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Background:The detection of synchronous metastases at primary diagnosis of breast cancer (BC) affects its initial management. A risk calculator that incorporates many factors to evaluate an individual's risk of harbouring synchronous metastases would be useful to adapt cancer management.Patients and Methods:Patients with primary diagnosis of BC were identified from three institutional databases sharing homogeneous work-up recommendations. A risk score for synchronous metastases was estimated and a nomogram was constructed using the first database. Its performance was assessed by receiver characteristic (ROC) analysis. The nomogram was externally validated in the two independent cohorts.Results:A preoperative nomogram based on the clinical tumour size (P<0.001), clinical nodal status (P<0.001), oestrogen (P=0.17) and progesterone receptors (P=0.04) was developed. The nomogram accuracy was 87.3% (95% confidence interval (CI), 84.45-90.2%). Overall, the area under the ROC curve (AUC) was 86.1% for the validation set from the Institut Curie-René Huguenin, and 63.8% for the MD Anderson validation set. The negative predictive value (NPV) was high in the three cohorts (97-99%).Conclusions:We developed and validated a strong metastasis risk calculator that can evaluate with high accuracy an individual's risk of harbouring synchronous metastases at diagnosis of primary BC.Condensed abstract:A nomogram to predict synchronous metastases at diagnosis of breast cancer was developed and externally validated. This tool allows avoiding unnecessary expensive work-up. [ABSTRACT FROM AUTHOR]

Background: The detection of synchronous metastases at primary diagnosis of breast cancer (BC) affects its initial management. A risk calculator that incorporates many factors to evaluate an individual's risk of harbouring synchronous metastases would be useful to adapt cancer management.Patients and Methods: Patients with primary diagnosis of BC were identified from three institutional databases sharing homogeneous work-up recommendations. A risk score for synchronous metastases was estimated and a nomogram was constructed using the first database. Its performance was assessed by receiver characteristic (ROC) analysis. The nomogram was externally validated in the two independent cohorts.Results: A preoperative nomogram based on the clinical tumour size (P<0.001), clinical nodal status (P<0.001), oestrogen (P=0.17) and progesterone receptors (P=0.04) was developed. The nomogram accuracy was 87.3% (95% confidence interval (CI), 84.45-90.2%). Overall, the area under the ROC curve (AUC) was 86.1% for the validation set from the Institut Curie-René Huguenin, and 63.8% for the MD Anderson validation set. The negative predictive value (NPV) was high in the three cohorts (97-99%).Conclusions: We developed and validated a strong metastasis risk calculator that can evaluate with high accuracy an individual's risk of harbouring synchronous metastases at diagnosis of primary BC.Condensed Abstract: A nomogram to predict synchronous metastases at diagnosis of breast cancer was developed and externally validated. This tool allows avoiding unnecessary expensive work-up. [ABSTRACT FROM AUTHOR]

Abstract: Background: Currently, the benefit of chemotherapy (CT) in node-negative breast carcinoma (NNBC) is discussed. The evaluation of classical clinical and histological factors is limited to assess individual outcome. A statistical model was developed to improve the prognostic accuracy of NNBC. Methods: A total of 305 node-negative breast carcinomas who underwent surgery (+/– radiotherapy) but no adjuvant treatment were selected. Putative prognosis factors including age, tumour size, oestrogen receptor (ER), progesterone receptor (PgR), Scarff–Bloom–Richardon (SBR) grading, urokinase plasminogen activator (uPA), plasminogen activator inhibitor 1 (PAI-1) and thymidine kinase (TK) were evaluated. The developed model was internally validated using Harrell’s concordance index. A prognosis index (PI) was proposed and compared with Adjuvant! Online program. Results: Age (p <0.001), pathological tumour size (pT) (p< 0.001), PgR (p =0.02), and PAI-1 (p ⩽0.001) were included in the Cox regression model predicting Breast cancer specific survival (BCSS) at 5-years. Internal validation revealed a concordance index of 0.71. A PI score was derived from our nomogram. The PI score was significantly associated with BCSS (hazard ratio (HR): 4.1 for intermediate, p =0.02, HR: 8.8, p <0.001 for high group) as compared to Adjuvant! Online score (HR: 1.4, p =0.14). Conclusion: A nomogram can be used to predict probability survival curves for individual breast cancer patients. [Copyright &y& Elsevier]

Background The aim of neoadjuvant chemotherapy is to increase the likelihood of successful breast conservation surgery (BCS). Accurate identification of BCS candidates is a diagnostic challenge. Breast Cancer Index (BCI) predicts recurrence risk in estrogen receptor + lymph node − breast cancer. Performance of BCI to predict chemosensitivity based on pathological complete response (pCR) and BCS was assessed. Methods Real-time RT-PCR BCI assay was conducted using tumor samples from 150 breast cancer patients treated with neoadjuvant chemotherapy. Logistical regression and c-index were used to assess predictive strength and additive accuracy of BCI beyond clinicopathologic factors. Results BCI classified 42 % of patients as low, 35 % as intermediate and 23 % as high risk. Low BCI risk group had 98.4 % negative predictive value (NPV) for pCR and 86 % NPV for BCS. High versus low BCI group had a 34 and 5.8 greater likelihood of achieving pCR and BCS, respectively (P = 0.0055; P = 0.0022). BCI increased c-index for pCR (0.875–0.924; P = 0.017) and BCS prediction (0.788–0.843; P = 0.027) beyond clinicopathologic factors. Conclusions BCI significantly predicted pCR and BCS beyond clinicopathologic factors. High NPVs indicate that BCI could be a useful tool to identify breast cancer patients who are not eligible for neoadjuvant chemotherapy. These results suggest that BCI could be used to assess both chemosensitivity and eligibility for BCS. [ABSTRACT FROM AUTHOR]

Purpose: Although a potential role of the Epstein-Barr virus (EBV) in the pathogenesis of breast cancer (BC) has been underlined, results remain conflicting. Particularly, the impact of EBV infection on biological markers of BC has received little investigation.Methods: In this study, we established the frequency of EBV-infected BC using real-time quantitative PCR (RT-PCR) in 196 BC specimens. Biological and pathological characteristics according to EBV status were evaluated.Results: EBV DNA was present in 65 of the 196 (33.2%) cases studied. EBV-positive BCs tended to be tumours with a more aggressive phenotype, more frequently oestrogen receptor negative (P=0.05) and with high histological grade (P=0.01). Overexpression of thymidine kinase activity was higher in EBV-infected BC (P=0.007). The presence of EBV was weakly associated with HER2 gene amplification (P=0.08).Conclusion: Our study provides evidence for EBV-associated BC undergoing distinct carcinogenic processes, with more aggressive features. [ABSTRACT FROM AUTHOR]

The purpose of this investigation was to determine the diagnostic accuracy of quantitative real-time polymerase chain reaction (PCR) assay in diagnosing bacterial vaginosis versus the standard methods, the Amsel criteria and the Nugent score. The Amsel criteria, the Nugent score, and results from the molecular tool were obtained independently from vaginal samples of 163 pregnant women who reported abnormal vaginal symptoms before 20 weeks gestation. To determine the performance of the molecular tool, we calculated the kappa value, sensitivity, specificity, and positive and negative predictive values. Either or both of the Amsel criteria (≥3 criteria) and the Nugent score (score ≥7) indicated that 25 women (15%) had bacterial vaginosis, and the remaining 138 women did not. DNA levels of Gardnerella vaginalis or Atopobium vaginae exceeded 10 copies/mL or 10 copies/mL, respectively, in 34 (21%) of the 163 samples. Complete agreement between both reference methods and high concentrations of G. vaginalis and A. vaginae was found in 94.5% of women (154/163 samples, kappa value = 0.81, 95% confidence interval 0.70-0.81). The nine samples with discordant results were categorized as intermediate flora by the Nugent score. The molecular tool predicted bacterial vaginosis with a sensitivity of 100%, a specificity of 93%, a positive predictive value of 73%, and a negative predictive value of 100%. The quantitative real-time PCR assay shows excellent agreement with the results of both reference methods for the diagnosis of bacterial vaginosis. [ABSTRACT FROM AUTHOR]

Objective: To estimate the relationship between vaginal quantification of the main microorganisms related with bacterial vaginosis and the risk of preterm delivery among women with preterm labor.Methods: Molecular methods were used to prospectively quantify Lactobacillus species, Gardnerella vaginalis, Atopobium vaginae, and Mycoplasma hominis in vaginal fluid samples from women admitted for spontaneous preterm labor with intact membranes from July 2007 through July 2008. The primary outcome measure was the relationship between bacterial concentration at admission and preterm delivery, before 37 weeks of gestation. Sensitivity and specificity of molecular cutoff values and 95% confidence intervals (CIs) were calculated using the University of British Columbia Bayesian Calculator type 2.Results: Of the 90 women included, 36 delivered before 37 weeks of gestation (40%). Preterm delivery was not associated with the presence of Lactobacillus species, G vaginalis, A vaginae, or M hominis. In contrast, molecular quantification detected high concentrations of A vaginae (10(6)/mL or more: 25.0% in the preterm group and 9.3% in the term group, P=.04) and G vaginalis (10(7)/mL or more: 16.7% and 3.7%, P=.03) more often in women with preterm deliveries compared with term deliveries. Moreover, high vaginal concentrations of these two microorganisms together were associated with a significantly (P=.03) shorter interval between preterm labor and delivery (46 days, 95% CI 30-61) than were lower concentrations (85 days, 95% CI 75-95). The hazard ratio for a short preterm labor-to-delivery interval was three times higher for high vaginal fluid concentrations of A vaginae and G vaginalis than for lower concentrations (hazard ratio 3.3, 95% CI 1.1-9.5, P=.03).Conclusion: The risk of preterm delivery is significantly associated with high vaginal concentrations of A vaginae and G vaginalis in women with preterm labor.Clinical Trial Registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00484653.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Abstract: Achieving a mastectomy occurs in one third of the acts of breast cancer surgery. In the present context, the increase in the diagnosis of early breast cancer, including widespread or multifocal forms, the possibility of a reconstruction at the same time is discussed. It will be proposed in a specific context, taking into account various factors: oncological (characteristics of the tumor, adjuvant treatments), clinical (smoking, comorbidity) and psychological (choice of the patient). The technique of mastectomy will be adapted to the indication and choice of reconstruction procedure. Including the preservation of the nipple-areola complex, or the skin envelope will be possible for some guidance. The reconstruction is possible with the use of breast implants, or musculocutaneous flaps or by the combination of both. Some of these techniques are associated with significant morbidity, and appropriate selection of procedure to the patient will guarantee a lower risk of complications. [Copyright &y& Elsevier]

Collagen IV is a major component of the vascular basement membrane and may be a marker of angiogenesis. Serum levels of this protein are elevated in some human cancers. Our objectives were to compare collagen IV levels in the serum of breast cancer patients and healthy women and to examine changes during preoperative chemotherapy. Sera from 51 patients with stage II-III breast cancer and 55 healthy controls were analysed. Collagen IV level was measured by a commercially available sandwich enzyme link immunoassay. Baseline serum levels were compared between cancer patients and healthy women and paired pre- and post-chemotherapy measurements were also performed in 39 patients who received preoperative chemotherapy and were correlated with response to therapy. The median serum collagen IV concentration was significantly higher in cancer patients (166 microg l(-1)) than in healthy women (115 microg l(-1)), P<0.001. Chemotherapy induced a significant further increase in serum collagen IV (167 microg l(-1) prechemo vs 206 microg l(-1) postchemo, P=0.001). There were no correlations between baseline collagen IV levels and response to therapy, age, clinical stage or HER2 status. In conclusion, patients with breast cancer have elevated levels of collagen IV compared to healthy women and collagen IV levels increase further during chemotherapy. [ABSTRACT FROM AUTHOR]

Objective: To develop a nomogram to predict macrosomia with a combination of clinical and ultrasound variables. Methods: Data from 194 women who underwent sonographic fetal weight estimation were used to develop and calibrate a nomogram to predict fetal macrosomia. The nomogram was subjected to 200 bootstrap resamples for internal validation and to reduce overfit bias. An Internet-based tool was developed to facilitate use of the nomogram. Results: The macrosomia prediction nomogram, based on parity, ethnicity, body mass index and fetal weight estimated macrosomia, had good discrimination and calibration before and after bootstrapping (area under curve (AUC), 0.860 and 0.850, respectively). The predictive accuracy of our nomogram was significantly better than was sonographically estimated fetal weight using Hadlock's formula (AUC, 0.740; P<0.001). We have provided a web-based interface to predict the individual probability of macrosomia. Conclusion: We have developed a nomogram to predict the individual probability of macrosomia based on clinical and ultrasound findings. Our web-based interface should help to guide patients and physicians in decision-making. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the role of specimen radiography in predicting margin status for non-palpable breast malignancies. Methods: We retrospectively reviewed the clinical and pathological data together with specimen radiographs of 164 women with ductal carcinoma in situ, who were referred to our centre between January 1997 and December 2000. In all cases microcalcifications were discovered on mammography. Lesions were localized preoperatively using a guide-wire. Specimen radiography findings and clinicopathological data were correlated with pathological findings. Results: Findings comprised 122 pure ductal carcinomas in situ (74%) and 42 mixed carcinomas, both infiltrating and in situ (26%). On the specimen radiographs, the lesions were close (<1mm) to one edge of the lumpectomy in 34 (21%) cases. Histologically, there were 103 positive resection margins (<1mm, 63%) and only 61 negative margins (> or =1mm, 37%). On univariate analysis, factors associated with positive resection margins were found to be distance from microcalcifications to edge of lesion on specimen radiographs, and radiological multifocality. On multivariate analysis (logistic regression), a radiological margin <5mm and multifocality were the only risk factors for close histological margins. Radiological margins were not associated with surgical findings. Conclusion: Our results demonstrate that there is a correlation between specimen radiographs and histological results. The clinical relevance of this should be evaluated in a prospective study. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the efficacy of cervix ripening with vaginal controlled-release Propess®. Patients and methods: A retrospective study of all women who underwent cervical ripening with Propess® during the study period from 1st January 2002 to 31st December 2004 was carried out. A total of 130 patients who experienced Propess® was compared with the next following patient who delivered spontaneously matched on gestational age. Modes of delivery, failure of labor, maternal morbidity were recorded. Results: Indications for induction of labor were: post-term pregnancies in 18.5%, pre-eclampsia in 20.8%, oligohydroamnios in 18.5%, post-term pregnancy and oligohydramnios in 10.8%, intra-uterine fetal growth in 6.9%, premature rupture of membranes in 6.9%, diminution of fetal mobility in 6.1% and miscellaneous in 11.5%. Failure of cervical ripening was 21.2%. Patients in the Propess® group had a 3.5 fold higher risk of Cesarean section [95% CI: 1.5–8.3; P <0.04]. There was no case of maternal or fetal death. There was no difference in incidence of maternal complications, and post-partum haemorrhage. Discussion and conclusion: Use of vaginal pessary Propess® does not induce adverse maternal or fetal morbidity. However, it was associated with a higher incidence of Cesarean delivery. [Copyright &y& Elsevier]

Abstract: Objective. – To determine the most relevant findings for diagnosis of adnexal torsion and predictive factors of adnexal necrosis. Patients and methods. – Clinical, biological, ultrasound, pathologic and surgical findings in surgically confirmed cases of adnexal torsion treated over a five-year period in a gynaecologic emergency department were retrospectively reviewed. Results. – A total of 52 cases of adnexal torsion were studied. Abdominal pain was present in 80.8%, vomiting in 13.5% and fever only in 9.6%. Leukocytosis was noted in 19 (36.5%). The most frequent ultrasound findings were ovarian enlargement in 22 patients (42.3%), ovarian cysts in 26 (50%), and hyperechogenic parenchyma with follicles along the periphery of the ovary in 13 (25%). Age over 40 years and a delay to surgery longer than 10 hours were significantly associated with diagnosis of adnexal necrosis. Discussion and conclusion. – Prompt diagnosis of adnexal torsion requires a combination of clinical, biological and radiological evidence. No predictive factors of necrosis are found. Risk of adnexal torsion is potentially increased by waiting period for surgery and patient''s age. [Copyright &y& Elsevier]

Background: In University hospitals or Comprehensive Cancer Centers (CCC), breast cancer (BC) patients have a theoretically large access to clinical trials as part of the management and treatment of their localized or advanced disease. Though, most patients are not proposed inclusion into suitable trials or studies or do not accept them. We aimed at determining the factors that influence physicians and patient's choice to respectively propose or enter clinical trials for which the patients were considered eligible by MTM. Methods: Patients who were considered eligible for a clinical trial by a BC-specific multidisciplinary team meeting (MTM) assessing their cases were prospectively registered during a 6 months period. The complete files of these patients were prospectively registered following initial written proposal by the MTM. The 27 clinical trials proposed were classified in 5 categories: cognitive studies, imaging, radiation therapy, diagnostic/prognostic biology, or interventional therapeutic studies. Detailed analysis of factors predicting physician's proposal and patient's final inclusion was conducted. Candidate factors were age, socio-demographic characteristics, PS, type of clinician, time intervals, stage of disease, type of disease, type of study, single vs multiple study proposal. Results: MTM proposed 547 inclusions into clinical trials for 397 patients between March 3rd and Sept 21st, 2011. 267 pts were considered eligible for 1 trial, 100 for 2, 25 for 3, 4 for 4 and 1 for 5 trials; 211 for cognitive studies, 13 for imaging, 71 for radiation therapy, 136 for diagnostic/prognostic biology, 116 for interventional therapeutic studies. Upon referral physician's visit, the trial was only proposed in 39.3% and pts were finally included in 29.1% of the cases. Reasons for non inclusion were patients' refusal in only 5-11%, but absence of proposal by physician in 45-81 %, according to the types of studies. The only factor predicting both proposal by the referral physician's and final inclusion into trials was type of study (both p < 0.001). Diagnostic/prognostic biology trials were proposed in 71 %, while interventional therapeutic and cognitive studies were only respectively proposed in 35 and 19% of the cases. The factors predicting non-inclusion upon physicians' proposal were professional status (p = 0.03) and type of study (p = 0.0007). The highest inclusion rates were among retired pts and those with executive work (84 and 76% respectively). Conclusion: The main reason for non inclusion into clinical trials remains absence of physicians' proposal, while professional status and type of study influence both the physicians' and the patients' decision. Educative measures dedicated mostly to treating physicians might be proposed. [ABSTRACT FROM AUTHOR]

Background: Population-based mammography screening has resulted in the increased detection of suspicious, non-palpable lesions that require histopathological assessment. When a "pre-malignant" lesion, such as lobular carcinoma in situ (LCIS), atypical ductal or lobular hyperplasia (ADH and ALH) or flat epithelial atypia (FEA), is discovered on the primary biopsy, a surgical excision is recommended due to the risk of underestimation of the lesion. DCIS or invasive carcinoma is finally retrieved in 10-30% of the patients, meaning a large part receive unnecessary surgery. The aim of this study was to define a nomogram integrating clinical, imaging and histological data to predict for the risk of underestimation of the lesion. Intentionally, we decided to include all the premalignant lesions which implied the same management, whereas most of the previous models of the literature are focused in only one or another type of atypia. Patients and Methods: We collected complete clinical, radiological and double-reading histological data on all patients with a diagnosis of pure atypical lesion (CLIS, ADH, ALH, FEA) on image-guided biopsy performed at the One-Stop Unjt of our breast care center from 2004 to 2011. Univariate and multivariate logistic regression analyses were used to develop a model predicting for the presence of DCIS or invasive carcinoma on the final surgical sample, and build a nomogram. This nomogram was evaluated on a training set of 205 patients treated at IGR. Results: 205 patients were eligible for the study. Of these 205 patients, 50 cancers (24.4%) were diagnosed at definitive surgery (21 DCIS, 20 ductal and 9 lobular invasive carcinoma). Univariate analysis retrieved age (p = 0.03), number of biopsy cores (p = 0.02) and type of radiological anomalies (p = 0.02) as factors associated with cancer at surgery. The presence of microcalcifications on biopsies of limit significance was included in the multivariate analysis (p = 0.09). The final most informative nomogram included information on patient age (p = 0.03), type of radiological anomalies (p = 0.02) and number of biopsy cores (p = 0.04). The predictive accuracy of the nomogram was 0.71 and 0.68 in the training set before and after bootstrapping, respectively. The calibration of the nomogram was good. The sensitivity, specificity, positive predictive value, and negative predictive values were 68%, 73%, 45%, and 88%, respectively. Conclusion: This nomogram could help identify a subset of patients with premalignant disease for whom surgery could be spared and who would be eligible for exclusive clinical follow-up. A validation study is currently undergoing in an external dataset. [ABSTRACT FROM AUTHOR]

A response by C. Mazouni and colleagues to a letter to the editor on their article "Epstein-Barr virus as a market of biological aggressiveness in breast cancer" in the 2011 issue is presented.

Le cancer du sein et sa prise en charge restent un problème majeur de santé publique chez la femme. L'épidémiologie des complications liée à la radiothérapie après une reconstruction mammaire immédiate prothétique (RMIP) reste insuffisante et ses conséquences esthétiques mal définies. L'objectif de ce travail était de comparer les taux de complications et les résultats esthétiques des reconstructions mammaires immédiates (RMI) par prothèse avec et sans radiothérapie, afin de déterminer les facteurs de risques de complications et de mauvais résultats esthétiques. Une étude rétrospective a été conduite entre janvier 2014 et décembre 2016 portant sur des patientes atteintes d'un cancer du sein et devant bénéficier d'une mastectomie totale sous cutanée (MTSC) avec une RMIP. Le critère d'évaluation était le taux d'échec de reconstruction et le rendu esthétique global, les critères secondaires évaluaient le taux de complications précoces et tardives. Il fut réalisé une analyse multivariée pour déceler des facteurs de risques prédictifs de complication. Trois cent trente-trois patientes ont été incluses : 157 dans le bras radiothérapie et 176 pour le groupe sans radiothérapie. Les caractéristiques préopératoires étaient comparables. Le suivi moyen était de 1 à 3 ans sans perdu de vue. Le résultat sur le critère de jugement principal montrait que les patientes qui avaient bénéficié d'une radiothérapie avaient le même risque d'échec de reconstruction que les patientes non irradiées. L'analyse en sous-groupe ne révélait aucune différence significative : 12,7 % d'échec de reconstruction pour le bras irradié versus 12,5 %. Concernant l'évaluation de l'altération des résultats esthétiques, il fut constaté comme différence un meilleur taux de patientes avec d'« excellents » résultats dans le bras sans radiothérapie (35 % vs 8,2 %). Les résultats sur les critères secondaires étaient comparables. La radiothérapie chez les patientes bénéficiant d'une RMIP n'augmente pas le risque d'échec de reconstruction et de mauvais résultats esthétiques comparativement aux patientes non irradiées. Il est donc licite de proposer pour toutes patientes devant bénéficier d'une MTSC suivie d'une radiothérapie, une RMIP et ainsi de leur éviter une reconstruction secondaire, plus impactante sur le plan psychologique. Breast cancer and its treatment remains a public health problem. There is still a lack of epidemiological data concerning complications and aesthetic results bound to radiotherapy after an immediate breast reconstruction. The objective of this study was to compare outcomes of immediate breast reconstruction regardless to the use of radiotherapy (history of radiotherapy or adjuvant radiation therapy), in order to determine risk factor of complications and bad aesthetic results. We conducted a retrospective study between January 2014 and December 2016 at the hospital "Gustave Roussy" in Paris, concerning breast cancer patients who needed immediate breast reconstruction after total mastectomy. The primary endpoint was to assess the failure rate of reconstruction and the aesthetic result, the secondary endpoint assessed the early and late rate of complications. We realized a multivariate analysis in order to identify risks factors that may predict complications. Three hundred and thirty three patients have been included: 157 in the "radiotherapy group" compared to 176 in the "no radiotherapy group". Preoperative characteristics were comparable. Average follow-up was between 1 and 3 years without missing. Patients who benefited from radiotherapy had an equal risk failure of reconstruction. The subgroup analysis revealed non-significant differences: 12.7% failure rate reconstruction in the "radiotherapy group" vs. 12.5%. We could notify a better rate of "excellent results" in the "no radiotherapy group": 35% vs. 8.2%. Secondary outcomes were comparable. Radiotherapy related to immediate breast reconstruction didn't increase the failure rate of reconstruction or aesthetic results, comparatively to non-irradiated patients. It is therefore permissible to suggest an immediate breast reconstruction to any patients which would benefit from a total mastectomy followed by radiotherapy; in order to prevent them from a secondary breast reconstruction, who could be physically and psychologically more impactful. [ABSTRACT FROM AUTHOR]

Résumé La reconstruction mammaire immédiate a montré de nombreux avantages en termes de résultats esthétiques et d'amélioration de la qualité de vie des patientes comparativement à la reconstruction mammaire secondaire. Les antécédents de radiothérapie ou la nécessité de traitement adjuvants (radiothérapie, chimiothérapie...) ne sont plus des contre-indications à la reconstruction mammaire immédiate. Il est, cependant, nécessaire de respecter certaines règles pour diminuer le risque de complications : le choix de la technique de reconstruction, la gestion de l'enveloppe cutanée en fonction de la forme du sein que l'on souhaite reconstruire, les délais entre le 1er et le 2e temps de reconstruction en fonction d'une éventuelle chimiothérapie ou radiothérapie adjuvante. Summary Immediate breast reconstruction showed many advantages in terms of aesthetic and functional results and improvement of quality of life when compared to delayed breast reconstruction. Previous radiotherapy or the use of adjuvant treatments such as radiation therapy, or chemotherapy are no longer a contraindication for immediate breast reconstruction. However, it is important to respect certain rules in order to decrease the risk of complications: the choice of reconstruction technique, the management of the skin envelope according to the breast shape you want to create, the time delay between the first and the second stage of reconstruction depending on a possible adjuvant treatment. [ABSTRACT FROM AUTHOR]

Résumé Le vert d’indocyanine est un colorant soluble dans l’eau, à élimination hépatique et excrétion biliaire. Illuminé par une source laser infrarouge, le vert d’indocyanine émet une lumière fluorescente dans le spectre du proche-infrarouge qui est invisible à l’œil nu mais qui peut être visualisée à l’aide d’une caméra proche-infrarouge. Lorsqu’il est injecté en intraveineux, il peut être utilisé comme marqueur de la perfusion cutanée. Injecté en sous-cutané, il permet de cartographier le réseau lymphatique. En chirurgie sénologique et en reconstruction mammaire, il est utilisé pour repérer le ganglion sentinelle chez les patientes atteintes d’un cancer du sein, pour évaluer la perfusion des lambeaux cutanés de mastectomie, pour évaluer la perfusion des lambeaux libres utilisés en reconstruction mammaire autologue et dans la prise en charge du lymphœdème secondaires des membres. Le vert d’indocyanine pourrait être enfin utilisé pour guider l’excision des tumeurs non palpables du sein. Summary The Indocyanine green (ICG) is a soluble dye that is eliminated by the liver and excreted in bile. When illuminated by an near-infrared light, the ICG emits fluorescence in the near-infrared spectrum, which can be captured by a near-infrared camera-handled device. In case of intravenous injection, ICG may be used as a marker of skin perfusion. In case of interstitial injection, it may be useful for lymphatic network mapping. In oncological and reconstructive breast surgery, ICG is used for sentinel lymph node identification, to predict mastectomy skin flap necrosis, to assess the perfusion of free flaps in autologous reconstruction and for diagnosis and treatment of upper limb secondary lymphedema. Intraoperative indocyanine green fluorescence might also be used to guide the excision of nonpalpable breast cancer. [ABSTRACT FROM AUTHOR]

This study evaluates the long-term outcomes of a retrospective cohort of breast cancer (BC) patients who had received curatively intended premastectomy radiation therapy (RT). We analysed locoregional control, disease-free survival (DFS) and overall survival (OS), pathological complete remission (pCR), predictors thereof, and immediate safety. The series consisted of 187 patients with a median age of 49 years [43–60] and T2–T4 or N2 tumours. Between 1970 and 1984, they had received slightly hypofractionated RT to the whole breast, ipsilateral supraclavicular fossa and axilla ± the internal mammary chain (45–55 Gy/18 fractions of 2.5 Gy/34 days) systematically followed by a modified radical mastectomy with an axillary dissection. No other preoperative treatment was given. Among the 166 centrally reviewed tumour biopsy specimens, 22% had a triple-negative (TN) phenotype, 17% were HER2 3 + or amplified and 61% were ER+. The median follow-up was 32 years [23–35]. The 25-year locoregional control rate was 89% [93%–82%] and the 25-year DFS and OS rates were identical, 30% [24%–37%]. A pCR in the tumour and lymph nodes had been achieved in 18 among all patients (10%), but in 26% with TN disease. In the multivariate analysis, the TN status was the only predictive factor of pCR (OR = 5.49, 95% confidence interval [CI] 1.87–16.1, p = 0.002). Also, the pN status (HR = 1.69, [1.28–2.22], p = 0.0002) and TN subtype (HR = 1.80, [1.00–3.26], p = 0.05) exerted a significant prognostic impact on OS. The postoperative complication rate (grade >2) was 19% with 4.3% of localized skin necrosis. Preoperative RT followed by radical surgery is feasible and associated with good long-term locoregional control. [ABSTRACT FROM AUTHOR]

Résumé Les indications de reconstruction mammaire immédiate s'étendent aux carcinomes infiltrants, du fait de nouvelles techniques de couverture des implants par matrice et du fait du développement des lambeaux perforants. Ces techniques autorisent les traitements adjuvants. Il faut, cependant, que la décision de reconstruction immédiate soit encadrée par l'avis de la RCP oncologique et il faut aussi évaluer les bénéfices et risques au regard de la morphologie de la patiente et de ses comorbidités. Le type de mastectomie choisi : classique ou avec conservation de peau et/ou avec conservation de la plaque aréolo-mamelonnaire (PAM) dépend de la forme et du volume du sein, de la localisation de la tumeur dans le sein et par rapport à la PAM. Nous définissons un algorithme pour permettre en cas de mastectomie thérapeutique avec ou sans radiothérapie adjuvante, une reconstruction immédiate par prothèse ou lambeau libre ou pédiculé. Summary Immediate breast reconstruction indications extend to infiltrating carcinomas, due to new matrix implant coverage techniques and the development of perforator flaps. These techniques allow adjuvant treatments. However, the decision of immediate reconstruction must be discussed with the oncological multidisciplinary team and the benefits/risks must also be evaluated in relation to the morphology of the patients and their co-morbidities. The chosen type of mastectomy: conventional or skin sparing and/or nipple sparing depends on the shape and volume of the breast, the localization of the tumor in the breast and the distance from the nipple areola complex (NAC). We describe an algorithm to allow, in the case of therapeutic mastectomy with or without adjuvant radiotherapy, an immediate reconstruction with implants or free or pedicled flaps. [ABSTRACT FROM AUTHOR]

Context and Aims: Breast cancer prognosis and predictive biomarkers development would allow sparing some patients from chemotherapy or identifying patients for whom chemotherapy would be indicated. In this context, in 2009, the French National Cancer Institute, a National Health and Science Agency dedicated to cancer, in collaboration with the « Société française de sénologie et de pathologie mammaire » published a report on the assessment of the prognostic and the predictive clinical validity of tissular biomarkers, uPA/PAI-1, Oncotype DX™ and MammaPrint ®, in breast cancer management. They concluded that only the uPA/PAI-1 prognosis value reached the highest level of evidence (LOE I according to Hayes 1998 classification). In 2012, it was decided to update this report since new data have emerged and because information disparities among clinicians have been identified. This article aims to present the main conclusions together with the levels of evidence associated with those conclusions. Methods: The updating process was based on literature published since 2009 appraisal and on multidisciplinary and independent experts' opinion. The levels of evidence (LOE) used are those of the classification defined by Simon in 2009 (updated Hayes 1998 classification): LOE IA and LOE IB: high level of evidence; LOE IIB and LOE IIC: intermediate level of evidence; LOE IIIC and LOE IV-VD: low level of evidence. Conclusions: Among patients without lymph-node involvement, uPA/PAI-1, invasion process biomarkers, reach the highest level of evidence for 10 years recurrence free survival prognosis (LOE IA according to Simon). The predictive value to anthracyclins chemotherapy remains to be confirmed. No data were identified on uPA/PAI-1 medico-economic value. Oncotype DX™ and MammaPrint® prognosis and predictive value do not reach the LOE I level. This updating' process confirms the 2009 levels of evidence for all the three biomarkers prognosis value. Besides, concerning Oncotype DX™ and MammaPrint®, new data do not allow to conclude neither to their complementary clinical information to other clinicopathological existing biomarkers nor to a favorable cost-efficiency ratio in therapeutic decision making and this because of the methodological weakness and uncertainty that are identified in the selected studies. Practically, beyond the prognosis and predictive biomarkers validity, the clinical utility of a new biomarker for chemotherapy indication depends on its clinical added information with regard to validated biomarkers (HR, HER2 and Ki67) and to clinicopathological parameters. Since they are the sole validated biomarkers of the invasion process, uPA/PAI-1 could complete clinical information of other clinicopathological factors and consequently could confer an added clinical value. However, data concerning the impact of this information on chemotherapy clinical indication are lacking. [ABSTRACT FROM AUTHOR]

J. Cyrta, F. Andreiuolo, S. Azoulay, C. Balleyguier, C. Bourgier, C. Mazouni, M.-C. Mathieu, S. Delaloge and P. Vielh Pure and mixed mucinous carcinoma of the breast: fine needle aspiration cytology findings and review of the literature Objective: Mucinous (colloid) breast carcinoma accounts for 1-6% of all breast cancer. It comprises pure mucinous tumours and mixed infiltrating ductal carcinomas with a mucinous component. As this latter mixed form has a worse prognosis than pure colloid carcinoma, making this diagnosis on fine needle aspiration cytology (FNAC) might influence the choice of treatment. Methods: We report a consecutive series of 22 cases consisting of 17 mixed and five pure mucinous carcinomas diagnosed by cytology and verified on histopathology. Patients underwent FNAC at the one-stop clinic of our institution during a 7-year period of time. Cytological findings were evaluated by a semi-quantitative method and included percentage of smear surface occupied by mucin, shape of cell groupings, size and outline of tumour nuclei as well as presence or absence of nucleolus. Results: Three of five pure mucinous carcinomas displayed at least two of the following features: abundant mucin, small nuclei and/or regular nuclear outlines. Sparse mucin, large nuclei, irregular nuclear outlines or the presence of nucleoli were found in 7 out of 17 mixed mucinous carcinomas but not in pure tumours. Conclusion: Cytopathological identification of patients with pure mucinous carcinomas may be performed in a limited number of cases. [ABSTRACT FROM AUTHOR]

Objective: To compare maternal morbidity after Thierry's spatulas or vacuum-assisted deliveries. Patients and methods: Retrospective study, at the French hospital la Conception, in Marseilles. All successful instrumental deliveries between November 2003 and May 2005 were reviewed, that is to say 264. Univariate and multivariate analyses were performed comparing maternal morbidity in the two groups. The primary outcome measure was perineal trauma. Secondary outcomes were blood loss and duration of hospitalization. Results: Among the 264 deliveries, there were 96 vacuum deliveries and 168 Thierry's spatulas extraction. Thierry's spatulas were used more often in nulliparous patients (<0.001). Patients in the group of Thierry's spatulas have a higher rate of epidural analgesia (p =0.05), a longer duration of first (p =0.002) and second stage of labor (p =0.03). There was no difference in incidence of sphincter tears between women who underwent Thierry's spatulas and those who underwent vacuum delivery with respective incidence of 4.2 and 3.2% (p =0.67). There was a significant difference in post-partum hemoglobin value with a higher blood loss in the group of Thierry's spatulas (<0.001). Mean duration of hospitalization was longer in the group with Thierry's spatulas (5.6 days) than in the group who underwent vacuum delivery (4.7 days) (p <0.001). Discussion and conclusion: Incidence of third degree tears was similar between the vacuum and Thierry's spatulas group. Deliveries with vacuum are associated with less blood loss and a shorter hospitalization stay. [Copyright &y& Elsevier]

Objective: This study was undertaken to evaluate prevalence of low urinary tract symptoms (LUTS) after Thierry's spatula delivery at first pregnancy. Patients and methods: A retrospective study of 236 primiparous with instrumental delivery or spontaneous delivery who had delivered from January 2001 to December 2002. Low urinary tract symptoms (LUTS) were evaluated one year after delivery with a questionnaire. Incidence of LUTS was compared depending on mode of delivery. Results: Of the 236 patients included, 88.1% replied to the questionnaire, 106 who delivered spontaneously and 102 who underwent Thierry''s spatula delivery. The incidence of urinary incontinence was similar after instrumental deliveries and after spontaneous vaginal deliveries (34.9 versus 24.5%, p =0.10). In univariate analysis, symptoms of urinary urgency and urinary frequency were higher after instrumental delivery than after spontaneous delivery, respectively, 34.9 versus 22.5%, p =0.049 and 19.8 versus 8.8%, p =0.03. After controlling for confounding factors, no difference in LUTS was observed between the two groups; the respective adjusted odds-ratios (95% IC) were 1,5 (0.8–3) for urinary incontinence, 1.7 (0.9–3.5) for urgency and 2.5 (0.9–6.3) for urinary frequency. Discussion and conclusion: One year after delivery, one third of patients will present urinary incontinence and more than 50% will complain of bladder instability symptoms. Compared to spontaneous vaginal delivery, the use of Thierry''s spatulas at first pregnancy does not induce higher risk of LUTS. [Copyright &y& Elsevier]

Provides information about several medical research related to urogynecology. "Urinary Urgency and Frequency, and Chronic Urethral and/or Pelvic Pain in Females. Can Doxycycline Help?," by F. C. Burkhard, N. Blick and W. W. Hochreiter; "Pelvic Fracture-Associated Urethral Injuries in Girls: Experience With Primary Repair," by L. N. Dorairajan, H. Gupta and S. Kumar; "Tension-Free Vaginal Tape and Laparoscopic Mesh Colposuspension for Stress Urinary Incontinence," by A. Valpas, A. Kivela and J. Penttinen; "Persistent Urinary Retention After Tension-Free Vaginal Tape: A New Surgical Solution," by W. Zubke, S. Becker and B. Kramer; Others.

Elderly breast cancer (BC) patients have been underrepresented in clinical trials whereas ∼60% of deaths from BC occur in women aged 65 years and older. The management of elderly women with early BC requires careful evaluation of risks and benefits of available treatment options. Clinical trials for elderly patients in the adjuvant setting are lacking, and efficacy results obtained in general population cannot be directly extrapolated to elderly patients without specific evidences. Therefore, we examined factors associated with the prescription of adjuvant chemotherapy (aCT) and the impact of this treatment on overall survival (OS) in a large cohort of patients aged 65 years and older. Patients were retrospectively identified from a large cohort of 23,134 early BC patients who underwent primary surgery in 18 academic centres between 1990 and 2014. A binary logistic regression was built to identify the factors associated with aCT administration. The impact of aCT on OS was analysed using a multivariate Cox regression model including age, histology, grade, tumour size, lymphovascular invasion (LVI), nodal status and endocrine therapy (ET) and endocrine receptors (ER). A propensity score-based matching analysis was performed. Of 6605 patients aged 65 years and older, 1493 received aCT (22.6%). Administration of aCT was predominantly associated with macroscopic lymph node involvement (LNi) and ER-negative status but common predictors, such as age < 80 years, ductal histology, tumour size ≥ 20mm, ET and tumour grade were also found as statistically significant. In a Cox model including age, histology, LVI, tumour size, LNi, ET, ER and grade, aCT was significantly associated with better OS (HR 0.71, 95% CI 0.58 to 0.86; p < 0.001). Ten-year OS estimates in case-matched patients for propensity score analysis were 76.8% (95% CI 76.6 to 77.1) in the aCT group vs. 61.5% (95% CI 61.3 to 61.7) without aCT (p < 0.0001). Interestingly, this benefit was maintained in the over-80s subgroup. The factors associated with aCT use in the elderly are similar to those usually found in younger age groups. By highlighting an OS benefit, even in the "very old" subgroup, our results may help clarifying the role of aCT in elderly patients. Houvenaeghel Gilles. Has not received any funding. All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background: Lymphocele is the principal post-operative morbidity following axillary node dissection. According to the literature, the incidence can vary from 4% to 89%. Encouraging results in terms of reducing postoperative lymphoceles as well as the volume and duration of drainage using octreotide LAR has been recently reported. Pasireotide LAR, a long acting drug designed to target multiple somatostatin receptors, was evaluated in this trial. Trial design: A phase II, two centers, randomized, double-blind, non-comparative pilot study was carried out in order to evaluate efficacy and safety of a single injection of pasireotide LAR 60 mg administered 7-10 days before scheduled mastectomy with axillary dissection surgery. This study included a parallel placebo arm to assess the natural course of the disease. Eligibility criteria: Adult female breast cancer patients planned to undergo a mastectomy (without reconstruction at the same time) and axillary node dissection. Specific aims: To assess the efficacy and safety of a single injection of pasireotide LAR 60 mg or placebo prior to mastectomy with axillary lymph node dissection surgery in reducing symptomatic lymphocele development. Symptomatic lymphocele was evaluated and was defined as: 1. total lymphocele drainage/aspiration volume (unique or iterative) >60 cc inclusive within the 28 days after surgery (excluding post-surgery drain) or; 2. a systematic aspiration volume at day 28 > 120 cc. Statistical methods: The statistical analysis was carried out sequentially after observing the absence of symptomatic lymphocele for each patient. It involves estimating the probability of a response in each group using a Bayesian design based on a beta-binomial model. The probability of response was considered random and its prior distribution was centered on 80% in the pasireotide group and 60% in the placebo group according to the investigators initial guesses. The distribution of the probability of response was updated after the observation of the patients included in the trial. Results: A total of 90 patients were included over 18 months: 42 in the treatment group and 48 in the placebo group. In the treatment group, the posterior mean estimation of the response rate (i.e. patients who did not experience a symptomatic lymphocele) was 62.4% (95% CI: 48.6%-75.3%) and 50.2% in the placebo group (95% CI: 37.6%-62.8%%). In the treatment group, one serious adverse event occurred in a patient with known insulin dependent diabetes requiring hospitalization for hyperglycaemia. Conclusion: A one time injection of pasireotide LAR to prevent symptomatic lymphocele development in women undergoing mastectomy with axillary dissection is promising. Further clinical studies are warranted. [ABSTRACT FROM AUTHOR]