86.1%) was the lump. The primary tentative diagnosis came from the patient in 63.4% of the cases, from the physician in 28.9% of the cases, and only after mammography in 7.7% of the cases. False-negative palpation findings and false-negative mammography findings were observed in 9.9% and 5.0% of cases respectively. There was a clear dependence on the tumor stage. Carcinomas that were first diagnosed by means of mammography manifested a five-year survival rate of 82.6% and a recurrence rate of 15.2%. Carcinomas that were first discovered by the patient or the physician reached a five-year survival rate of 67.7% and 70.6% respectively. Here, too, the recurrence rate was higher, at 26.2% and 22.1% respectively. The data show that the carcinomas that were first suspected mammographically were smaller and manifested lymph node metastases more rarely. In order to reduce the number of false-negative findings the physician performing a mammography or assessing X-ray films should himself submit the breast in question to a thorough palpatory examination.

Adult↗
PubMed1987

[The significance of mammographic symptoms in clinically occult findings].

The significance of various radiographic signs in 183 patients with clinically occult breast disease is described. 30.6% had a carcinoma of the breast or a carcinoma in situ. The radiological features have varying predictive values and there is variation in the incidence of lymph node metastases. It is considered useful to classify the radiological appearances under the headings of round foci, star-shaped opacities, diffuse opacities, opacities with calcification and groups of micro-calcification. Despite the early diagnosis, 24% of patients already had lymph node metastases.

Adult↗
PubMed1985

[Initial experiences with the "Mammotest" stereotactic diagnosis system in the diagnosis of roentgenologically unclear changes in the breast].

The article reports on first experiences with the stereotactic diagnosis device "Mammotest" in the diagnosis of diseases of the breast. Preoperative stereotactic carbon marking of non-palpable changes requiring clarification via mammography was successful in 94% of the cases. With the stereotactic cytological clarification by means of Nordenström's cannula the high rate of cellular material which could not be clarified, was unsatisfactory. Stereotactic histological punch biopsy in case of unclear mammographic findings enables exact localisation of the punch and histological examination of the punch biopsy. Mammographic follow-up did not yield any false negative finding to date.

Biopsy, Needle↗