Breast imaging reporting and data system (BI-RADS) or French "classification ACR" What tool for what use? A point of view.

The American College of Radiology Task Force on Breast Cancer published in 2003 the fourth edition of BI-RADS for Mammography. It is a lexicon of mammography terms including illustrations of each feature described, followed by a reporting format with assessment categories according to the degree of concern. The aim is to reduce inconsistencies in mammography reports and recommendations for assessment, to facilitate outcome monitoring and to allow each radiologist to audit his own mammography practice. In France, the Société Française de Radiologie acquired the rights to translate BI-RADS, word for word and without adaptation or influence. The last edition was published in 2004. Simultaneously, French Haute Autorité de Santé and National Committee for Breast Cancer Screening proposed to all community practice mammography facilities a classification of detected abnormalities stating more clearly than BI-RADS do which feature has to be included in such and such assessment category and how to manage it. This "classification ACR" is adapted from BI-RADS but strongly influenced by the context of the French nationwide screening programme, and by European recommendations to limitate undesirable risks of screening such as false positive and overdiagnosis. The differences between the two systems are discussed.

Mammography of ductal carcinoma in situ of the breast: review of 909 cases with radiographic-pathologic correlations.

We retrospectively analysed mammographies of 909 ductal carcinoma in situ (DCIS) (1980-1999) and compared our results to those of literature. Microcalcifications were present in 75% of the cases, and soft-tissue abnormalities in 27% cases with association with calcifications in 14% of cases. Palpable masses were found in 12% of the cases and nipple discharge was present in 12% of the cases. The radiographic-pathologic correlation allowed to suspect the DCIS "aggressiveness" on radiologic signs. Granular, linear, branching and/or galactophoric topography of the microcalcifications were correlated with necrosis, grade 3, comedocarcinoma type. A number of microcalcifications higher than 20 was correlated with necrosis and grade 3. Mammographic size was correlated to histologic size. Masses were correlated with grade 1. A diagnosis strategy can be proposed with a multidisciplinar approach.

[Diagnostic approach to breast papillary lesions]. / Approche diagnostique dans les lesions papillaires du sein.

Breast papillary lesions are difficult to interpret and include a large variety of benign, atypical and malignant lesions. We report the case of a 41-Year-old woman presenting with an intracystic papillary carcinoma, in order to illustrate our pragmatic diagnostic approach, which includes the use of a decision tree, useful for differentiating the different types of breast papillary lesions.

[Breast cancer diagnosis among women aged 75 and over: study on information delivered by organized breast cancer screening agencies to women reaching the limit age]. / Diagnostic du cancer du sein après 74 ans: information donnée par les structures de gestion du dépistage organisé à la sortie de la tranche d'âge concernée.

Breast cancer among older women is a major and increasing public health issue. No clear recommendation has been established in France after 74 years, the age limit for state-organised screening program. A survey was performed among all regional agencies in charge of the breast screening to analyse which information is delivered to women reaching the age of 75 years. A postal survey sent to 91 French organised cancer screening agencies. Among the 89 agencies that answered, only 22 deliver a systematic written information. Twelve suggest that mammographic screening should be continued, and five mention clinical examination. Twenty agencies dispatch the screening to general practitioners or gynaecologists. Two information letters insist on the ongoing risk of breast cancer. Most of the written information is given with the last mammography report. No impact study has ever been performed. In our study, only 25% of the screening agencies give systematic information to women. The modalities and the substance of this information are heterogeneous. A better information seems to be a key-point for earlier clinical breast cancer diagnosis among older women, for whom there is little direct evidence of the benefit of systematic mammographic screening.

[Patients' information in percutaneous core breast biopsy]. / Le don d'information dans les prélèvements percutanés mammaires: savoir le dire, savoir le faire.

Information takes a large part of patient's perceptions of the procedure. If the information is adapted, patients tolerate the procedure well. We point out indications and explain the different types of procedure. For infraclinical masses, sonographically guided automated core needle biopsy removes samples. Sonographically guided vacuum-assisted large-core biopsy is only used for diagnosis generally on second purpose for masses. Stereotaxic vacuum-assisted large-core biopsy is used for microcalcifications (needle 8 or 11 gauge). Haematoma and bleeding are rare (< 4%), but care is necessary to avoid complications. Information is executed before the procedure and a booklet is giving to the women. This information has to be adapted because lot of informations could increase patient's anxiety if they don't want more informations and "not enough information" could also increase anxiety if they want more informations. The practitioner, by hearing, his formation and his experience, is able to adapt informations.