Search

OBJECTIVES The purpose of this retrospective observational study is to report author's experience in computed-tomography (CT)-guided percutaneous vertebroplasty (PV) of the cervicothoracic junction. METHODS The records of all consecutive patients treated by PV at levels C7, T1, T2, and T3 in a tertiary cancer center during year 2020 were extracted from the Institutional electronic archive. Following data were collected: demographics, indication for PV, procedure features, outcomes, and complications. Technical success was defined as when the trocar was placed into the vertebral body, allowing the injection of polymethyl-metacrylate (PMMA). RESULTS Eleven patients were identified who received PV on 14 levels. Mean procedure duration was 57 ± 22 min (range [31-142]). A "trans-pedicular approach at the targeted level" was used in 1 vertebra (7%), a "costotransverse approach, at the targeted level" was used in 1 vertebra (7%), a "transpedicular approach via the level below" was used in 3 vertebrae (22%), and a "costotransverse approach via the level below" was used in 9 vertebrae (64%). Meantime to deploy each trocar was 20 ± 5 min (range [12-32]). Technical success was achieved in 14/14 (100%) of vertebrae. Mean postoperative hospitalization duration was 1.9 ± 1.7 days (range [1-11]). According to CIRSE classification, no adverse event occurred. PMMA leakage occurred in two patients; both remained asymptomatic. CONCLUSION This study provides arguments in favor of safety and efficiency of CT-guided vertebroplasty of levels C7, T1, T2, and T3, for both trocar deployment and monitoring of the vertebral body filling during the PMMA injection.

Unlike for soft tissue sarcomas, percutaneous biopsy is not validated for uterine myometrial tumors, leading to leiomyosarcoma inadvertent morcellation and overtreatment in childbearing patients. This study aimed to evaluate preoperative percutaneous uterine needle biopsy (PUB) with microscopic examination (M-PUB) and array-comparative genomic hybridization (MCGH-PUB).This was a prospective single-center cohort study including all consecutive patients who were candidates for hysterectomy because of suspected uterine leiomyosarcoma on magnetic resonance imaging (MRI) who received PUB. Microscopic and array-CGH analyses with genomic index (GI) counts were performed to guide the therapeutic strategy. Smooth-muscle tumors with suspect features with a GI above 15 were deemed malignant, as were tumors without microscopic malignant features with a complex genomic profile (GI above 30 or malignant profile). Preoperative diagnoses based on M-PUB and MCGH-PUB were compared with the postsurgical pathological specimen or follow-up.From November 2016 to February 2022, 34 patients were included. Based on the surgical specimen (N = 23) or follow-up (N = 11), final diagnoses were 11 sarcomas and 23 non-sarcomas. The median follow-up was 12 months (IQR 6-37). The diagnostic accuracies of M-PUB and MCGH-PUB were 94% and 100%, respectively. The sensitivity, specificity, and negative predictive value of MCGH-PUB were 100%, 100%, and 100%, respectively. A high GI was significantly associated with malignancy (P0.001). Genomic analyses allowed malignancy upgrades for four tumors. There were no complications and no dissemination along the biopsy track.MCGH-PUB is safe and accurate for preoperatively diagnosing uterine sarcomas and should be used routinely after suspicious MRI to tailor surgery.

Resume L’extension tumorale aux ganglions lymphatiques chez les patientes atteintes d’un cancer du sein est un facteur pronostique majeur. Meme s’il existe differentes methodes de biopsie des ganglions lymphatiques, cette technique est maintenant largement utilisee et acceptee comme norme de soins dans le monde entier. Mais ces techniques ont un taux de faux negatifs de 10 a 15 %, y compris en cas de ganglions macrometastatiques. L’evaluation clinique etant limitee, la multimodalite est couramment utilisee pour predire l’extension ganglionnaire. L’echographie est l’examen de premiere intention. Elle doit etre bilaterale comparative et doit explorer les ganglions axillaires, ceux de la chaine mammaires internes, retropectoraux et sus-claviculaires. Selon leur aspect echographique, les ganglions lymphatiques axillaires peuvent etre divises en trois groupes : d’aspect normal, incertain ou suspect. L’aspiration a l’aiguille fine ou la microbiopsie sont les deux techniques utilisees pour prelever un echantillon de ganglions lymphatiques et doivent etre realisees chez des patientes presentant des ganglions lymphatiques indetermines ou suspects. L’IRM, la TDM et la TEP-TDM peuvent etre utilisees pour evaluer l’etendue de l’extension ganglionnaire, principalement chez les patientes atteintes des tumeurs malignes de plus de 3cm ou N+ echographqiue. Cet article propose une description des meilleures methodes d’imagerie actuelle pour statuer sur le stade N0 radiologique (rN0) avant la prise en charge therapeutique des cancers du sein.

La Presse Medicale - In Press.Proof corrected by the author Available online since jeudi 26 fevrier 2015