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P J Tanis

Publications and source records attributed to P J Tanis.

At least 19 recordsLinked to original sources
PubMed2005

[Three men with breast cancer].

In three men, aged 81, 66 and 58 years, breast cancer was diagnosed. All three were treated by modified radical mastectomy and axillary-node dissection. They received tamoxifen and the first and the third patient also received radiotherapy. Presentation of these patients is usually delayed, because of the rarity of and unfamiliarity with the disease. Consequently, the disease is often in a more advanced stage at presentation and overall mortality is higher in comparison with women with breast cancer. However, survival of male patients is similar to survival of female patients when matched for age and stage. This stresses the importance of a timely diagnosis. As in women, of the known risk factors for male breast cancer, a positive family history is one of the most important ones. Modified radical mastectomy, combined with sentinel-node biopsy by experienced teams, is the standard treatment. Criteria for adjuvant systemic treatment are identical for men and women, although hormonal therapy (tamoxifen) has a more prominent place in the adjuvant setting because of the high percentage of positive hormone receptors in men.

Aged↗
PubMed2005

Surgery for isolated lung metastasis in two patients with bladder cancer.

Two patients presented with an isolated pulmonary lesion on routine x-ray of the thorax almost 2 years after treatment of bladder cancer. Needle biopsy showed squamous cell carcinoma in the first patient but did not classify the lesion in the second patient. No evidence of extrapulmonary disease was found. Lobectomy was performed. Pathologic examination showed similar histologic and immunohistochemical characteristics as the primary bladder carcinoma. Postoperatively, it was decided not to give chemotherapy. One patient died 6 months postoperatively and 1 patient was alive 27 months after metastasectomy without evidence of disease.

Aged↗
PubMed2005

Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases.

PURPOSE: In this retrospective study we compared the clinical outcome of early vs delayed excision of lymph node metastases in patients with penile squamous cell carcinoma. MATERIALS AND METHODS: A total of 40 patients with a T2-3 penile carcinoma with lymph node metastases were included in this study. All patients initially presented with bilateral impalpable lymph nodes. In 20 patients (50%) metastases were removed when they became clinically apparent during meticulous followup (median interval 6 months, range 1 to 24). There were 20 patients (50%) who underwent resection of inguinal metastases detected on dynamic sentinel node biopsy before they became palpable. The histopathological characteristics of the tumors and lymph nodes were reevaluated. RESULTS: The 2 populations were similar in terms of patient age, T-stage, pathological tumor grade, vascular invasion and infiltration depth. Disease specific 3-year survival of patients with positive lymph nodes detected during surveillance was 35% and in those who underwent early resection, 84% (log rank p = 0.0017). In multivariate analysis early resection of occult inguinal metastases detected on dynamic sentinel node biopsy was an independent prognostic factor for disease specific survival (p = 0.006). CONCLUSIONS: Early resection of lymph node metastases in patients with penile carcinoma improves survival.

Disease-Free Survival↗
PubMed2004

[Sentinel node metastasis in the case of colorectal cancer. No role for sentinel node biopsy at present].

With sufficient experience, sentinel node biopsy has a high identification rate for several techniques in the case of colorectal cancer. However, the sensitivity of the procedure seems to be too low to justify the replacement of routine pathological examination of the whole mesentery by sentinel node biopsy. Unexpected lymphatic drainage patterns can be found in about 5% of the patients. Therefore, the role of sentinel node biopsy in determining the extension of the resection is minimal in the case of colorectal cancer. In contrast, sentinel node biopsy is helpful in identifying the lymph nodes with the highest risk of harbouring metastases and it facilitates the scrutinising of the lymph node by the pathologist. This will lead to more micrometastases being detected. The prognostic significance of micrometastases and the impact on survival of adjuvant systemic therapy in such patients should be investigated in randomised controlled trials. At present, sentinel node biopsy in colorectal cancer should be restricted to a research setting.

Colorectal Neoplasms↗
PubMed2004

Radio-guided surgery improves outcome of therapeutic excision in non-palpable invasive breast cancer.

Intratumoral injection of a radiocolloid for lymphatic mapping enables the therapeutic excision of clinically occult breast cancer with the aid of a gamma-ray detection probe. The aim of this study was to determine the success rate of radio-guided tumour excision in addition to a guide wire and to identify factors predicting clear margins. Sixty-five consecutive patients underwent radio-guided tumour excision after intratumoral injection of 99mTc-nanocolloid guided by ultrasound or stereotaxis. A localization wire was inserted after scintigraphy had been performed (group 1). The results were compared with retrospective data from 67 consecutive patients who underwent therapeutic wire-directed excision alone (group 2). Factors predicting clear margins (> or = 1 mm) were determined in a logistic regression model. Adequate margins were obtained in 83% of group 1 and in 64% of group 2 (P = 0.014). The invasive component was incompletely excised in two patients in group 1 and in 14 patients in group 2. Further surgery was performed in four patients in group 1 and in 14 patients in group 2. Factors predictive of clear margins were decreasing pathological tumour diameter (P = 0.035), increasing weight of the specimen (P = 0.046), absence of microcalcifications (P = 0.004) and absence of carcinoma in situ component (P = 0.024). Radio-guided excision was an independent predictor of complete excision of the invasive component (P = 0.012). The application of radio-guided surgery combined with wire localization seems to improve the outcome of therapeutic excision of non-palpable invasive breast cancer compared with wire-directed excision alone.

Breast Neoplasms↗
PubMed2003

Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer.

Currently, breast cancer patients without clinically suspicious lymph nodes are candidates for sentinel lymph node procedures (SLNPs). The aims of this study were to investigate whether preoperative axillary ultrasonography and fine-needle aspiration cytology (FNA) can reduce the number of the more time-consuming SLNPs, and to identify a subset of quantitative nodal features to predict metastatic involvement. 268 axillae were ultrasonographically examined. FNA was performed on suspicious nodes (smallest diameter > or =5 mm or atypical cortex appearance). SLNP was omitted if a tumour-positive node was found on FNA. Length, width, maximum cortex thickness and appearance of cortex and hilus were ultrasonographically established. In 93 axillae (35%), at least one node was detected with ultrasound. FNA was performed once per axilla on 66 nodes; 37 (56%) contained tumour cells. 31% of all tumour-positive axillae (macro-+micrometastases) was found by ultrasound and FNA (37/121). 41% of all axillae containing macrometastases was found by ultrasound and FNA (36/87). SLNPs were reduced by 14% (37/268). Maximum cortex thickness is the main feature to predict metastatic involvement (area under Receiver Operating Characteristic (ROC) curve (A(Z))=0.87).

Adult↗
PubMed2003

Management of clinically node negative penile carcinoma: improved survival after the introduction of dynamic sentinel node biopsy.

PURPOSE: We evaluated the clinical outcome of clinically node negative penile carcinoma managed by surveillance or further diagnosed by dynamic sentinel node biopsy with subsequent resection of lymph node metastases. MATERIALS AND METHODS: From 1956 to 1994, 85 patients with primary T2-3N0M0 penile squamous cell carcinoma were treated with initial surveillance of the regional lymph nodes. From 1994 until 2001, 68 patients underwent dynamic sentinel node biopsy. RESULTS: The 2 populations were similar in terms of patient age, clinical T stage, tumor grade, vascular invasion and infiltration depth. Disease specific 3-year survival in the surveillance and sentinel node groups was 79% and 91%, respectively (log rank test p = 0.04). CONCLUSIONS: Early detection of lymph node metastases by dynamic sentinel node biopsy and subsequent resection in clinically node negative T2-3 penile carcinoma improves survival compared with a policy of surveillance.

Aged↗
PubMed2002

Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients.

The purpose of this study was to evaluate the occurrence of lymphatic drainage to non-axillary sentinel nodes and to determine the implications of this phenomenon. A total of 549 breast cancer patients underwent lymphoscintigraphy after intratumoural injection of (99m)Tc-nanocolloid. The sentinel node was intraoperatively identified with the aid of intratumoural administered patent blue dye and a gamma-ray detection probe. Histopathological examination of sentinel nodes included step-sectioning at six levels and immunohistochemical staining. A sentinel node outside level I or II of the axilla was found in 149 patients (27%): internal mammary sentinel nodes in 86 patients, other non-axillary sentinel nodes in 44 and both internal mammary and other non-axillary sentinel nodes in nineteen patients. The intra-operative identification rate was 80%. Internal mammary metastases were found in seventeen patients and metastases in other non-axillary sentinel nodes in ten patients. Staging improved in 13% of patients with non-axillary sentinel lymph nodes and their treatment strategy was changed in 17%. A small proportion of clinically node negative breast cancer patients can be staged more precisely by biopsy of sentinel nodes outside level I and II of the axilla, resulting in additional decision criteria for postoperative regional or systemic therapy.

Adult↗
PubMed2002

The illusion of the learning phase for lymphatic mapping.

BACKGROUND: We provide a statistical analysis of the learning phase for sentinel node biopsy. METHODS: Four learning phases were analyzed: 25, 50, 75, and 150 procedures with a corresponding number of 10, 20, 30, and 60 tumor-positive cases. Critical values of nonidentification rate and false-negative rate were defined. The binomial distribution was used to calculate the probabilities of correctly or incorrectly accepting the quality of the performance, given a certain long-term nonidentification or false-negative rate. RESULTS: The chance of incorrectly reaching a favorable false-negative rate of <10% (critical value) in 20 metastasized patients was 18% for a surgeon with a long-term probability of false-negative procedures of 15%. This chance was reduced to 10% with a learning phase of 60 tumor-positive cases. When this chance has to be further reduced to 5%, the critical value has to be lower in smaller groups of patients: 5% false-negative rate in 20 tumor-positive procedures. CONCLUSIONS: A learning phase of at least 150 procedures with 60 tumor-positive cases is needed to draw any reliable conclusion about the quality of sentinel node biopsy. In general, a compromise has to be made between the reliability of the results and the practically achievable number of procedures.

Binomial Distribution↗
PubMed2002

The hidden sentinel node in breast cancer.

The purpose of this study was to analyse the occurrence of non-visualisation during preoperative lymphoscintigraphy for sentinel node identification in breast cancer. Preoperative lymphoscintigraphy was performed in 495 clinically node-negative breast cancer patients (501 sentinel node procedures) after injection of technetium-99m nanocolloid. Anterior and prone lateral (hanging breast) planar images were obtained a few minutes and 4 h after injection. The sentinel node was intraoperatively identified with the aid of patent blue dye and a gamma-ray detection probe. A sentinel node was visualised on the 4-h images in 449 of 501 procedures (90%). This visualisation rate improved from 76% to 94% during the study period. Delayed imaging (5-23 h) in 19 patients whose sentinel nodes failed to show, resulted in visualisation in four of them. A repeat injection of radiocolloid in 11 patients revealed a sentinel node in six. In the end, the visualisation rate was 92%. The sentinel node was surgically retrieved in 24 of the remaining 42 patients with non-visualisation (57%). Sentinel nodes that were visualised were tumour-positive in 38% and non-visualised sentinel nodes were involved in 50% (chi2, P=0.17). In a multivariate regression analysis, scintigraphic non-visualisation was independently associated with increased patient age (P<0.001), decreased tracer dose (P<0.001) and increased number of tumour-positive lymph nodes (P=0.013). The use of a sufficient amount of radioactivity (at least 100 MBq) is recommended for lymphatic mapping in breast cancer, especially in elderly women. Delayed imaging and re-injection of the radioactive tracer increase the visualisation rate. The non-visualised sentinel node can be identified intraoperatively in more than half of the patients.

Adult↗
PubMed2002

Dynamic sentinel node biopsy for penile cancer: reliability of a staging technique.

PURPOSE: We determine the value of dynamic sentinel node biopsy for staging squamous cell carcinoma of the penis. MATERIALS AND METHODS: A total of 90 patients with clinically node negative penile cancer were prospectively entered in this study. Preoperative lymphoscintigraphy was performed after intradermal injection of 99mtechnetium nanocolloid around the primary tumor. The sentinel node was intraoperatively identified with the aid of intradermal administered patent blue dye and a gamma ray detection probe. Histopathological examination of sentinel nodes included serial sectioning and immunohistochemical staining. Regional lymph node dissection was performed only if metastasis was found in a sentinel node. Median followup was 36 months (range 5 to 95). RESULTS: Lymphoscintigraphy visualized 217 sentinel nodes in 159 inguinal regions of 88 patients. A total of 208 sentinel nodes were intraoperatively identified in 149 inguinal regions of 88 patients. Sentinel node metastasis was found in 19 inguinal regions of 18 patients. Four of 8 patients with unilateral clinical stage N1 disease had a tumor positive sentinel node on the opposite site. Regional recurrence after excision of a tumor negative sentinel node or after nonvisualization was seen in 5 patients, resulting in a false-negative rate of 22% (5 of 23). The 3-year disease specific survival was 98% and 71% for patients with a tumor negative or tumor positive sentinel node, respectively (p = 0.0018). CONCLUSIONS: Occult lymph node metastases in penile cancer can be detected with a sensitivity of about 80% by dynamic sentinel node biopsy, including preoperative lymphoscintigraphy, vital dye and a gamma ray detection probe.

Adult↗
PubMed2001

History of sentinel node and validation of the technique.

Sentinel node biopsy is a minimally invasive technique to select patients with occult lymph node metastases who may benefit from further regional or systemic therapy. The sentinel node is the first lymph node reached by metastasising cells from a primary tumour. Attempts to remove this node with a procedure based on standard anatomical patterns did not become popular. The development of the dynamic technique of intraoperative lymphatic mapping in the 1990s resulted in general acceptance of the sentinel node concept. This hypothesis of sequential tumour dissemination seems to be valid according to numerous studies of sentinel node biopsy with confirmatory regional lymph node dissection. This report describes the history and the validation of the technique, with particular reference to breast cancer.

Biopsy↗
PubMed2001

Penile lymphoscintigraphy for sentinel node identification.

Lymphoscintigraphy for sentinel node (SN) identification has been extensively validated in breast cancer and melanoma. The aim of this study was to evaluate the findings of lymphoscintigraphy for SN identification in carcinoma of the penis. Lymphoscintigraphy was performed in 74 consecutive patients (mean age 62.2 years, range 28-87 years) with clinically lymph node-negative squamous cell carcinoma of the penis (stage T2 or greater). Following local anaesthesia by xylocaine 10% spray, technetium-99m nanocolloid (mean dose 64.8 MBq, range 40-131 MBq) in a volume of 0.3-0.4 ml was injected intradermally around the tumour. Shortly after injection, a 20-min dynamic study was performed with a dual-head gamma camera; subsequently, static anterior and lateral images were obtained at 30 min and 2 h using simultaneous cobalt-57 flood source transmission scanning. 57Co-assisted skin marking defined SN location for gamma probe/blue dye-guided biopsy, which was performed the next day. The SN visualization rate was 97% (72/74). Lymphatic drainage was bilateral in 81% of the cases (58/72), exclusively to the left groin in 13% (9/72) and only to the right groin in 6%. Bilateral lymph node drainage was synchronous in 38% (22/58) and asynchronous in 62% (in 18 patients the initial route was the left groin, and in the other 18, the right groin). Visualization before 30 min occurred in 66 patients (93%), in 64 of them (88%) already during the dynamic study. A total of 173 SNs were visualized (85 in the right groin, 88 in the left groin). Pitfalls were caused by inguinal skin contamination during injection (four patients) and intracavernous administration (one patient). At surgery, a total of 161 SNs were identified and removed. Sixteen patients (22%) had a tumour-positive SN and underwent standard regional lymph node dissection subsequently. During follow-up (median 28 months, range 3-74 months), two patients with a negative SN developed lymph node metastases in the mapped basin. It is concluded that penile lymphoscintigraphy is a valid and well-tolerated method for lymphatic mapping and SN identification. Although bilateral early inguinal drainage is the most frequent pattern, late imaging is recommended principally in patients with initial unilateral drainage in order to exclude delayed lymph node filling in the contralateral groin. SN identification may lead to a more accurate staging and avoid extensive lymph node dissection in the majority of patients with penile carcinoma.

Adult↗
PubMed2001

Summary of the Second International Sentinel Node Conference.

A personal account is given of the most notable developments in lymphatic mapping that were discussed at the international conference "Sentinel Node 2000", held in December 2000 in Santa Monica. The latest advances in tracers, imaging, instrumentation and radiation are first outlined. Thereafter, techniques, results and controversies with respect to melanoma, breast cancer and other cancers are discussed. It is concluded that lymphatic mapping is quickly gaining momentum. The technique that is best used for lymphatic mapping is well established in melanoma but not in breast cancer. The results of large randomised studies are awaited in both these diseases. Gastrointestinal cancer is the main new focus.

Breast Neoplasms↗