In vivo assessment of the elastic properties of the external anal sphincter in term pregnant women using shear wave elastography.

INTRODUCTION AND HYPOTHESIS: The objective was to assess the intraobserver intersession and interobserver intrasession reliability of shear wave elastography applied to the external anal sphincter in term pregnant women. METHODS: This prospective study involved nulliparous pregnant women at 37 weeks or more with two visits (V1: one observer; V2 two observers) planned within a 12-h to 7-day interval. Measurements were performed using an Aixplorer V12® device with an SL 18-5 linear probe using a transperineal approach, allowing a measurement of the shear modulus (SM) in kPa. Measures were performed at rest, Valsalva maneuver, and maximal contraction. Reliability was assessed using the intraclass correlation coefficient (ICC). The study was approved by an ethics committee (ID RCB: 2020-A00764-65). RESULTS: A total of 37 women were included. Intraobserver reliability was excellent at rest (ICC = 0.91 [0.84-0.95) and good during the Valsalva maneuver (ICC = 0.83 [0.72-0.90]) and contraction (ICC = 0.85 [0.75-0.91]). Interobserver reliability was good at rest (ICC = 0.79 [0.66-0.87]) and during Valsalva (ICC = 0.84 [0.73-0.90]), but moderate during contraction (ICC = 0.70 [0.53-0.82]). CONCLUSIONS: Shear wave elastography is a reliable tool for assessing the elastic properties of the external anal sphincter in term pregnant women.

[Should knowledge of BRCA1 status impact the choice of chemotherapy in metastatic breast cancer: a review]. / La connaissance du statut de BRCA1 devrait-elle avoir un impact sur le choix d'un cytotoxique dans le cancer du sein ? Revue de la littérature.

BRCA1 and BRCA2 mutations account for 40% of cancer predisposition gene mutations identified in the current French diagnostic setting. The proteins encoded by these genes are implicated in DNA repair pathways. As a result, loss of BRCA1 or BRCA2 function may modify chemo-sensitivity. This literature review aims to determine whether BRCA1 mutation status should influence the choice of systemic treatment in breast cancer. Fourteen articles and four abstracts from 12 retrospective analyses and 6 prospective studies were identified in the literature review. CMF-type and taxane-based protocols appear to be insufficiently effective, while anthracycline activity does not seem to be affected by BRCA1 status. BRCA1-mutated tumours appear to be highly sensitive to platinum, in both the neoadjuvant and metastatic setting. Olaparib, a PARP inhibitor, has only been evaluated in one study in metastatic patients, with promising results. The presence of a BRCA1 mutation can lead to an adaptation of therapies in the metastatic stages in breast cancer. The rapid identification of BRCA1 mutations and the adaptation of treatment according to this status in the (neo)adjuvant setting is likely to become a reality in the coming years.