[Performances of breast magnetic resonance imaging in the context of neoadjuvant chemotherapy for breast cancer to predict pathological complete response]. / Performances de l'imagerie par résonance magnétique au cours des chimiothérapies néoadjuvantes du cancer du sein pour prédire la réponse pathologique complète.

PURPOSE: The objective of this work was to estimate the reliability of MRI after neoadjuvant chemotherapy (NAC) for breast cancer to detect a residual tumour by comparing the tumoral size measured by MRI with the histological size. We also estimated the concordance of diagnosis of complete pathological response between histological examination and MRI. MATERIALS AND METHODS: We included all the patients who received a neoadjuvant chemotherapy for breast cancer in the university hospital of Tours from January, 2008 to December 31st, 2012 and in the comprehensive cancer centre of Rennes from January, 2008 till May 31st 201. We considered that the pathological response was complete (pCR) when there was no residual invasive tumour in the mammary surgical specimen. RESULTS: Two hundred and fifty-one women who received NAC for a non-metastatic breast cancer were included in the study: 103 in Tours and 148 in Rennes. Two women (0.8%) refused breast surgery whatever the type. One hundred and twenty-three (49%) women had a breast conservative surgery. One hundred and fifteen (45.8%) had a mastectomy and 11 (4.4%) had breast conservative surgery followed by mastectomy for positive margins. A complete pathological response was present in 54 cases (21.5%). We did not found any significant difference between characteristics of patients with pCR or not. CONCLUSION: Breast MRI remains the most performing examination to evaluate the initial tumoral size and the residual tumour after NAC, but does not add any value at mid or at the end of treatment for the patients to whom a mastectomy is decided at presentation. The correlation between the breast MRI and the histology size is not perfect, but at the moment, MRI stills of the most performing examination to predict the pCR.

[Delivery in lateral position. Comparative study in low risk pregnancy between lateral and dorsal position for the delivery in eutocic vaginal birth]. / Accouchement sur le côté. Étude comparative chez les grossesses à bas risque entre décubitus latéral et dorsal lors de la phase expulsive des accouchements eutociques.

OBJECTIVE: For several years in French labour wards, delivery in the lateral decubitus position (LP) has raised great interest. We wanted to assess perineal outcomes and neonatal morbidity following delivery in the lateral LP compared to the dorsal decubitus position (DP). PATIENTS AND METHODS: Two teams of midwives, in a private and in a public hospital, performed a total of 6800 deliveries in the area of Tours following a training session on the techniques of delivery in the lateral decubitus position. The design was a retrospective case-control study including patients with low obstetrical risks and normal vaginal delivery. We included 645 patients who gave birth from May 1st to September 30th, 2007. RESULTS: We showed a significant difference in perineum outcomes, with a lower episiotomy rate (56.7% in LP/40.7% in DP, P=0.0001), a higher rate of intact perineum (56.7% in LP/40.7% in DP, P=0.0001) and no differences with respect to perineal laceration. These differences were significant in primiparous (intact perineum: 46.8% in LP/20.2% in DP, P=0.004; episiotomy: 17% en DL/44.7% en DD, P=0.006) and secondiparous patients (episiotomy: 8.6% in LP/30.7% in DP, P=0.0001). We showed significant differences in fetal heart abnormalities during labour in favour of the lateral decubitus position (no anomaly, P=0.00004; separated decrease, P=0.04; bradycardia, P=0.0009; early decrease, P=0.04). DISCUSSION AND CONCLUSION: The neonatal mortality and morbidity did not differ between delivery positions. The lateral position seems to be protective for the perineum without affecting neonatal outcome. Incorporating lateral decubitus deliver into daily practice is possible in large groups of midwives after appropriate training.