Sentinel lymph node biopsy without axillary lymphadenectomy after neoadjuvant chemotherapy is accurate and safe for selected patients: the GANEA 2 study.

PURPOSE: GANEA2 study was designed to assess accuracy and safety of sentinel lymph node (SLN) after neo-adjuvant chemotherapy (NAC) in breast cancer patients. METHODS: Early breast cancer patients treated with NAC were included. Before NAC, patients with cytologically proven node involvement were allocated into the pN1 group, other patient were allocated into the cN0 group. After NAC, pN1 group patients underwent SLN and axillary lymph node dissection (ALND); cN0 group patients underwent SLN and ALND only in case of mapping failure or SLN involvement. The main endpoint was SLN false negative rate (FNR). Secondary endpoints were predictive factors for remaining positive ALND and survival of patients treated with SLN alone. RESULTS: From 2010 to 2014, 957 patients were included. Among the 419 patients from the cN0 group treated with SLN alone, one axillary relapse occurred during the follow-up. Among pN1 group patients, with successful mapping, 103 had a negative SLN. The FNR was 11.9% (95% CI 7.3-17.9%). Multivariate analysis showed that residual breast tumor size after NAC ≥ 5 mm and lympho-vascular invasion remained independent predictors for involved ALND. For patients with initially involved node, with negative SLN after NAC, no lympho-vascular invasion and a remaining breast tumor size 5 mm, the risk of a positive ALND is 3.7% regardless the number of SLN removed. CONCLUSION: In patients with no initial node involvement, negative SLN after NAC allows to safely avoid an ALND. Residual breast tumor and lympho-vascular invasion after NAC allow identifying patients with initially involved node with a low risk of ALND involvement.

[Prophylactic surgery in patients mutated BRCA or high risk: retrospective study of 61 patients in the ICO]. / La chirurgie prophylactique chez les patientes mutées BRCA ou à haut risque: étude rétrospective de 61 patientes de l'ICO.

BACKGROUND: Genetic predisposition is involved in only 10% of patients with breast cancer. This study was to evaluate the impact of prophylactic surgery. PATIENTS AND METHODS: This is a retrospective study of 61 patients who received prophylactic breast surgery. Data collection was carried out through the computer file of the ICO. The inclusion criteria were: patients who benefited from a bilateral prophylactic mastectomy. There were no exclusion criteria. Patients received a satisfaction questionnaire to complete. RESULTS: Our study included 61 patients, 67% had a history of breast cancer. Bilateral prophylactic surgery was performed in 40 patients. It was made an average of two interventions, 44.3% of them presented postoperative complications, 18% recovery. Forty-three patients were satisfied with the medical information before surgery. The end result matched the expectations of 54.4% and 67.4% of patients would be ready to start. It was found pain associated with breast surgery in 56.5% of patients and almost half reported a change in their sexual life. DISCUSSION AND CONCLUSION: Prophylactic mastectomy is the most effective technique to prevent the risk of breast cancer. The consequences of such an action are important. It is necessary to better select patients who would benefit most from this type of surgery.

[Primitive neuroendocrine cancer of the breast. Post-traumatic discovery of a man]. / Tumeur neuroendocrine primitive du sein. Découverte post-traumatique chez un homme.

We report a primitive neuroendocrine breast tumor (NET) in a male. This situation is uncommon by its mode of discovery. We have treated a 74-year-old man with a lesion in the left areola initially considered as an organized hematoma due to a severe trauma. The ablation was performed by direct access under local anesthesia. The analysis of the piece has showed a NET of the breast due to the positivity of the neuroendocrine, cytokeratin and hormone markers. No other NET lesion was found, excluding the secondary origin of the breast tumor. Complementary therapies associated mastectomy, lymphadenectomy, hormonotherapy. Male breast cancer is rare. NET are exceptional, only a dozen of male NET is reported. These tumors affect a specific population and have a better prognosis than infiltrating ductal carcinoma. In our case, no causal link can be demonstrated between trauma and tumor microenvironment necessary for the growth of quiescent cancer cells.

[MR imaging features of deep pelvic endometriosis: correlation with laparoscopy]. / Caractéristiques IRM de l'endométriose profonde: corrélation aux résultats coelioscopiques.

UNLABELLED: Deep pelvic endometriosis is an invalidating disorder affecting the retrocervical region, rectosigmoid colon and urinary bladder generally requiring surgical management. MRI is the preoperative imaging modality of choice. The purpose of this paper is to describe the MR imaging features of deep pelvic endometriosis with laparoscopic correlation. METHODS: Thirty-five patients with clinical suspicion of deep pelvic endometriosis underwent pelvic MRI. Results of MRI, including morphological and signal characteristics features of the lesions were compared to laparoscopic fidings. RESULTS: Laparoscopy detected lesions of deep pelvic endometriosis of the uterosacral ligaments (n=10), torus uterinum (n=9), rectosigmoid (n=11), Douglas pouch (n=9), recto-vaginal septum (n=6), bladder (n=4) and posterior vaginal cul-de-sac (n=2). The sensitivity, specificity, positive predictive value and negative predictive value of MRI were assessed for each localization. CONCLUSION: MRI allows diagnosis of deep pelvic endometriosis of the bladder, rectosigmoid and Douglas pouch and with lower sensitivity for lesions of the uterosacral ligaments, posterior vaginal cul-de-sac and rectovaginal septum.

Curative cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis and synchronous resectable liver metastases arising from colorectal cancer.

OBJECTIVES: This study describes the outcomes of patients with colorectal peritoneal carcinomatosis (PC) with or without liver metastases (LMs) after curative surgery combined with hyperthermic intraperitoneal chemotherapy, in order to assess prognostic factors. BACKGROUND: Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) increases overall survival (OS) in patients with PC. The optimal treatment both for PC and for LMs within one surgical operation remains controversial. METHODS: Patients with PC who underwent CRS followed by HIPEC were evaluated from a prospective database. Overall survival and disease free survival (DFS) rates in patients with PC and with or without LMs were compared. Univariate and multivariate analyses were performed to evaluate predictive variables for survival. RESULTS: From 1999 to 2011, 22 patients with PC and synchronous LMs (PCLM group), were compared to 36 patients with PC alone (PC group). No significant difference was found between the two groups. The median OS were 36 months [range, 20-113] for the PCLM group and 25 months [14-82] for the PC group (p > 0.05) with 5-year OS rates of 38% and 40% respectively (p > 0.05). The median DFS were 9 months [9-20] and 11.8 months [6.5-23] respectively (p = 0.04). The grade III-IV morbidity and cytoreduction score (CCS) >0 (p < 0.05) were identified as independent factors for poor OS. Resections of LMs and CCS >0 impair significantly DFS. CONCLUSIONS: Synchronous complete CRS of PC and LMs from a colorectal origin plus HIPEC is a feasible therapeutic option. The improvement in OS is similar to that provided for patients with PC alone.

Evaluation of mastectomy with immediate autologous latissimus dorsi breast reconstruction following neoadjuvant chemotherapy and radiation therapy: A single institution study of 111 cases of invasive breast carcinoma.

PURPOSE: The aim of the study was to evaluate morbidity and patient satisfaction following surgically treated skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) following mastectomy with neoadjuvant chemotherapy (NACT), and preoperative radiotherapy (RT), for operable invasive breast cancer. PATIENTS AND METHODS: This retrospective single-institution study included 111 patients who underwent a mastectomy with IBR after RT and/or NACT for invasive breast carcinoma at the Institut de Cancérologie de l'Ouest Paul Papin from January 1997 to January 2012. Only patients with breast reconstruction by autologous latissimus dorsi flap with (LDI) or without (ALD) implant were considered. The primary endpoints were the delay in therapeutic sequence, post-operative complication rate, surgical revision rate, time of hospitalization and the anonymous analysis of the patient satisfaction survey. RESULTS: 111 patients underwent mastectomy after RT. The median age was 48 years old and the median body mass index (BMI) was 23.6. SSM were performed in 94.5% of cases. The median interval between the end of chemotherapy (CT) and the beginning of RT was 30 days while the median interval between the end of RT and surgery was 41 days. The rate of primary complications was 66.6% including seroma secretion (reduced to 10.8% when seroma secretion was excluded). The necrosis rate was 5.4%. The average patient satisfaction score for the reconstruction was 17 out of 20. Five-year disease-free and overall survival rates were 93.2% and 98.3% respectively with a median follow-up of 31.6 months. There was only one case of local relapse diagnosed after seven years of follow-up. CONCLUSION: This study shows that our therapeutic sequence does not appear to increase IBR morbidity and remains within the acceptable safety margins of oncological treatment. It also gives a high quality aesthetic result that helps to maintain patient self-esteem.

[Isthmic pregnancy located in a previous caesarean section scar treated with methotrexate. A case report]. / Grossesse isthmique localisée au niveau d'une cicatrice d'hystérotomie traitée par méthotrexate. A propos d'un cas.

We report a case of a patient who presented an isthmic pregnancy successfully treated with an intramuscular injection of methotrexate. The diagnosis of isthmic pregnancy was made clinically (cervical colour was normal, inferior segment soft and enlarged) and echographically (long cervix, foetal sack situated in the isthmus and the uterine body was empty). An isthmic full term pregnancy is possible but would carry major haemorrhagic risk. There are several therapeutic options if the pregnancy is interrupted: medical treatment of methotrexate, curettage, curettage with embolisation of the uterine arteries and as a last resort, hysterectomy. The success of conservative treatment seems to be related to the criteria known for the cervical pregnancy, which are cardiac activity, the level of HCG, gestational age and cranial-caudal length.

[Low-grade endometrial stromal sarcoma: contribution of hormone therapy and etoposide]. / Sarcome du chorion cytogène de bas grade. Mise au point sur l'intérêt de l'hormonothérapie et de l'étoposide à partir de 4 cas.

Endometrial stromal sarcoma is a rare malignant uterine tumor. We report 4 cases of low-grade endometrial stromal sarcoma, corresponding to the form with a mitotic index at less than 10 mitoses per 10 high power fields (HPF), from which we carried out a review of the literature and defined the potential interest of hormone therapy and chemotherapy by etoposide. Generally diagnosed in pre-menopause, the main clinical signs, which are not very specific, are metrorrhagia and pelvic pain. The etiologic diagnosis is established from the pathology analysis. Intravascular extension, which is observed in nearly 50% of patients, should evoke the disease. The initial treatment is mainly based open surgery, generally total hysterectomy with annexectomy. There is no effective adjuvant treatment. The potential of reccurences remains around 50% with a 34-month median. Several therapeutic options are possible after recurrence but no standard treatment has been established. We are mainly interested in three medical options but the surgery remains an alternative of choice. Chemotherapy by oral etoposide offers easy administration, good compliance and acceptable toxicity with median 20-month remission in 3 patients before progression. Hormone therapy with progestogens (hormone receptor expression of the tumor is 71% for estrogens and 95% for progesterone) is widely studied in the literature with a 46% response rate and 46% rate of disease stabilization. Hormone therapy with an anti-aromatase appears to be a promising treatment according to the bibliographic references on this subject. Overall, prognosis of low-grade endometrial sarcoma is relatively good with 100% survival at 5 years. The progression pattern is slow, requiring regular and prolonged surveillance.

[Malignant tumors arising in extra-ovarian endometriosis: a case report]. / Endométriose extra-ovarienne dégénérée.

We report a case of degenerative extra-ovarian endometriosis. This is a rare complication of endometriosis, the frequency of which is estimated at 0.9%. In more than 50% of the cases, the diagnosis is made following investigation for abdominal pain. If the degeneration is of the same histological type as the endometriosis, it can be said to have arisen from the endometriosis. First-line treatment is surgery, removing as much endometriosis as possible, staging at this point is also necessary. Second-line treatment, with chemotherapy, radiotherapy and even hormonotherapy may be needed. Prognosis for this tumor is variable, from 10 to 100% five-year survival, depending on histological type and localization of the disease.

Pure mucinous carcinomas of the breast: prognostic study including DNA flow cytometry.

BACKGROUND: Prognostic factors for pure mucinous carcinomas of the breast are controversial; data on DNA ploidy and S-phase fraction (SPF) are lacking. We examined the relation of these parameters with histological features and patient survival. METHODS: DNA flow cytometry was performed on 69 fresh or frozen pure mucinous carcinomas samples. Results were interpreted according to patient survival. RESULTS: Tumor size exceeded 2 cm in 40.5% of cases. Lymph nodes were involved in 11.5% of cases and never when tumor size was less than 2 cm. Aneuploidy was only observed in one-quarter of the tumors. Very few tumors had a high-SPF or a high histological grade (7.2% of all cases). These two parameters were of prognostic value respectively for disease-free (P=0.035) and overall survival (0.050). Patients with tumors>2 cm had shorter overall survival than patients with tumors≤2 cm (P=0.028). Disease-free and overall survivals were not influenced by nodal status and hormone receptors (HRs) status. Patients with aneuploid tumors had shorter disease-free survival than patients with diploid tumors (P=0.031). The combination of tumor size and DNA ploidy was strongly predictive of survival (P<10(-3)): six patients with large aneuploid tumors had a poor outcome (1-year overall survival 16.7%). CONCLUSION: We identified a subset of patients with a poor prognosis, namely those with large aneuploid tumors. This study confirms the good prognosis of pure mucinous carcinomas, particularly when tumor is less than 2 cm (corresponding to cases without lymph nodes involvement), thus challenging the need for axillary nodal examination.