[Exploring a non-inflammatory clinical breast mass: Clinical practice guidelines]. / Exploration d'un syndrome de masse clinique non inflammatoire du sein: recommandations pour la pratique clinique.

PURPOSE: The aim of the study was to assess the diagnostic value of physical examination, radiologic explorations and percutaneous procedures of the breast in the exploration of a non-inflammatory palpable mass, in order to propose guidelines. METHOD: A systematic literature review was conducted in the Medline and Cochrane library databases. International guidelines in French and English language were also consulted until April 30th 2015. RESULTS: Physical examination of a non-inflammatory palpable breast mass is not sufficient to eliminate a breast cancer (LE2). Mammography alone has a sensitivity between 70 and 95% for the diagnosis of breast cancer (LE3). Echography alone has a sensitivity of 98 to 100% for the diagnosis of breast cancer (LE2). The core needle biopsy has a better sensitivity and specificity than the fine-needle aspiration for breast cancer diagnosis (LE2). The association of mammography and 2D echography presents excellent sensitivity and negative predictive value (close to 100 %) to exclude a breast cancer (LE3). A double evaluation using mammography and echography is recommended in the exploration of a non-inflammatory palpable breast mass (grade B).

Frequent and early in utero HIV-1 infection.

We have investigated in utero human immunodeficiency virus type 1 (HIV-1) transmission by analyzing human fetal tissues for the presence of viral DNA by means of the polymerase chain reaction (PCR). Thirty three fetal samples: thymus, spleen, and peripheral mononuclear blood cells (PMBC) were obtained at abortion (16 to 24 weeks) from HIV-1-infected asymptomatic women. The results of HIV-1-DNA detection were considered only in 9 cases where contamination of fetal samples by infected mother cells could be definitely eliminated by using primers specific for a polymorphic cellular locus. PCR allowed the identification of HIV-1 DNA sequences in 6/8, 8/9, and 5/9 of specimens from thymus, spleen, and PMBC, respectively. Positive results were shown in fetuses as early as 16 weeks. Viral cultures as well as assays for serum p24 HIV-1 antigen were negative in 9.9 and 33/33 tested, respectively. Therefore, our results indicate early and frequent in utero HIV-1 infection. Different patterns of viral activation after birth might then lead to either rapid or delayed onset of acquired immunodeficiency syndrome.