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Purpose: Estrogen receptor-positive (ER+) and -negative (ER) breast cancers are molecularly distinct diseases. We hypothesized that p53 mutations may lead to different transcriptional changes and carry different prognostic value in these two different types of cancers.Experimental Design: We developed a 39-gene p53 signature derived from 213 ER+ and a separate 30-gene signature from 38 ER− cancers with known mutation status and tested their prognostic and chemotherapy response predictive values in ER+ and ER− cancers, respectively.Results: External validation to predict p53 status (n = 103) showed sensitivity and specificity of 89% and 54% for the 39-gene signature, and 82% and 61% for the 30-gene signature. The 39-gene signature was predictive of worse distant metastasis free survival in ER+ cancers in two separate prognostic data sets (n = 255, HR: 2.3, P = 0.005 and n = 198, HR: 2.17, P = 0.09). It also predicted for poor prognosis even with adjuvant tamoxifen therapy (n = 277, HR = 2.43, P < 0.0001) but it was not prognostic in ER− cancers. It was also associated with higher chemotherapy sensitivity in ER+ but not in ER− cancers. The prognostic and predictive values remained significant in multivariate analysis. The 30-gene, ER−, p53 signature showed no prognostic or predictive values in ER+ cancers but it was associated with better prognosis in ER− cancers. It also had no chemotherapy response predictive value in ER− or ER+ cancers.Conclusions: P53 dysfunction is prognostically most relevant in ER+ cancers and supports the hypothesis that different predictive or prognostic markers will be needed for different molecular subsets of breast cancer. Clin Cancer Res; 17(8); 2591–601. ©2011 AACR.

Supplementary Figures S1-S5; Supplementary Methods; Supplementary Tables S1-S6.

International audience; IntroductionIn France, participation in the organized breast cancer screening program remains insufficient. A personalized approach adapted to the risk factors for breast cancer (RBC) should make screening more efficient. A RBC evaluation consultation would therefore make it possible to personalize this screening. Here we report our initial experience.Material and methodThis is a prospective study on women who were seen at the RBC evaluation consultation and analyzing: their profile, their risk assessed according to Tyrer Cuzick model (TC) ± Mammorisk© (MMR), the existence of an indication of oncogenetic consultation (Eisinger and Manchester score), their satisfaction and the recommended monitoring.ResultsAmong the women who had had a TCS and/or MMR evaluation of SCR (n = 153), 76 (50%) had a high risk (n = 67) or a very high risk (n = 9). Almost half (47%) had a possible (15%) or certain (32%) indication to an oncogenetic consultation. Regarding this consultation, 98% of women were satisfied or very satisfied. In total, 60% of women had a change in screening methods.ConclusionThis RBC evaluation consultation satisfies women and for a majority of them, modifies their methods of breast cancer screening.; IntroductionL’adhésion en France au programme de dépistage organisé du cancer du sein demeure insuffisante. Une approche personnalisée adaptée aux facteurs de risque de cancer du sein (RCS) permettrait une meilleure efficience du dépistage. Une consultation d’évaluation du RCS permettrait donc de personnaliser ce dépistage. Nous rapportons ici notre expérience initiale.Matériel et méthodeIl s’agit d’une étude prospective portant sur les femmes ayant été vues à la consultation d’évaluation du RCS et analysant : leur profil, leur risque évalué selon les modèles de Tyrer Cuzick (TC) ± Mammorisk© (MMR), l’existence d’une indication de consultation d’oncogénétique (scores d’Eisinger et de Manchester), leur satisfaction et la surveillance préconisée.RésultatsParmi les femmes ayant eu une évaluation du RCS par le modèle TC et/ou MMR (n = 153), 76 (50 %) avaient un risque élevé (n = 67) ou très élevé (n = 9). Près de la moitié (47 %) avait une indication possible (15 %) ou certaine (32 %) à une consultation d’oncogénétique. Concernant cette consultation, 98 % des femmes étaient satisfaites ou très satisfaites. Au total, 60 % des femmes ont eu un changement des modalités de surveillance.ConclusionCette consultation d’évaluation du RCS satisfait les femmes et pour une majorité d’entre elles, modifie les modalités de leur surveillance mammaire.

In France, participation in the organized breast cancer screening program remains insufficient. A personalized approach adapted to the risk factors for breast cancer (RBC) should make screening more efficient. A RBC evaluation consultation would therefore make it possible to personalize this screening. Here we report our initial experience.This is a prospective study on women who were seen at the RBC evaluation consultation and analyzing: their profile, their risk assessed according to Tyrer Cuzick model (TC)±Mammorisk© (MMR), the existence of an indication of oncogenetic consultation (Eisinger and Manchester score), their satisfaction and the recommended monitoring.Among the women who had had a TCS and/or MMR evaluation of SCR (n=153), 76 (50%) had a high risk (n=67) or a very high risk (n=9). Almost half (47%) had a possible (15%) or certain (32%) indication to an oncogenetic consultation. Regarding this consultation, 98% of women were satisfied or very satisfied. In total, 60% of women had a change in screening methods.This RBC evaluation consultation satisfies women and for a majority of them, modifies their methods of breast cancer screening.

To define the prognostic value of isolated tumor cells (ITC), micrometastases (pN1mi) and macrometastases in early stage breast cancer (ESBC). We conducted a retrospective multicenter cohort study at 13 French sites. All the eligible patients who underwent SLNB from January 1999 to December 2008 were identified, and appropriate data were extracted from medical records and analyzed. Among 8001 patients, including 70% node-negative (n = 5588), 4% ITC (n = 305), 10% pN1mi (n = 794) and 16% macrometastases (n = 1314) with a median follow-up of 61.3 months, overall survival (OS) and recurrence-free survival (RFS) rates at 84 months were not statistically different in ITC or pN1mi compared to tumor-free nodes. Axillary recurrence (AR) was significantly more frequent in ITC (1.7%) and pN1mi (1.5%) compared to negative nodes (0.6%). Survival and AR rates of single macrometastases were not different from those of ITC or pN1mi. In case of 2 macrometastases or more, survival rates decreased and recurrence rates increased significantly. Micrometastases and ITC do not have a negative prognostic value. Single macrometastases might have an intermediate prognostic value while 2 macrometastases or more are associated with poorer prognosis.

Resume La densite mammaire est depuis quelques annees au cœur de multiples controverses quant a sa qualite de facteur de risque independant de cancer du sein. Cet expose tentera de definir le terme de densite mammaire, d’etudier les facteurs influant sur ce parametre, d’exposer les differentes techniques disponibles pour la quantifier ainsi que les etudes suggerant une correlation avec le sur-risque de cancer du sein.

La complexite de la survenue d’une tumeur maligne au cours de la grossesse et la necessite d’obtenir des donnees epidemiologiques, pharmacologiques et biologiques completes ont rendu indispensable la creation d’un reseau national labellise. Ce reseau permet de repondre a de nombreuses interrogations auxquelles les cliniciens sont peu prepares: necessite d’une modification du schema therapeutique en fonction des traitements autorises.

Resume Objectif La reunion de concertation multidisciplinaire (RCP) a ete mise en place en France pour garantir une prise en charge homogene des patientes prises en charge en cancerologie en appliquant les referentiels en oncologie mammaire. Ces referentiels sont-ils reellement suivis dans les decisions emises par la RCP ? Patientes et methodes Nous avons analyse les 200 derniers dossiers de patientes operees en senologie dans le service. Nous avons cherche pour chaque dossier s’il avait ete presente a la RCP, a quel moment de la prise en charge et si la decision de RCP etait conforme aux referentiels utilises dans le service. Resultats Les 200 patientes avaient une moyenne d’âge de 56 ans (27–87 ans) et 145 (72,5 %) d’entre elles ont ete prises en charge pour un cancer invasif. Tous les dossiers ont ete discutes au moins une fois en RCP, 148 (74 %) en preoperatoire et 200 (100 %) en postoperatoire. Seules quatre decisions n’etaient pas conformes aux recommandations. Dans trois cas, la decision a ete motivee par le comite multidisciplinaire et dans un cas, la decision n’a pas ete motivee mais elle etait explicable. Discussion et conclusion Nous avons retrouve une bonne adequation des decisions de RCP avec les referentiels utilises dans notre centre. Certains dossiers compliques necessitent neanmoins d’adapter les referentiels aux particularites et aux souhaits de certaines patientes.

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. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-14-12.

Background. To reduce the incidence of microbial colonization of suture material, Triclosan- (TC-)coated suture materials have been developed. The aim of this study was to assess the incidence of suture-related complications (SRC) in breast surgery with and without the use of TC-coated sutures.Methods. We performed a study on two consecutive periods: 92 patients underwent breast surgery with conventional sutures (Group 1) and 98 with TC-coated sutures (Group 2). We performed subgroups analyses and developed a model to predict SRC in Group 1 and tested its clinical efficacy in Group 2 using a nomogram-based approach.Results. The SRC rates were 13% in Group 1 and 8% in Group 2. We found that some subgroups may benefit from TC-coated sutures. The discrimination obtained from a logistic regression model developed in Group 1 and based on multifocality, age and axillary lymphadenectomy was 0.88 (95% CI 0.77–0.95) (). There was a significant difference in Group 2 between predicted probabilities and observed percentages (). The predicted and observed proportions of complications in the high-risk group were 38% and 13%, respectively.Conclusion. This study used individual predictions of SRC and showed that using TC-coated suture may prevent SRC. This was particularly significant in high-risk patients.

Background: The role of DNA ploidy in genomic instability of cancer cells and prognosis has been described in a number of studies. The role of the centrosome in cell cycle has also been reported. Aim: In this study, we aimed to investigate the correlation between the centrosome and DNA ploidy in breast cancer in a search for a cytologic predictive and prognostic marker. Materials and Methods: Cell prints were prepared from cell culture of mesothelial cells, fibroblast cell line MRC5 and breast cancer cell lines MCF7 and T47D. Indirect immunofluorescence was used with anti-γ-tubulin and centrosomes were quantified using a fluorescence microscope. DNA ploidy was scored with the DNA index analyzed by flow cytometry. Results: The normal mesothelial cells (94% of the cells with one detected centrosome) and MRC5 diploid cells (68% with two centrosomes) were used as quality controls. A correlation between the number of centrosomes and DNA ploidy was found in MCF7 cell lines (64% of the cells with a number of centrosomes ≥ 3). It was not observed in invasive breast cancer samples; however, the frequency of cells with centrosomes ≥ 3 was found to be slightly higher in DNA aneuploid samples than in DNA diploid samples (15% vs 13.3%). Conclusion: Quantification of centrosome appears to be correlated to DNA ploidy in breast cancer cell lines and slightly associated to DNA aneuploidy in invasive breast cancer. Studies analyzing a larger number of samples as well as morphological abnormalities of the centrosome are needed.

Background Ko’s scoring system was developed to predict malignancy upgrades in patients diagnosed with atypical ductal hyperplasia by core needle biopsy. The Ko algorithm was able to identify a subset of patients who were eligible for exclusively clinical follow-up. The current study statistically investigated the patient outcomes to determine whether this scoring system could be translated and used safely in clinical practice. Methods We tested the statistical performance of the Ko scoring system against an external independent multicentre population. One hundred and seven cases of atypical ductal hyperplasia diagnosed by an 11-gauge biopsy needle were available for inclusion in this study. The discrimination, calibration and clinical utility of the scoring system were quantified. In addition, we tested the underestimation rate, sensitivity, specificity, and positive and negative predictive values according to the score threshold. Results The overall underestimation rate was 19% (20/107). The area under the receiver operating characteristic curve for the logistic regression model was 0.51 (95% confidence interval: 0.47–0.53). The model was not well calibrated. The lowest predicted underestimation rate was 11%. The sensitivity, specificity, positive predictive value, and negative predictive values were 90%, 22%, 20%, and 89%, respectively, according to the most accurate threshold proposed in the original study. Conclusion The scoring system was not sufficiently accurate to safely define a subset of patients who would be eligible for follow-up only and no additional treatment. These results demonstrate a lack of reproducibility in an external population. A multidisciplinary approach that correlates clinicopathological and mammographic features should be recommended for the management of these patients.

Background Bone metastasis (BM) is one of the most common sites of distant metastasis for breast cancer. We hypothesized that its occurrence can be predicted if a clinical nomogram can be developed, thus allowing for selection of patients at high risk for BM. Patients and Methods Medical records of patients with non metastatic breast cancer were prospectively collected for the period between January 1997 and February 2007 at the M.D. Anderson Cancer Center (Texas, USA). A multivariate logistic regression analysis of selected prognostic features was done. Based on Cox proportional hazards regression model, a nomogram to predict BM was constructed and validated in an independent cohort of 579 patients with non metastatic breast cancer at time of diagnosis treated at the Tenon Hospital (Paris, France) between January 2003 and December 2005. Results: Of 4175 patients with non metastatic breast cancer, 314 developed subsequent BM. Age, T stage, lymph node status, lymphovascular space invasion, breast cancer molecular subtype, adjuvant hormonotherapy were significantly and independently associated with subsequent BM. The nomogram had a concordance index of 0.69 (95% CI, 0.68 to 0.70) in the training set. The validation set showed a good discrimination with a concordance index of 0.65 (95% CI, 0.57 to 0.72). At 3, 5 and 7 years, the nomogram was well calibrated. Conclusion: We have developed a robust tool that is able to predict subsequent BM in patients with non metastatic breast cancer. Selection of an enriched patient population at high risk for BM will allow to practice individualized therapeutic strategies, an adapted medical supervision and will facilitate the design of trials aiming at its prevention with the use of biphosphonate treatment. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-06.

Background: Lymphocele is the principal post-operative morbidity following axillary node dissection. According to the literature, incidence can vary from 4 to 89%. Encouraging results in terms of reducing postoperative lymphoceles as well as drainage duration and volume using octreotide have been recorded recently. A new molecule, namely pasireotide, developed by Novartis Pharma AG, Basle Switzerland, is a somatostatin analog possessing high binding affinity to 4 of the 5 somatostatin receptors. Trial design: We are performing a prospective, randomized 1:1, double blind, multicenter trial against placebo with a Bayesian design. Eligibility criteria: any female patient scheduled for breast surgery with mastectomy and axillary node dissection indicated at the pre-surgical stage. Specific aims: The purpose of this trial is to assess the efficacy of a single pre-surgical injection of pasireotide LAR 60 mg im in reducing the postoperative incidence of symptomatic lymphoceles following mastectomy with axillary node dissection for breast cancer. Patients are followed up for 4 weeks Statistical methods: The statistical analysis will be carried out sequentially after observing the principal criterion (i.e. success is defined as a total volume of lymphocele following single or repeated aspiration ≤ 60 cc in the 28 days following surgery or a routine aspiration volume on the 28th day ≤ 120cc) of each patient included for each randomization group, with or without treatment. It involves estimating the probability of a response in each group using a Bayesian design based on a beta-binomial model. With the Bayesian approach, the response rate in each group (πi) is considered as a random variable, with a priori density focused on the anticipated response rate of 80% in the group receiving treatment and 60% in the non-treatment group, which will be sequentially updated as the observations are made according to a so-called a posteriori law. Present accrual and target accrual: The sample size consists of a total of 90 patients with 45 patients in the active treatment group and 45 patients in the placebo one. To date more than 50% of the patients have been included. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT2-07-01.

To determine the value of adding conventional imaging (mammography and ultrasonography [US]) to nonmasslike enhancement (NMLE) analysis with breast magnetic resonance (MR) imaging for predicting malignancy and for building an interpretation model incorporating all imaging modalities.The institutional ethics committees approved the study and granted a waiver of informed consent. In 115 women (mean age, 48.3 years; range, 21-76 years; 56 malignant, 12 high-risk, and 63 benign lesions), 131 NMLE lesions were analyzed. Two independent readers first classified MR images by using descriptive Breast Imaging Reporting and Data System (BI-RADS) criteria (BI-RADS classification with MR images alone [BI-RADS(MR)]) and later repeated this classification, adding information from conventional imaging (BI-RADS classification with combination of MR images and conventional images [BI-RADS(MR+Con)]). Lesion diagnosis was established with surgical histopathologic findings (n = 68), percutaneous biopsy results (n = 25), or 2 years of stability at MR imaging (n = 38). Receiver operating characteristic curves were built to compare BI-RADS(MR) with BI-RADS(MR+Con). A multivariate interpretation model was constructed and validated in a distinct cohort of 44 women.Values for inter- and intraobserver agreement, respectively, were better for BI-RADS(MR+Con) (κ = 0.847 and 0.937) than for BI-RADS(MR) (κ = 0.748 and 0.861). For both readers, the areas under the receiver operating characteristic curve (AUCs) for diagnosis of malignancy were also superior when BI-RADS(MR+Con) (AUC = 0.91 [reader 1] and 0.93 [reader 2]) was compared with BI-RADS(MR) (AUC = 0.84 [reader 1] and 0.87 [reader 2]) (P.05). An interpretation model combining conventional imaging with MR imaging criteria showed very good discrimination (AUC = 0.89 [training set] and 0.90 [validating set]).Adding conventional imaging to NMLE lesion characterization at breast MR imaging improved the diagnostic performance of radiologists, and the interpretation model used offers good accuracy with the potential to optimize the reproducibility of NMLE analysis at MR imaging.

Resume Cette mise au point presente l’interet des differentes modalites d’imagerie (mammographie, echographie et IRM) dans l’exploration de la pathologie mammaire chez l’homme. Elle rappelle la place de chacune des modalites dans l’exploration des differentes pathologies rencontrees. Celles ci sont largement dominees par la gynecomastie et le cancer dont les caracteristiques principales decrites dans la litterature sont rappelees. Au travers de differents cas cliniques, plusieurs pathologies benignes rares sont presentees a visee essentiellement iconographique car les differentes techniques d’imagerie actuelle ont une specificite limitee pour caracteriser de facon precise cet ensemble de pathologies. Enfin, un dernier chapitre est consacre a une mise au point sur le choix des differentes modalites d’imagerie en fonction du contexte clinique.

In breast conserving surgery (BCS), the usefulness to perform systematic cavity shaving is actively debated. Some investigators argued that systematic cavity shaving could avoid surgical re-excision and make diagnosis of unexpected multifocality. Others argued that usefulness of cavity shaving depends on volumes of resection. In this study one hundred patients undergoing BCS with systematic cavity shaving were included. Margins less than 3 mm were considered to be insufficient. We tested clinico-pathological characteristics in order to identify predictive model of cavity margin shaving utility and we sought to determine if cavity margin shaving usefulness depends on volumes of resection. We showed that cavity shaving avoids the need for re-excision in 24% of cases as well as diagnosis of multifocality in 6% of cases. However, the clinical usefulness of cavity shaving was not related to the volumes of resection.

Resume Objectifs La multifocalite dans les cancers du sein invasifs n’est pas reconnue comme un critere pronostique et n’est pas une indication de traitement adjuvant systemique. Par ailleurs, la methode la plus appropriee pour estimer la taille des tumeurs multifocales fait debat. Le but de cette etude est d’une part d’evaluer la valeur predictive et pronostique de la multifocalite, et d’autre part de comparer les differentes methodes utilisees pour estimer la taille de ces tumeurs. Patientes et methodes Entre 2001 et 2008, 1458 patientes ayant un cancer du sein invasif dont 16 % avec une tumeur multifocale ont ete incluses. Nous avons compare l’impact de la multifocalite sur le risque d’envahissement ganglionnaire, de recidives locales et a distance, et de survie globale. Trois methodes d’estimation de la taille des tumeurs multifocales ont ete comparees. Resultats La multifocalite est un facteur independant d’envahissement ganglionnaire. Les patientes ayant une tumeur multifocale ont un sur-risque d’environ 20 % d’envahissement ganglionnaire compare a une tumeur unifocale de meme taille. Considerer le diametre maximal du plus grand des foyers est la facon la plus appropriee d’estimer la taille tumorale d’un cancer multifocal. Discussion et conclusion On ne parvient pas a identifier de sous-groupe a faible risque d’envahissement ganglionnaire en cas de cancer multifocal. Ces resultats nous amenent a proposer d’etendre les indications de chimiotherapie adjuvante dans les cancers multifocaux, y compris en cas de tumeur de petite taille. Ces resultats devront etre valides par des essais multicentriques randomises.

Purpose: Estrogen receptor-positive (ER+) and -negative (ER) breast cancers are molecularly distinct diseases. We hypothesized that p53 mutations may lead to different transcriptional changes and carry different prognostic value in these two different types of cancers. Experimental Design: We developed a 39-gene p53 signature derived from 213 ER+ and a separate 30-gene signature from 38 ER− cancers with known mutation status and tested their prognostic and chemotherapy response predictive values in ER+ and ER− cancers, respectively. Results: External validation to predict p53 status (n = 103) showed sensitivity and specificity of 89% and 54% for the 39-gene signature, and 82% and 61% for the 30-gene signature. The 39-gene signature was predictive of worse distant metastasis free survival in ER+ cancers in two separate prognostic data sets (n = 255, HR: 2.3, P = 0.005 and n = 198, HR: 2.17, P = 0.09). It also predicted for poor prognosis even with adjuvant tamoxifen therapy (n = 277, HR = 2.43, P < 0.0001) but it was not prognostic in ER− cancers. It was also associated with higher chemotherapy sensitivity in ER+ but not in ER− cancers. The prognostic and predictive values remained significant in multivariate analysis. The 30-gene, ER−, p53 signature showed no prognostic or predictive values in ER+ cancers but it was associated with better prognosis in ER− cancers. It also had no chemotherapy response predictive value in ER− or ER+ cancers. Conclusions: P53 dysfunction is prognostically most relevant in ER+ cancers and supports the hypothesis that different predictive or prognostic markers will be needed for different molecular subsets of breast cancer. Clin Cancer Res; 17(8); 2591–601. ©2011 AACR.

Plusieurs etudes decrivent le role de l’ADN-ploidie dans les instabilites genomiques des cellules cancereuses et le pronostic. Le centrosome jouant un role important dans le cycle cellulaire, de nouveaux facteurs pronostiques pourront etre introduits pour mieux cibler les traitements. L’objectif de ce travail est de rechercher dans le cancer du sein une anomalie centrosomique et la correlation avec l’ADN-ploidie. Des lames sont realisees a partir des echantillons de prelevements mammaires et des suspensions cellulaires (cellules mesotheliales et lignees cellulaires MRC5, MCF7, T47D). L’immunofluorescence indirecte est utilisee avec l’anticorps anti-γ-tubuline puis un fragment F(ab′) 2 conjugue au fluoro-isothyanate. Les centrosomes sont quantifies au microscope a fluorescence. L’ADN-ploidie est definie par l’index d’ADN analysee par cytometrie en flux. Les cellules mesotheliales normales (94 % des cellules avec un centrosome) et les cellules MRC5 diploides cyclantes (68 % avec deux centrosomes) sont des controles de qualite des experiences. Une correlation entre l’ADN-ploidie et le nombre de centrosomes est retrouve dans les lignees MCF7 (64 % des cellules avec un nombre de centrosomes ≥ 3) mais pas dans les lignees T47D et les dix echantillons de carcinome invasif du sein analyses dans cette etude. L’absence de relation entre l’ADN-ploidie et le nombre de centrosomes pourrait etre due au petit nombre d’echantillons mammaires etudies, aux empreintes cellulaires ou au mecanisme tumoral. Un elargissement de l’etude sur un grand nombre d’echantillons et de pathologies mammaires et l’etude des anomalies morphologiques du centrosome sont prevus.

AIM: Multifocality in breast cancer has a great on treatment options. However, the prevalence of multifocality is currently underestimated at the time of diagnosis because of the lack of sensitivity of clinical examination and imaging. Our aim was to develop a tool for predicting multifocality based on clinical and immunohistochemical criteria. METHOD: This study was conducted at Tenon Hospital with samples from patients operated on between 2002 and 2009. We constructed a tissue micro-array (TMA) from 100 breast specimens: 50 multifocal tumors and 50 unifocal unifocal tumors. Unifocal tumors were matched with multifocal tumors by size of largest focus, hormonal receptor status and SBR grade. These unifocal controls had either a mastectomy or a pre-operative MRI to rule out occult multifocality. We studied the expression of ten different antibodies (HER2, KI67, CK 5/6, CK 14, CK18, Vimentine, C-kit, EGFR, p53, and p63). From the results of this analysis we developed a prediction model based on a multivariate logistic regression. RESULTS : For the proteins tested, the concordance of immunohistochemical staining of foci from multifocal tumors ranged from 72% to 100%. In the univariate analysis, only c-kit expression was significantly associated with multifocality (P CONCLUSION: We report the first clinico-biological predictor of multifocality. New markers are currently tested to improve the performance of the multivariate model. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-06-23.

Multifocality in breast cancer is a frequent phenomenon, whose prevalence may vary between 13 and 75%. The differences in estimation of the prevalence of multifocality across studies may be explained by the differing definitions used for multifocality and multicentricity; this inconsistency makes it difficult to analyze the literature on the subject. The incidence of multifocality is probably often underestimated. Currently, the diagnosis relies on imaging. The performance of mammography is relatively low, but the addition of breast ultrasonography can improve diagnostic sensitivity. Recently, breast magnetic resonance imaging (MRI) has been shown to be more accurate for detecting multifocality compared to conventional imaging. However, this modality is associated with high rates of false-positives that could result in inappropriate disease management. Thus, the use of MRI is not recommended as a first-line technique for diagnosing multifocality. The diagnosis of multifocality is important for breast cancer management, particularly with regards to the choice of surgery. A finding of multifocality may spur a decision to perform a wider excision that will avoid positive margins. Regarding the results of conservative surgery in the presence of multifocality, studies are contradictory, and no international consensus exists. Multifocality may also modify the management of the axillary basin; studies have shown that multifocality is associated to an over-risk of 20% of lymph node invasion. The sentinel node biopsy has been considered as an alternative to complete axillary lymph node dissection by the American Society of Clinical Oncology. The prognostic value of multifocality is still not well known, although some studies have suggested that it is associated with a worst prognosis. Further studies are needed to better assess the impact of multifocality on breast cancer prognosis.

Breast cancer is a frequent and heterogeneous disease. The choice of systemic treatments such as chemotherapy is based on predicting factors of response that did not much evolve. Preoperative chemotherapy provides an opportunity to directly assess tumor response to therapy. Predictors based on mathematical models could optimize those treatments. To go on this way, three different concepts have been developed to predict the preoperative chemotherapy complete response. Predictors based on clinical and pathological variables are specific of a tumor. They combine into mathematical models variables that have been previously identified as predicting the preoperative chemotherapy complete response. Predictors based on gene expression profile have been developed from groups of patients who received preoperative chemotherapy. They integrate multigene information to predict the tumor behaviour in front of several cytotoxic agents. Those predictors developed for each type of drug characterize the genetic chemoresistance of a tumor. In the same time, predictors of chemosensitivity developed from cell lines of diverse human cancer appeared. The authors established a genetic profile involved into chemoresistance and extrapolated the drug sensitivity for another type of cancer which was not represented, as breast cancer. All those predictors seem interesting but evolution of patients' characteristics and treatments induces a perpetual reassessment to optimize our predictive abilities.

Please cite this paper as: Rouzier R, Bergzoll C, Brun J, Dubernard G, Selle F, Uzan S, Pomel C, Darai E. The role of lymph node resection in ovarian cancer: analysis of the surveillance, epidemiology, and end results (SEER) database. BJOG 2010;117:1451–1458. Objective The therapeutic role of lymphadenectomy on the survival in patients with ovarian cancer is controversial. The aim of this study was to evaluate the survival impact of lymphadenectomy, depending on the disease stage and extent of the surgery. Design The surveillance, epidemiology, and end results (SEER) registry provided ovarian cancer data from 17 registries. Setting Surveillance, Epidemiology, and End Results database. Population The study population comprised 49 783 patients. Methods Survival was studied according to the number of lymph nodes removed, with stratifications on disease stage and extent of surgery. Main outcome measure The 5-year cause-specific survival rate. Results The median follow up for patients alive at the last follow-up visit was 39 months. The five-year cause-specific survival rates were 37, 62, and 71% for the groups in which no lymph nodes were examined, in which between one and nine nodes were examined, and in which ten or more nodes were examined, respectively (P

Breast cancer (BC) is the most frequently occurring cancer in women; early diagnosis and efficient treatments create higher event-free and overall survival rates. However, the mean age at first pregnancy continues to increase worldwide; the question of pregnancy after BC is thus raised more frequently. Chemotherapy may induce premature ovarian failure, depending largely on the woman's age and the drugs used, as well as the dosage and duration of treatment. It is important that fertility preservation strategies are addressed before chemotherapy. Pregnancy after BC may implicate a potentially higher risk of cancer recurrence, but the available literature provides reassuring data. The delay between cancer treatment and pregnancy should be discussed, depending on the initial stage of the disease. The risk of discontinuing tamoxifen prematurely should be carefully evaluated using standardised tools. The pregnancy outcome may as well be impaired by the history of cancer, leading to an increased likelihood of preterm birth and low birth weight rates. Proper follow-up and prevention should be provided based on the knowledge of these complications. Pregnancy after BC should be possible for most young BC patients in the future. This implies a global care program including multi-disciplinary teams is initiated prior to starting adjuvant treatment and particularly chemotherapy. The patient and her partner should be involved in the various steps of the process, after being properly informed.

Resume La population des femmes a haut risque de cancer du sein et/ou de l’ovaire (c’est-a-dire un risque relatif par rapport a la population generale superieur ou egal a 4 ou un risque absolu de plus de 20 %) regroupe les femmes porteuses d’une mutation constitutionnelle deletere des genes BRCA1 ou BRCA2 , les femmes dont l’histoire familiale est evocatrice d’un haut risque, et les femmes ayant presente une lesion mammaire benigne a risque, notamment les hyperplasies atypiques. Un centre specifique reunissant dans un groupe multidisciplinaire les differentes specialites impliquees dans la prise en charge de ces patientes (geneticien, radiologue, chirurgien/gynecologue, chirurgien plasticien, endocrinologue, anatomo-pathologiste, cytologiste, psychologue, oncologue medical) a ete cree a l’hopital Tenon. Ce centre permet d’etablir, en collaboration avec le medecin referent, les modalites d’un suivi personnalise evolutif adapte aux differentes etapes de la vie de chacune de ces femmes en accord avec les progres medicaux les plus recents.

Fetal CD34+ cells enter the maternal circulation during pregnancy and may persist for decades. These cells are usually depicted as hematopoietic stem/progenitor cells. Our objective was to further determine the phenotype of fetal chimeric CD34+ cells in placental maternal blood from the intervillous space (IVS). Human healthy term placentas were analyzed (n=9). All fetuses were male. CD34+ cells were identified in the IVS and further characterized as fetal or maternal using X and Y chromosome fluorescence in situ hybridization. The phenotype of fetal cells was further analyzed using anti-CD117 (c-kit), anti-CD133, anti-CD31, anti-von Willebrand factor (vWF), anti-vimentin, anti-CD45 and anti-cytokeratin (CK) antibodies. We used preeclamptic placentas of male (n=3) and healthy placentas of female fetuses (n=3) as controls. As expected fetal cells were easily identified in the IVS and significantly increased in cases of preeclampsia. Most CD34+ cells in the IVS were of fetal origin (90%) and were not surrounded by CK staining further showing that they were not in fetal trophoblastic villi. Similarly, about 40% of CD31+ and 6% of vimentin+ cells in the IVS were fetal in origin. No CD117+ or CD133+ fetal cells were found in the IVS of examined placentas. Besides, all the CD34+ cells identified in the IVS were co-labeled with vWF or CD31, suggesting their endothelial origin. These results suggest that most CD34+ cells in maternal placental blood at term are fetal in origin from endothelial and not hematopoietic lineages.

Resume Objectifs Le prelevement du ganglion sentinelle (GS) est devenu le nouveau standard de l’exploration axillaire pour les tumeurs du sein invasives, unifocales, de petite taille. La decouverte de la multifocalite a posteriori, alors que la procedure du GS a ete realisee et que ce dernier est indemne de metastase, pose la question de la necessite ou non d’un curage axillaire (CA) complementaire. Patientes et methodes Il s’agit d’une etude retrospective portant sur 43 patientes ayant une tumeur multifocale decouverte en peroperatoire ou lors de l’examen histologique definitif et qui ont beneficie de la procedure du GS. Un examen anatomopathologique par coupes seriees en hemateine eosine safran (HES) et immunohistochimie (IHC) a ete realise pour chaque GS. Resultats La taille histologique moyenne de la tumeur la plus volumineuse etait de 16,8 mm (1 a 52 mm). Le nombre moyen de GS preleves par patiente etait de 2,07 (1 a 5). Seize patientes (34,1 %) avaient au moins un GS positif. Vingt-sept patientes ont eu un curage complementaire. La valeur predictive negative (VPN) etait de 100 % (intervalle de confiance [IC] a 95 % : 87,1 a 100 %) avec un nombre de faux-negatifs de zero. Aucune recidive axillaire n’est survenue apres un recul moyen de 20,8 mois (1–77). Discussion et conclusion La puissance de notre etude est insuffisante pour valider la procedure du GS en cas de decouverte secondaire du caractere multifocal d’une tumeur invasive. Cependant, le taux de faux-negatif de 0 % nous permet de penser que d’autres etudes prospectives avec un CA systematique permettraient de preciser si, dans ce contexte, le GS peut etre une alternative au CA.

PurposeSeveral models have been developed to predict nonsentinel lymph node (non-SN) status in patients with breast cancer with sentinel lymph node (SN) metastasis. The purpose of our investigation was to compare available models in a prospective, multicenter study.Patients and MethodsIn a cohort of 561 positive-SN patients who underwent axillary lymph node dissection, we evaluated the areas under the receiver operating characteristic curves (AUCs), calibration, rates of false negatives (FN), and number of patients in the group at low risk for non-SN calculated from nine models. We also evaluated these parameters in the subgroup of patients with micrometastasis or isolated tumor cells (ITC) in the SN.ResultsAt least one non-SN was metastatic in 147 patients (26.2%). Only two of nine models had an AUC greater than 0.75. Three models were well calibrated. Two models yielded an FN rate less than 5%. Three models were able to assign more than a third of patients in the low-risk group. Overall, the Memorial Sloan-Kettering Cancer Center nomogram and Tenon score outperform other methods for all patients, including the subgroup of patients with only SN micrometastases or ITC.ConclusionOur study suggests that all models do not perform equally, especially for the subgroup of patients with only micrometastasis or ITC in the SN. We point out available evaluation methods to assess their performance and provide guidance for clinical practice.

Objective The aim of this study is to evaluate the accuracy and the safety of stereotactic vacuum-assisted breast biopsy with a 10-gauge hand-held portable system. Materials and methods Retrospective data review of 288 consecutive breast lesions that underwent stereotactic 10-gauge hand-held portable vacuum-assisted biopsy from October 2004 through March 2006, was performed. The mean number of core specimens and the percentage of complete radiological removal of the target lesion were analysed. ADH and DCIS under-estimation were evaluated, as were the immediate and delayed complications due to the procedure. Results The mean number of core specimens obtained per procedure was 9 (range 4–24). Complete radiological excision of the target lesion was achieved in 31.6% (91 of 288) with 91% of these lesions smaller than 10 mm (mean size 7 mm; range 4–20 mm). Under-estimation of ADH and DCIS was 18.2% (2 of 11) and 19.2% (9 of 47), respectively. There was no false negative result within a 3-year follow-up (from 2005 till date). Complications were mild and consisted of immediate bleeding and delayed haematomas. Conclusion Breast biopsy using 10-gauge vacuum system is an accurate and safe technique for sampling non-palpable breast lesions.

In breast cancer, nine models have been developed to predict non SN status in patients with SN metastasis. Four models are nomograms: the Memorial Sloan-Kettering Cancer Center nomogram (MSKCC nomogram), the nomogram of Degnim et al. (Mayo nomogram), the nomogram of Pal et al. (Cambridge nomogram), and the nomogram of Kohrt et al. (Stanford nomogram). Three models are scoring systems: the Tenon score, the score from the M.D. Anderson Cancer Center (MDA score), and the score of Saidi et al. Finally, two are recursive partitioning tools developed by Kohrt et al. Before being used in routine, these models have to be validated in independent populations based on discrimination and calibration. However, the main issue is their clinical utility based not only on the low false negative rate but also its potential to discriminate patients with a low risk of non SN involvement. Several institutions have tested the MSKCC nomogram, with AUC ranging from 0.58 to 0.86. It was not validated by four studies which did not recommend its use even in patients with micrometastasis.The external validation of the Tenon score confirmed its relevance with an AUC of 0.82.

La mama pasa por numerosas modificaciones fisiologicas durante el embarazo. Pero tambien puede constituir la localizacion de mastopatias benignas o tumores, benignos o malignos, lo cual puede ser muy angustioso para la paciente y para el medico. Para eliminar un cancer, cuyo diagnostico suele ser tardio y dificil durante el embarazo, es necesario explorar toda masa mamaria. No es excepcional que un cancer de mama se descubra durante el embarazo (el 3% de los canceres de mama) y la mayor parte de las mastopatias benignas pueden parecerse a un tumor maligno, sobre todo en caso de infiltracion hemorragica de un tumor benigno. La exploracion prioritaria es la ecografia mamaria; la mamografia no esta contraindicada, pero su sensibilidad esta disminuida. No hay que dudar en recurrir a la citologia e incluso a la biopsia. El tratamiento va desde una simple vigilancia en caso de adenoma lactante o una puncion evacuante en caso de galactocele hasta una mastectomia bilateral en caso de gigantomastia gravidica con repercusion maternofetal. El tratamiento del cancer tiene que ser lo mas parecido posible al que se realiza fuera del embarazo, pero hay que aplazar la radioterapia y la hormonoterapia hasta despues del parto; la interrupcion del embarazo no modifica su pronostico.

Objective The purpose of this study was to investigate the risk of carcinoma in patients with a diagnosis of papilloma of the breast made on ultrasound large core biopsy or stereotactic vacuum-assisted biopsies. Material and methods This retrospective database review (2000–2007) included 130 patients with a papilloma diagnosed on preoperative biopsies or excisional surgery specimen. The mean patient age was 52 years (range, 20–80 years). The examinations included mammography and ultrasonography in all 130 patients. The final surgical histology was compared to preoperative biopsy diagnosis, and then factors associated with underestimation of malignancy were evaluated in univariate and multivariate analyses. Results The preoperative histology was available for 63 patients. Benign papilloma had been identified by ductography in 34 patients and by preoperative biopsy in 48 patients. Mammography showed microcalcifications in 25 cases and nipple discharge was present in 59 patients. Malignancy was found on final histology in 8% of patients with initial diagnosis of benign papilloma. In this study group, age of more than 50 years, presence of nipple discharge and microcalcifications were found to be significantly related to the risk of malignancy (p = 0.001, 0.05 and 0.02, respectively). Conclusion Since benign papilloma can be associated to malignancy at excisional biopsy, we still recommend surgical excision for papilloma especially when associated to identified risk factors of malignancy.

Summary Background: Occult invasive disease could be found at definitive histology in patients initially diagnosed with large ductal carcinoma in situ (DCIS). Sentinel lymph node (SLN) biopsy is a reliable and minimally invasive procedure providing axillary information and avoiding a second operation in this particular group of patients. The aim of our study was to assess the value of SLN biopsy in patients with large DCIS who are at highest risk for being upstaged to invasive carcinoma. Patients and methods: The study included 195 patients diagnosed with DCIS upon initial core biopsy and undergoing SLN biopsy. Many features were correlated with the presence of unsuspected invasive disease and positive SLN biopsy using univariate and multivariate analyses. Results: Of the 110 patients with pure DCIS, seven patients (6%) had a metastatic lymph node; 31 patients (16%) were found to have invasive disease upon final histology. Univariate analysis of predictors of unsuspected invasive carcinoma showed that patients having a preoperative biopsy that indicated DCIS with microinvasion (DCISM) or large DCIS were at a higher risk of invasive carcinoma after histological examination of the operative specimen. Of the 31 patients who were upstaged to invasive carcinoma at final histology, seven patients (22%) had a positive SLN biopsy. The analysis of predictors of positive SLN in our study shows that diffuse DCIS requiring mastectomy is the main risk factor for SLN metastasis. Conclusion: There are no real predictive factors for invasive disease in patients with an initial diagnosis of DCIS or DCISM. Our study supports the value of SLN biopsy in patients with a preoperative DCISM biopsy or patients with a large pure DCIS biopsy requiring mastectomy.

After a pregnancy, there is a transitory increase in the risk of breast cancer. During the pregnancy, the number of mammary epithelial cells increases massively. This increase seems partly due to the expansion of stem cells and proliferating intermediate cells. This proliferation of epithelial cells is accompanied by angiogenesis and by recruitment of stromal cells, as well as changes of the extracellular matrix. During any pregnancy, there is cell trafficking between mother and foetus. Hematopoietic or mesenchymal foetal stem cells are transferred in maternal circulation and could be used by the tumor as support cells and take part in the tumoral development. The study of the mechanisms of this specific oncogenesis may help to develop chemoprevention strategies.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 1S - p. 121-130

Resume Objectif Le cancer du sein bilateral synchrone (CSBS) n’est pas une entite rare, et les femmes deja atteintes d’un cancer unilateral ont un risque supplementaire de cancer controlateral. L’objectif de cette etude a ete d’evaluer les caracteristiques et le traitement des cancers du sein bilateraux synchrones (CSBS). Patientes et methodes Entre juillet 1992 et mai 2006, 62 patientes ont ete prises en charge pour un CSBS. Les tumeurs ont ete separees en tumeurs droite et gauche et la population divisee en deux periodes d’etude. Les donnees epidemiologiques, les circonstances diagnostiques, les traitements et les caracteristiques histologiques tumorales ont ete analyses et compares entre les differents groupes d’etude. Resultats L’incidence globale des CSBS etait de 2,6 %. Les patientes presentant un CSBS avaient un antecedent familial de cancer du sein dans 23,7 % des cas. Le tableau le plus frequent associait une tumeur palpable a une lesion controlaterale infraclinique (43,5 %). L’IRM a permis de diagnostiquer sept tumeurs. Parmi les patientes, 38,7 % ont eu une mastectomie bilaterale et 33,9 % ont beneficie de la technique du ganglion sentinelle. La proportion de carcinomes lobulaires invasifs etait de 17,7 %, identique a celle de tumeurs multifocales. Les tumeurs droite et gauche etaient du meme type histologique dans 78,3 % des cas et l’expression des recepteurs aux œstrogenes etait identique dans 91,4 % des cas. Discussion et conclusion Les principaux facteurs de risque de CSBS sont la notion d’une histoire familiale de cancer du sein, le type histologique lobulaire invasif et le caractere multifocal de la premiere tumeur. Une prise en charge chirurgicale conservatrice est possible ainsi que l’utilisation de la technique du ganglion sentinelle. Les CSBS ont des similitudes histologiques, probablement dues a des facteurs environnementaux.

The role of sentinel lymph node (SLN) biopsy in patients with initial diagnosis of ductal carcinoma in situ (DCIS) is still a dilemma. Different studies are trying to define predicting factors of invasive cancer in DCIS. The aim of this study was to confirm the value of SLN biopsy in DCIS because of the invasive upstaging risk on final histology. Patients with initial diagnosis of DCIS and with axillary SLN biopsy were selected. All diagnoses were confirmed by biopsy of mammographic lesions. Surgical treatment was lumpectomy or mastectomy associated with SLN biopsy. Imprint stains were performed, and then serial sections were stained with hematoxylin and eosin (H&E) and with immunohistochemistry (IHC). A complete axillary lymph node dissection (ALND) was performed during the same surgery when a node metastasis was found. Eighty patients were enrolled in the study. Of the 61 patients who were initially diagnosed with DCIS, 12 (20%) were upstaged to microinvasive or invasive carcinoma and 9 (15%) had a metastatic SLN. Patients upstaged to invasive carcinoma had macrometastatic SLN immediately fed by a complete ALND. SLN micrometastases and isolated cells were detected by IHC and secondary complete ALND found an additional metastatic lymph node in one patient. Tumor size larger than 30 mm and mastectomy were the only significative predicting factors of upstaged disease (p

Background: The sentinel node (SN) is defined as the first node in the lymphatic system that drains a tumor site. If the SN is not metastatic, then all other nodes should also be disease-free. We used serial sections and immunohistochemical (IHC) staining to examine both SN and non-sentinel nodes (non-SNs). Patients and methods: Twenty-three patients (median age 69 years) with early endometrial cancer underwent a laparoscopic SN procedure based on a combined detection method, followed by complete laparoscopic pelvic lymphadenectomy. If the SN was free of metastasis by both hematoxylin and eosin (H&E) and IHC staining, all non-SNs were also examined by the combined staining method. Results: SNs were identified in 19 patients (82.6%). A total of 47 SNs were removed (mean 2.5). Ten SNs (21.3%) from five patients (26.3%) were found to be metastatic at the final histologic assessment. In 14 patients, no metastatic SN involvement was detected by H&E and IHC staining. In these 14 patients, 120 non-SNs were examined by serial sectioning and IHC, and none were found to be metastatic. Conclusion: The SN procedure appears to reliably predict the metastatic status of the regional lymphatic basin in patients with early endometrial cancer.

Sentinel lymph node (SN) biopsy for breast cancer has been introduced in the mid-1990s and it has now been performed on thousands of patients. This procedure has been rapidly adopted around the world by surgical specialists in clinical practice as a diagnostic procedure instead of the axillary lymph node dissection. The diffusion of the SN mapping in routine must be careful by respecting some principles of methodology and especially of training, in order to maintain its irreversible development. However, the advent of this mini-invasive technique revealed new questions, which the concept of the SN procedure raises: can we increase the current indications? Could axillary lymph node dissection be avoided in patients with metastatic SN? What is the morbidity of the biopsy of the SN? Which is the prognostic value of micrometastatis discovered by the diffusion of the ultra-stadification of the SNs? The GS procedure is a diagnostic method the reliability of which is now on accepted in its usual indications (tumours in place, small size breast tumour without palpable adenopathy). The value of the axillary dissection after metastatic SN is the subject of debates and controversies although axillary dissection remains recommended. So the use of scores or predictive nomograms is currently developed to select the patients being able not to justify of complementary axillary dissection, and seems promising.

Background: It has been suggested that histologically undetectable or 'occult' metastases in the lymphatic system could explain some recurrences. HPV DNA screening by means of the polymerase chain reaction (PCR) has been proposed as a method to detect occult metastases. This study was designed to determine the frequency of HPV DNA detection by PCR in sentinel lymph node (SN), and its relation to the clinical characteristics and outcome of women with cervical cancer. Patients and methods: The primary cervical tumor and SN were tested for HPV DNA by means of PCR in 59 patients. Results: Fifteen (25.4%) of the 59 women undergoing the SN procedure had an involved SN. HPV DNA was more frequent in positive SN than in negative SN (P < 0.0001). Seven patients had a recurrence, after a mean delay of 17 months (range: 10-26). One of seven patients with a recurrence had an involved SN. HPV DNA was detected in an SN of one of seven patients with recurrence and nine (19.5%) of 46 patients without recurrence (not significant). Conclusion: In women with cervical cancer, HPV DNA screening of sentinel nodes might help to identify patients at risk of lymph node metastases and recurrence.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 36 - N° 5 - p. 468-472