Assessment of percutaneous fine needle aspiration cytology as a technique to provide diagnostic and prognostic information in neuroblastoma.

The International Neuroblastoma Staging System (INSS) criteria for diagnosis requires an unequivocal pathological diagnosis and favours the identification of prognostic markers in the samples. Surgical biopsies of the primary tumour and bone marrow (BM) sampling in metastatic disease constitute the major sources of tumour material for the laboratory. We analysed the possibility of percutaneous fine needle aspiration cytology (FNAC) constituting an alternative procedure to the conventional technique of sampling of the primary tumour in children with advanced neuroblastoma. From July 1987 through July 1998, 64 consecutive children suspected of having advanced neuroblastoma and referred to our institution underwent percutaneous FNAC of deeply located tumours. FNAC was performed using 22-gauge needles under ultrasound guidance, before any chemotherapy and within the first days following admission. No complication occurred after FNAC. The median number of the extracted tumour cells was 2.3x10(6) (range: 0-40.6x10(6)). Cytology analysis was possible in 59/64 cases (92%) and immunocytochemistry in 56/64 (88%) allowing confirmation of the diagnosis. N-Myc analysis was available in 46/64 (72%). In addition, the presence of a partial deletion of chromosome 1p (del 1p) was assessed, since 1992, in 24/47 cases (51%), where enough cells were available. FNAC of deeply located advanced neuroblastoma is safe and information is available in a few hours after admission. The provided material is reliable for confirmation of diagnosis and analysis of biological prognostic markers in the majority of cases. More invasive tumour sampling procedures are required only in selected cases.

Assessment of osteosarcoma response to neoadjuvant chemotherapy: comparative usefulness of dynamic gadolinium-enhanced spin-echo magnetic resonance imaging and technetium-99m skeletal angioscintigraphy.

The aim of this work was to study and compare the usefulness of dynamic contrast-enhanced spin-echo MR imaging with high temporal resolution hydroxymethylene diphosphonate technetium-99 m skeletal angioscintigraphy in predicting the osteosarcoma histological response to neoadjuvant chemotherapy. Twelve patients with resectable osteosarcoma were prospectively monitored with dynamic MR imaging and skeletal scintigraphy before start of neoadjuvant chemotherapy, after two cycles of therapy and before surgery. Neoplasm signal intensity and activity intensity were plotted against time, and slopes were calculated for percentage increase over baseline values in the first minute. Stability and increase in slope values during or after chemotherapy were defined as a "radiological non-response". Changes in slopes were compared with the "histological response" (Huvos grading). At midpoint of the chemotherapy, these two imaging modalities failed in predicting final histological response. After the completion of the chemotherapy, these imaging modalities allowed the prediction of histological response with the same accuracy (91 %). In this series, dynamic MR imaging and technetium skeletal scintigraphy provide similar results regarding the prediction of final histological response during neoadjuvant chemotherapy; these results cannot be used to modify the therapeutic protocol at midpoint of chemotherapy; these imaging tools predict accurately the histological response at the end of chemotherapy. These latter results may permit anticipation of the adjuvant chemotherapy strategy during decalcification procedures in resected osteosarcoma and thus to monitor chemotherapy in non-surgical osteosarcoma.

[Assessment of procarbazine, vincristine and lomustine association (PCV protocol) in oligodendroglioma and mixed glioma]. / Evaluation de l'association procarbazine, vincristine et lomustine (PCV) dans l'oligodendrogliome et les gliomes mixtes.

Effective chemotherapy using PCV (procarbazine, lomustine and vincristine) has been documented in anaplastic oligodendrogliomas and oligoastrocytomas. A pilot study using PCV was conducted for relapsing patients with anaplastic oligodendrogliomas and oligoastrocytomas. Preliminary results are reported. Fourteen patients were enrolled. All received at least two courses of PCV and were evaluable for response. Eleven patients (78%) responded to chemotherapy with complete responses in 2 patients. Response was more obvious regarding contrast enhanced areas than volumes changes (11 responses versus 7). A story of seizure was the main clinical prognostic factor for response. All toxicities were manageable and no treatment related death occurred. Chemotherapy is an effective treatment in aggressive oligodendrogliomas. Further studies must assess the role of chemotherapy in the multidisciplinary management of oligodendroglioma.

[Stereotaxic mammary core biopsy. II. Complementarity or competition with surgical biopsy]. / La microbiopsie mammaire stéréotaxique. II.Complémentarité ou concurrence avec la biopsie chirurgicale?

In breast disease, the only resemblance between needle core biopsy and fine needle aspiration cytology is the mammographic guide to puncture. On selected cases, the efficacy of needle core and surgical biopsy is similar. Inclusion of core breast biopsy in the diagnostic tools requires a repeated pluridisciplinary concentration.