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After chemotherapy, patients with non-seminomatous germ cell tumors (NSGCTs) with residual masses >1 cm on computed tomography (CT) undergo surgery. However, in approximately 50% of cases, these masses only consist of necrosis/fibrosis. We aimed to develop a radiomics score to predict the malignant character of residual masses to avoid surgical overtreatment. Patients with NSGCTs who underwent surgery for residual masses between September 2007 and July 2020 were retrospectively identified from a unicenter database. Residual masses were delineated on post-chemotherapy contrast-enhanced CT scans. Tumor textures were obtained using the free software LifeX. We constructed a radiomics score using a penalized logistic regression model in a training dataset, and evaluated its performance on a test dataset. We included 76 patients, with 149 residual masses; 97 masses were malignant (65%). In the training dataset (n = 99 residual masses), the best model (ELASTIC-NET) led to a radiomics score based on eight texture features. In the test dataset, the area under the curve (AUC), sensibility, and specificity of this model were respectively estimated at 0.82 (95%CI, 0.69–0.95), 90.6% (75.0–98.0), and 61.1% (35.7–82.7). Our radiomics score may help in the prediction of the malignant nature of residual post-chemotherapy masses in NSGCTs before surgery, and thus limit overtreatment. However, these results are insufficient to simply select patients for surgery.

Purpose The purpose of this study was to create a deep learning algorithm to infer the benign or malignant nature of breast nodules using two-dimensional B-mode ultrasound data initially marked as BI-RADS 3 and 4. Materials and methods An ensemble of mask region-based convolutional neural networks (Mask-RCNN) combining nodule segmentation and classification were trained to explicitly localize the nodule and generate a probability of the nodule to be malignant on two-dimensional B-mode ultrasound. These probabilities were aggregated at test time to produce final results. Resulting inferences were assessed using area under the curve (AUC). Results A total of 460 ultrasound images of breast nodules classified as BI-RADS 3 or 4 were included. There were 295 benign and 165 malignant breast nodules used for training and validation, and another 137 breast nodules images used for testing. As a part of the challenge, the distribution of benign and malignant breast nodules in the test database remained unknown. The obtained AUC was 0.69 (95% CI: 0.57–0.82) on the training set and 0.67 on the test set. Conclusion The proposed deep learning solution helps classify benign and malignant breast nodules based solely on two-dimensional ultrasound images initially marked as BIRADS 3 and 4.

Autologous fat grafting (AFG) is a promising breast reconstruction technique, following surgery. However, fat necrosis after AFG can cause palpable nodules, inducing anxiety and prompting additional investigations. We aimed to determine the occurrence rate and to identify the risk factors of palpable nodules in breast cancer patients prompting complementary explorations. We retrospectively reviewed the computerized files of consecutive breast cancer patients who underwent AFG after mastectomy or breast conservative treatment (BCT) at our center from January 2013 to December 2016. We collected data regarding palpable nodule incidences and suspicious breast imaging findings that led to additional explorations. Of the 252 patients reviewed, 222 (88%) underwent AFG for breast reconstruction, while 30 (12%) underwent AFG for correction of defects after BCT. The follow-up period ranged from 0 to 74 months (median: 27 months), and 201 patients had follow-ups beyond 1 year. Of the 252 patients, 66 (26.2%) underwent at least one control imaging and 24 (10%) underwent a biopsy, including 6 (2.4%) locoregional recurrence. Sixty patients (24%) were diagnosed with nodules during follow-ups. Among them, 52 (87%) patients had additional imaging, and 17 patients (28%) had a biopsy, including 82% benign histology. Patients with BCT had significantly more palpable nodules at 1 year than patients who underwent total mastectomy (odds ratio = 2.50, 95% confidence interval: 1.04. 6.03, p = 0.04). This study underlines the importance of preoperative patient information. This intervention and its follow-up should be reserved for experienced teams to limit unnecessary additional explorations. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Resume Les patients transgenres ont un risque senologique mal connu malgre leur nombre et leur acceptation sociale croissante. Les donnees epidemiologiques sont generalement extrapolees par rapport a celles des femmes cisgenres et menopausees. Les hommes effectuant une transition vers le genre feminin deviendront des femmes transgenres. Ces patients beneficieront d’une hormonotherapie a base d’œstradiol afin d’acquerir des caracteres sexuels secondaires feminins. L’incidence des neoplasies mammaires est similaire a celles des hommes cisgenres. L’âge de decouverte de ces neoplasies est plus tardif et les cancers sont deceles a un stade plus evolue que chez les femmes cisgenres. Apres 5 ans d’hormonotherapie et a partir de 50 ans, il est consensuel de leur faire beneficier d’une mammographie de depistage sans que le rythme soit clairement defini. Les femmes effectuant une transition vers le genre masculin deviendront des hommes transgenres. Ces patientes beneficieront d’une hormonotherapie a base de testosterone afin d’acquerir des caracteres sexuels secondaires masculins. Ces patientes peuvent beneficier d’une mastectomie totale bilaterale avec greffe du mamelon appelee « top surgery ». En fonction des facteurs de risque familiaux, le chirurgien pourra demander un bilan preoperatoire, restant a sa discretion. Seul le depistage biennal classique en l’absence de chirurgie mammaire est consensuel. Certaines societes savantes recommandent de realiser un examen clinique annuel de la paroi thoracique si la « top surgery » a ete realisee. Les radiologues doivent connaitre les specificites liees a la prise en charge des patients transgenres pour permettre une prise en charge optimale.

The management of desmoid-type fibromatosis has considerably evolved these last years, toward first-line active surveillance then systemic or local symptomatic treatment in case of aggressive tumor. Magnetic resonance imaging is the modality of choice in each of these treatment settings. It needs multiparametric approach taking into account mainly the tumor size, and T2-weighted signal that is correlated with histological composition and clinical behavior. A volumetric approach should be favored for the evaluation of tumor size change. The interest of paramagnetic contrast injection and tumor enhancement requires further investigation.

This paper deals with the place in 2021 of artificial intelligence for screening of breast cancer in France et discusses of the different types of use and their performance in the literature (Standalone, Augmented radiologist, triage). Moreover, this paper will give an overview of the potential applications of AI in the future (Personalized screening, prediction of interval cancers).

Second reading is an important part of breast cancer organized screening program. Image quality control and detection of non-diagnosed cancer by first reader are the two goals of this process. In France, 6 % of all screening cancer are diagnosed by second reading, actually done on screen film. With the technologic evolution (Digital breast tomosynthesis, Artificial intelligence) and societal digitalization, this process need to evolve. After some report about organization and results for second reading in France and outside, current and future shortcomings, proposition from professionals involved in breast cancer screening are made to improve this public health program.

Resume L’imagerie du cancer du sein a beaucoup evolue au cours des 20 dernieres annees en profitant du developpement incessant de l’informatique. De nouvelles solutions techniques en mammographie (tomosynthese-angiomammographie), en echographie (elastographie, echographie automatisee) et en IRM (diffusion, protocole court) mais egalement en medecine nucleaire vont possiblement remplacer nos outils actuels. Mais la veritable revolution a venir sera certainement l’utilisation des enormes volumes de donnees numeriques actuellement inexploitees dans le cadre des solutions apportees par les techniques d’intelligence artificielle (aide a l’interpretation, radiomiques) ou alors des progres des techniques de biologie (genomique, proteomique) qui permettront de proposer une imagerie veritablement personnalisee aux femmes.

French program of breast cancer screening is implemented since15 years and results are in adequation with international guidelines except for participation. To answer to recurrent controversies about breast cancer screening, publications from National Institute of French cancer registry confirm the positive impact of screening on decreasing mortality for participating women. The harms of mammography (and not from screening) need to be communicated to the invited women to help them to make decision about participation but also the risk of worse prognosis in case of symptomatic cancer. The future of screening will be different and works are in progress to find new ways to select women who will beneficiate for screening and whose cancer needs to be treated. Until then, the only way to screen for breast cancer stays the mammographic process as well as other technics in case of dense breast or in case of family history of breast cancer.

Purpose :Since ACOSOG Z1011 trial, the role of axillary US preoperative has been redirected for predicting extensive axillary involvement. Our study is aimed to evaluate routinely US axillary prediction for extensive nodal burden in breast cancer. Materials and methods :The study was approved by the institutional reaview board and the requirement for in-formed consent was waived.All patients in our institution with early-stage invasive breast cancer have a systematic axillary ultrasound (US) evaluation before surgery.A prospective study of radiology and pathology records concerns all consecutives patients to evaluate US correlation with surgical findings beetwen November 1, 2020 and July 15, 2021.Neoadjuvant chemotherapy, ductal carcinoma in situ on breast biopsy, and relapse cases were excluded.Criteria used to define abnormal lymph nodes included : focal or diffuse cortical thickening with cortex thicker than >4mm, replacement or effacement of the fatty hilium, or rounder lymph node.3 US prediction groups were defined as: US G0 normal (no suspicious lymph node) ;US G1 non extensive involvement (1 or 2 suspicious nodes) ; US G2 extensive involvement (≥3 suspicious nodes).In case of preoperative positive axillary biopsy, positive intraoperative examination, or patients without Acosog criteria, an axillary dissection was systematically performed.3 pathologic groups were defined as : path G0 (pN0) ; path G1 (≤2pN+) ; path G2 (≥3pN+).Statiscal analysis was performed with the chi-square the Fisher’s exact test.NPV for extensive axillary burden is defined as the proportion of patients with a negative test result (US G0 or US G1) that does not have extensive nodal involvement histologically (path G0 or path G1). Results. The study is still ongoing. On the 241 first cases, 64.3% (155/241) were cT1, 82.9% (200/241) were cN0. 163(78.3%) had Ductal invasive carcinoma, 37 were lobular histologic characteristics (17.8%) and 8 were mixted (3.8%).6.2% (15/241) patients presented extensive nodal involvement. ConclusionThe results of this study are preliminary. They will be completed after the next study closure. In the first results, it is globally observed that the preoperative ultrasound makes it possible to exclude more than 97% of extensive involvement (>2pN+). In case of less than 3 US suspected axillary nodes , sentinel node biospy remains indicated. The false negative rate cannot be calculated on this day and will not be presented until later. Path G0Path G1Path G2totalUS G0156243187US G1310922US G20033total1593415241VPN for extensive nodal disease is 97.9% (193/197).In abnormal US groups (US G1+US G2), 48% (12/24) patients had extensive axillary involvement. Citation Format: Camille Defoort, Joanna Chemaly, Luc Ceugnart, Marie-Pierre Chauvet. Axillary extensive burden evaluation by ultrasound in preoperative nodal staging in breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-01-11.

e13594 Background: During the French COVID-19 pandemic, clinical activity for cancer care has declined and modified the management of patients in cancer institute. France has imposed two national lockdowns of the population (from March 17 to May 11 and from October 30 to December 15 2020). We evaluate the impact of the lockdown period in North France on clinical activity. Methods: We measured and compared key-indicators of clinical activity between different periods: 2019 versus 2020; before and during the first and second lockdown. Results are given as percentage of changes with 95% confidence interval (CI). Results: The comparative analysis between 2019 and 2020 showed that most clinical activities except hospitalizations (-0.0% [-0.2; +0.1%] has changed. There was a significant increase in overall treated patients (+0.4% [+0.3; +0.5], telemedicine +99.9% [+99.4; +99.7], MRI (+8.8% [+8.2; +9.5], ambulatory chemotherapy (+3.5% [+3.3; +3.8]), number of chemotherapies prepared (+2.0 [+.1.9; +2.2]) and admission in palliative care unit (+15.3%, [+10.8; +19.8]). On the contrary, a significant decrease in treated patients aged > 65 years old (-6.4% [-6.9; -5.9]), incidence rate (-3.1% [-3.6; -2.7]), multidisciplinary team meeting on patient assessment (-3.1% [-3.5;-2.5]), pathology reports (-2.9% (-3.3;-2.6]), radiotherapy (-4.6% [-4.7;-4.4]) and surgery (-6.7% [-7.4;-5.6]) were observed. In 2020, before and during the first lockdown all key-indicators declined except telemedicine (+40,400%) and admission in palliative care unit (+35.5% [+31.0-+49.7]). During the first lockdown, key-indicators decreased from -63.0% [-70.3-59.2] for outpatient visits to -5.1% [-7.0-3.8] for chemotherapy. The impact caused by the second lockdown was non-significant compared to the first one since all key-indicators has increased during the second lockdown: from +23.8% [+22.2; +25.5] for radiotherapy to +76.6% [+72.5; +79.5] for the management of new cases. Conclusions: Dramatic changes occurred in 2020 during the COVID-19-related lockdown compared to 2019. An Increase in chemotherapy treatment and admission on palliative care unit and a decrease in surgery and radiotherapy strongly suggests that the clinical activity was changed in 2020 compared to 2019. This was in line with the reduction of cancer screening in 2020. The impact of the first lockdown on clinical activities was higher compared to the second one. These observations should be investigated further in order to better understand the effects of a pandemic-related lockdown on cancer care.

Resume La surveillance d’une anomalie mammaire classee ACR 3 est fiable et reproductible. La nouvelle version du lexique BIRADS n’apporte pas de modification substantielle a la pratique quotidienne. Elle introduit l’elastographie et le mode doppler au lexique echographique, mais reste relativement floue sur les criteres ACR 3 en IRM, notamment pour les rehaussements non masse. La surveillance sur deux ans permet de diminuer le nombre d’actes interventionnels inutiles et le sur-diagnostic induit par ces gestes, tout en evitant des faux negatifs.

The management of desmoid-type fibromatosis has considerably evolved these last years, toward first-line active surveillance then systemic or local symptomatic treatment in case of aggressive tumor. Magnetic resonance imaging is the modality of choice in each of these treatment settings. It needs multiparametric approach taking into account mainly the tumor size, and T2-weighted signal that is correlated with histological composition and clinical behavior. A volumetric approach should be favored for the evaluation of tumor size change. The interest of paramagnetic contrast injection and tumor enhancement requires further investigation.

International audience; The objective of this article was to evaluate the evidence currently available about the clinical value of artificial intelligence (AI) in breast imaging. Nine experts from the disciplines involved in breast disease management – including physicists and radiologists – convened a meeting on June 3, 2019 to discuss the evidence for the use of this technology in plenary and focused sessions. Prior to the meeting, the group performed a literature review on predefined topics. This paper presents the consensus reached by this working group on recommendations for the future use of AI in breast screening and related research topics.

Breast cancer imaging is always improving for the last 20 years in spite of digitalization and computer development. News tools in mammography (Digital Breast Tomosynthesis, Contrast enhanced mammography), sonography (elastography, Automated echography), MRI (Diffusion, abbreviated MRI) and Nuclear medicine has the great potential to be the future of breats imaging. But true revolution will be to use the huge volume of "hidden" imaging data, by Intelligence Artificial process or Biological progress (in genomics, proteiomics) to purpose to our patient a personalized imaging.

PURPOSE We evaluated the addition of breast magnetic resonance imaging (MRI) to standard radiologic evaluation on the re-intervention rate in women with ductal carcinoma in situ (DCIS) undergoing breast-conserving surgery. PATIENTS AND METHODS Women with biopsy-proven DCIS corresponding to a unifocal microcalcification cluster or a mass less than 30 mm were randomly assigned to undergo MRI or standard evaluation. The primary end point was the re-intervention rate for positive or close margins (< 2 mm) in the 6 months after randomization ( ClinicalTrials.gov identifier: NCT01112254). RESULTS A total of 360 patients from 10 hospitals in France were included in the study. Of the 352 analyzable patients, 178 were randomly assigned to the MRI arm, and 174 were assigned to the control arm. In the intent-to-treat analysis, 82 of 345 patients with the assessable end point were reoperated for positive or close margins within 6 months, resulting in a re-intervention rate of 20% (35 of 173) in the MRI arm and 27% (47 of 172) in the control arm. The absolute difference of 7% (95% CI, −2% to 16%) corresponded to a relative reduction of 26% (stratified odds ratio, 0.68; 95% CI, 0.41 to 1.1; P = .13). When considering only the per-protocol population with an assessable end point, the difference was 9% (stratified odds ratio, 0.59; 95% CI, 0.35 to 1.0; P = .05). Total mastectomy rates were 18% (31 of 176) in the MRI arm and 17% (30 of 173) in the control arm (stratified P = .93). For 100 lesions seen on MRI, nonmass-like enhancement was more predominant (82%) than mass enhancement (20%). Nevertheless, no specific morphologic and kinetic parameters for DCIS were identified. CONCLUSION The study did not show sufficient surgical improvement with the use of preoperative MRI to be clinically relevant in DCIS staging. However, this could be reconsidered with the improvement of new MRI sequences and new modalities in magnetic resonance techniques.

Resume Le depistage organise des cancers du sein exclu actuellement un grand nombre de patientes qui presentent un risque eleve de cancer du sein. Une integration de ces femmes dans un systeme organise permettrait, outre la gratuite, d’homogeneiser les pratiques, d’effectuer une seconde lecture et d’evaluer les resultats de ces suivis. Pour les femmes a tres haut risque, evaluees par une consultation oncogenetique, la specificite du depistage et le niveau d’expertise requis s’opposent a une integration dans un systeme global. Pour les autres categories de femmes a haut risque selon la Haute Autorite de sante (HAS), l’adaptation du depistage organise des cancers du sein pourrait s’envisager, mais de nombreux facteurs limitants existent, notamment pour l’identification precise de ces femmes et la constitution de bases de donnees fiables.

Resume Objectif Depuis les dernieres recommandations nationales elaborees par l’Institut national du cancer (INCa) et la Societe francaise de senologie et de pathologie mammaire (SFSPM) sur l’ensemble de la prise en charge diagnostique et therapeutique des carcinomes canalaires in situ (CCIS), de nouvelles publications ont fait emerger des interrogations en termes de bonnes pratiques et sur les possibilites de desescalade therapeutique dans la prise en charge des CCIS. L’actualisation de ces recommandations intervient dans un contexte de questionnement sur le surdiagnostic et son corollaire le surtraitement. Elle met a la disposition des professionnels des informations sur les bonnes pratiques correspondant a l’etat le plus recent des connaissances scientifiques et etudie notamment les possibilites de desescalade therapeutique. Methode Le processus d’elaboration est base sur une revue systematique de la litterature et sur le jugement argumente d’experts cliniciens au sein d’un groupe de travail multidisciplinaire. Avant publication, les recommandations sont revues par plus de cent experts cliniciens independants du groupe de travail. Resultats Cet article presente les recommandations nationales relatives a l’indication de l’IRM, la place de la macrobiopsie en cas de microcalcifications et la conduite a tenir en cas de CCIS de bas grade identifie par biopsie, dans le diagnostic des CCIS.

Objective To investigate whether there were suspicious criteria on the initial MRI in BIRADS 3 lesions. To analyze the value of “blooming sign” as an additional criterion for malignancy. Materials and methods In this retrospective study the lesion morphological and enhancement characteristics were analyzed. The “blooming sign” (BS), defined as the lesion size increase between the early and the late phase after gadolinium was assessed. We determined the optimal cut-off value for the BS to distinguish benign and malignant breast lesions. Results 100 lesions were classified BIRADS 3 in 75 patients (12%). Four of the five malignant lesions had suspicious BIRADS criteria on the index MRI. 45 lesions were stable and 30 lesions resolved spontaneously during the follow-up MRI. The optimal cut-off value for the BS was 8.54% with 100% sensitivity, 94% specificity, 44% positive and 100% negative predictive values. Using reclassification rule to upgrade benign BIRADS lesions with suspicious BS feature and downgrade suspicious BIRADS lesions with benign BS feature increased MRI specificity (89%), sensitivity (100%) while preserving NPV (100%). Conclusions This study showed the suggestive part of classified BIRADS 3 lesions. The blooming sign seems to be a good additional parameter to increase MRI specificity when associated to BIRADS criteria.

Resume L’imagerie par tomosynthese qui permet d’obtenir des images par plan de coupe peut donc etre comparee aux images obtenues par IRM. La correlation est souvent forte (pour les masses et distorsion architecturale notamment) mais certaines images vues en IRM se presentent de facon tres differentes en tomosynthese. Par ailleurs, la decouverte en tomosynthese d’images non retrouvees sur les cliches bidimensionnels et sur l’echographie impose parfois le recours a l’IRM pour verifier la veracite de l’image. Dans ces cas, il faudra aussi gerer les incidentalomes generes par cette technique d’imagerie sensible mais moyennement specifique. La tomosynthese pourrait aussi etre utile en bilan de seconde intention apres IRM et echographie non contributive. Une formation specifique a cette nouvelle technique s’avere indispensable.

French program of breast cancer screening is implemented since15 years and results are in adequation with international guidelines except for participation. To answer to recurrent controversies about breast cancer screening, publications from National Institute of French cancer registry confirm the positive impact of screening on decreasing mortality for participating women. The harms of mammography (and not from screening) need to be communicated to the invited women to help them to make decision about participation but also the risk of worse prognosis in case of symptomatic cancer. The future of screening will be different and works are in progress to find new ways to select women who will beneficiate for screening and whose cancer needs to be treated. Until then, the only way to screen for breast cancer stays the mammographic process as well as other technics in case of dense breast or in case of family history of breast cancer.

International audience; OBJECTIVE: The Response Evaluation Criteria in Solid Tumors (RECIST) can have limitations when used to evaluate local treatments for cancer, especially for liver malignancies treated by stereotactic body radiation therapy (SBRT). The aim of this study was to validate the relationship between the occurrence of lobulated enhancement (LE) and local relapse and to evaluate the utility of this relationship for predicting local progression.METHODS: Imaging data of 59 lesions in 46 patients, including 281 computed tomographic (CT) scans, were retrospectively and blindly reviewed by 3 radiologists. One radiologist measured the lesion size, for each CT and overall, to classify responses using RECIST threshold criteria. The second studied LE occurrence. A third radiologist was later included and studied LE occurrence to evaluate the interobserver consistency for LE evaluation.RESULTS: The mean duration of follow-up was 13.6 months. LE was observed in 16 of 18 progressive lesions, occurring before size-based progression in 50% of cases, and the median delay of LE detection was 3.2 months. The sensitivity of LE to predict progression was 89%, and its specificity was 100%. The positive predictive value was 100%, the negative predictive value was 95.3%, and the overall accuracy was 97%. The probability of local progression-free survival at 12 months was significantly higher for lesions without LE compared with all lesions: 0.80 (CI 95%: 0.65-0.89) versus 0.69 (CI 95%: 0.54-0.80), respectively. The overall concordance rate between the 2 readers of LE was 97.9%.CONCLUSIONS: Response assessment of liver metastases treated by SBRT can be improved by including LE. This study demonstrates the diagnostic and predictive utility of LE for assessing local progression at a size still eligible for local salvage treatment.

Resume Une patiente traitee d’un cancer du sein doit beneficier d’un examen clinique semestriel et d’une mammographie annuelle en cas de traitement conservateur. En dehors des lesions infracliniques decouvertes lors du bilan d’imagerie, le radiologue peut etre confronte a des situations cliniques particulieres (masse, induration, syndrome inflammatoire, œdeme mammaire) qui necessitent une prise en charge adaptee en etroite concertation avec les cliniciens referents. La recidive mammaire doit etre recherchee mais dans la plupart des cas, le symptome clinique correspondra a une anomalie post-therapeutique benigne.

To report experience with fiducial marker insertion and describe an advantageous, novel technique for fiducial placement in the liver for stereotactic body radiation therapy with respiratory tracking.We implanted 1444 fiducials (single: 834; linked: 610) in 328 patients with 424 hepatic lesions. Two methods of implantation were compared: the standard method (631 single fiducials) performed on 153 patients from May 2007 to May 2010, and the cube method (813 fiducials: 610 linked/203 single) applied to 175 patients from April 2010 to March 2013. The standard method involved implanting a single marker at a time. The novel technique entailed implanting 2 pairs of linked markers when possible in a way to occupy the perpendicular edges of a cube containing the tumor inside.Mean duration of the cube method was shorter than the standard method (46 vs 61 minutes; P.0001). Median numbers of skin and subcapsular entries were significantly smaller with the cube method (2 vs 4, P.0001, and 2 vs 4, P.0001, respectively). The rate of overall complications (total, major, and minor) was significantly lower in the cube method group compared with the standard method group (5.7% vs 13.7%; P=.013). Major complications occurred while using single markers only. The success rate was 98.9% for the cube method and 99.3% for the standard method.We propose a new technique of hepatic fiducial implantation that makes use of linked fiducials and involves fewer skin entries and shorter time of implantation. The technique is less complication-prone and is migration-resistant.

Resume Le depistage par mammographie du cancer du sein fait l’objet depuis plusieurs annees de controverses sur son efficacite en termes de diminution de la mortalite specifique, des faux positifs et du surdiagnostic induit. L’analyse de la litterature recente et notamment des revues independantes montre que cette action de sante publique a un impact positif permettant une diminution de la mortalite specifique de 20 % environ au prix d’un surdiagnostic evalue entre 5 et 11 %. Les benefices du depistage mammographique sont donc significatifs mais il convient de donner aux femmes une information complete et loyale sur les effets indesirables que comporte toute intervention dans le domaine medical (faux positifs, faux negatifs, surdiagnostic et exposition aux rayonnements ionisants).

The reduction in mortality specifically from breast cancer, demonstrated in the major meta-analyses in the 1980s resulted in public health breast cancer screening programs being set up in many countries, including France. Recent publications have challenged the usefulness of screening, by insisting in particular on the negative effects of overdiagnosis and the lack of any significant impact on mortality. From analysis of the literature and particularly independent reviews published in 2012, we provide some answers for doctors faced with the legitimate concerns of women. These studies confirm that screening in the right age group reduces specific mortality by at least 20% at a cost of overdiagnosis estimated at between 1 and 15%.

Resume La diminution de mortalite specifique par cancer du sein, demontree dans les grandes meta-analyses des annees 1980 a ete a l’origine de la mise en place de programmes de depistage du cancer du sein dans de nombreux pays dont la France, veritables programmes de sante publique. Des publications recentes ont remis en cause l’interet du depistage en insistant sur les effets negatifs en particulier le surdiagnostic et l’absence d’impact significatif sur la mortalite. A partir d’une analyse de la litterature et notamment des travaux de synthese independants publies en 2012, nous apportons des elements de reponse aux medecins face aux interrogations legitimes des femmes. Ces travaux confirment que le depistage dans la classe d’âge permet une diminution de la mortalite specifique d’au moins 20 % au prix d’un surdiagnostic estime entre 1 et 15 %.

Resume L’osteosarcome vertebral primitif est une forme rare d’osteosarcome, se distinguant des formes appendiculaires par un pic d’incidence a un âge plus eleve et un pronostic plus sombre, explique notamment par la difficulte de l’exerese chirurgicale. Nous presentons ainsi cinq cas d’osteosarcome vertebral primitif histologiquement prouve, suivis dans notre institution entre 2004 et 2012 permettant d’illustrer certains points semiologiques radiologiques essentiels pouvant aider a evoquer cette entite rare.

Purpose To determine whether it is appropriate to routinely undertake surgery if flat epithelial atypia (FEA) or pure flat epithelial atypia (pFEA) is found on large-core biopsy. Patients and methods Between 2005 and 2010, 1678 large-core biopsy procedures were carried out, which led to 136 FEA sites being identified, 63 of which across 59 patients were pFEA (four patients had two sites of pFEA each). Forty-eight patients underwent further surgical excision, equating to 52 excised sites of pFEA. Results Of the 52 operated sites, there were 20 benign lesions (38%), 26 borderline lesions (56%), and three ductal carcinomas in situ (6%). The rate of histologic underestimation was put at 3.8%. Of the three cases that were underestimated, one was discarded because the definitive histology was not representative of the site from which microcalcifications had initially been taken. The other two cases that were underestimated were found in patients with an increased individual risk of breast cancer. Conclusion In patients with no personal or first-degree family history of breast cancer, after complete or subtotal excision under radiology of the radiological lesion, and while excluding images fitting BI-RADS 5, annual monitoring may be offered as an alternative to surgical excision in view of the absence of underestimation found in our study.

Stereotactic radiation therapy (SRT) is becoming more and more important in the treatment of inoperable patients with early stages of pulmonary carcinomas (T1-T2 N0M0). In certain cases, evaluation of the response is still problematical and it can be difficult to differentiate response from progression. The aim of this paper is to set out these various changes and to produce a protocol for optimal monitoring. By comparing our clinical experience with data from the literature, the main visual aspects on a CT scan are set out and illustrated for each clinical situation: radiation pneumonitis, radiation fibrosis, therapeutic response and progression. The literature was reviewed by querying the main databases and selecting papers concerning pulmonary SRT and post-therapeutic radiological appearance. CT appearance induced by SRT differs significantly from images after classic conformal radiation therapy, both morphologically and chronologically. In particular, the modifications induced by stereotactic radiation therapy are only seen in a limited volume surrounding the volume treated. Knowledge of the radiological criteria necessary to differentiate between a therapeutic response and recurrence is of major importance in the present context of increase in use of this technique.

Resume La radiotherapie stereotaxique (RST) prend une place de plus en plus importante dans le traitement des patients inoperables atteints de carcinomes pulmonaires de stade precoce (T1-T2 N0M0). L’evaluation de la reponse reste dans certains cas difficiles et il peut etre difficile de differencier une reponse d’une progression. Le but de cet article est d’exposer ces differents changements et de conclure sur un protocole de surveillance optimal. En confrontant notre experience clinique et les donnees de la litterature, les principaux aspects scannographiques sont exposes et illustres pour chaque situation clinique : pneumopathie radique, fibrose radique, reponse therapeutique et progression. Une revue de la litterature a ete realisee en interrogeant les principales bases de donnees et en selectionnant les articles traitant de la RST pulmonaire et des aspects radiologiques post-therapeutiques. Les aspects scannographiques induits par la RST different significativement des images retrouvees apres radiotherapie conformationnelle classique sur les plans morphologiques et chronologiques. En particulier, les modifications induites par la RST sont limitees a un volume restreint, entourant le volume traite. La connaissance des criteres radiologiques necessaires pour differencier une reponse therapeutique d’une recidive est un enjeu majeur dans le contexte actuel de developpement de cette technique.

Since the last guidelines published by the French National Cancer Institute (INCa) and the learning society "Société française de sénologie et de pathologie mammaire (SFSPM)" in 2009 about diagnosis and management of ductal carcinoma in situ, new data raised issues about overdiagnosis and its consequences, overtreatment. Therefore, an update was necessary, to provide healthcare professionals up-to-date guidelines and study therapeutic desescalation in particular.The clinical practice guidelines development process is based on systematic literature review and critical appraisal by a multidisciplinary experts workgroup. The recommendations are thus based on the best available evidence and experts agreement. Prior to publication, the guidelines are also reviewed by more than 100 independent practitioners in cancer care delivery.This article presents French guidelines about MRI and vacuum assisted breast biopsy indications for DCIS diagnosis and the management of low-grade DCIS.

Resume L’objectif de cette mise au point est de decrire la mise en route d’une IRM 3T dans un centre de lutte contre le cancer. Les sequences fonctionnelles deviennent indispensables pour l’evaluation des therapeutiques ciblees et la realisation de ces sequences en routine dans des temps d’examen corrects n’est possible qu’a 3T. Les contraintes techniques sont maitrisees avec les IRM de troisieme generation et l’amelioration de la resolution spatiale dans des temps d’examen reduits de 30 a 50 % est un reel confort pour les patients. Neanmoins, les contraintes financieres representent un handicap majeur : avec une tarification basee sur le cout et l’amortissement d’imageurs 1,5T qui sont deux fois moins chers il n’est pas possible d’arriver a un equilibre economique.

Endometrial cancer is staged according to the International Federation of Gynecology and Obstetrics surgical system. Clinical estimation of stage, however, can be inaccurate in more than 20%, and therefore, preoperative imaging of the disease may assist in planning the optimal course of treatment. Magnetic resonance imaging (MRI) may detect gross myometrial extension or extension of tumor to the cervical stroma, which can alter management and therefore help in preoperative surgical planning. This issue is increasingly relevant as less invasive surgical techniques, such as laparoscopic surgeries, are becoming more commonplace for lower stage cancers. Currently, MRI is the most widely used modality for preoperative planning.

Resume Le traitement des cancers localement evolues du col uterin est une chimioradiotherapie concomitante. Le pronostic local et la survie globale des patientes dependent du volume tumoral, de l’extension locoregionale et de la radiosensibilite de la lesion. Celle-ci est fonction de l’hypoxie tumorale, de la pression interstitielle tumorale et de l’existence d’une anemie. L’IRM dynamique apres injection de contraste permet de quantifier des parametres vasculaires temoins des deux premiers facteurs. L’analyse conjointe du volume tumoral, de l’anemie et des parametres vasculaires avant et en cours de traitement permet une correlation forte avec le risque de recidive locale et la survie globale.