[Surgery or not on an atypical breast lesion? Taking anxiety into account in shared decision support from a prospective cohort of 300 patients]. / Opérer ou non une lésion atypique du sein ? Prise en compte de l'anxiété dans l'aide à la décision partagée à partir d'une cohorte prospective de 300 patientes.

INTRODUCTION: Organized and individual breast screening have been accompanied by an increase in the detection of "atypical breast lesions (ABL)". Recently, the NOMAT multicenter study proposed a predictive model of the risk of developing breast cancer after detection of an ABL in order to avoid surgical removal of "low-risk" lesions. It also aimed to provide information on psychological experience, in particularly anxiety, to assist in the shared medical decision process. METHODS: Three hundred women undergoing surgery for ABL were included between 2015 and 2018 at 18 French centers. Women completed questionnaires before and after surgery assessing their level of anxiety (STAI-State, STAI-Trait), their level of tolerance to uncertainty, their perceived risk of developing a breast cancer, and their satisfaction with the management care. RESULTS: One hundred nighty nine patients completed the STAI-Status before and after surgery. Overall, a decrease in anxiety level (35.4 vs 42.7, P<0.001) was observed. Anxious temperament and greater intolerance to uncertainty were significantly associated swith decreased anxiety (33%), whereas younger age was associated with increased anxiety (8%). CONCLUSION: Surgery for ABL seems to be associated with only a few cases with an increase in anxiety and seems to increase the perception of the risk of developing breast cancer. Taking into account the psychological dimension remains in all cases essential in the process of shared therapeutic decision.

Is a breast MRI possible and indicated in case of suspicion of breast cancer during lactation?

The paper tries to answer two questions: the safety of the injection of gadolinium during breastfeeding; the value of a breast MRI in the nursing mother if breast cancer is suspected. Recent Anglo-Saxon publications are in favour of continued breastfeeding following the injection of gadolinium. In fact, only a minute quantity of contrast product passes into the mother's milk, much less than the threshold recommended in paediatrics in the infant. However, a suspension of lactation for 24h after the injection of gadolinium chelate is still recommended in France. The literature is poor as regards the contribution of the MRI during lactation, although the data indicates that the MRI is contributory, in spite of the physiological changes in the breast during this period. In fact, all of the lesions have been visualised and correctly classified according to the BI-RADS classification by the ACR(1). However, the semiology is specific and has to be known.

[MRI evaluation of residual breast carcinoma after neoadjuvant chemotherapy]. / Cancer du sein traité par chimiothérapie néoadjuvante: évaluation du reliquat tumoral par l'IRM mammaire.

PURPOSE: This study aims to evaluate the sensibility and specificity of MRI in the detection and size measuring of residual breast cancer in patients treated with neoadjuvant chemotherapy before surgery. PATIENTS AND METHODS: This is a retrospective study of 32 women, who underwent breast MRI before and after neoadjuvant treatment. MRI has been confronted to surgical pathology results. RESULTS: The sensibility of MRI to assess pathologic Complete Response (no invasive residual tumor) was excellent (100%) but the specificity was low (55,5%). There was no false negative case and four false positive cases (Two ductal carcinomas in situ and two scars-like fibrosis). When MRI outcomes were compared with the presence or absence of invasive or in situ residual carcinoma, only one false negative case was noticed (one "in situ" residual tumor). The correlation between tumor size measured by MRI and histopathology was low (r=0,32). Underestimations of tumor size were due to non-continuous tumor regression or invasive lobular carcinoma or association of invasive carcinoma and intra ductal breast cancer. Over estimations of tumor size were due to chemotherapy-induced changes. CONCLUSION: MRI is a sensitive but poorly specific method to assess the pathological complete response after neoadjuvant chemotherapy. Estimation of tumor size and detection of isolated residual in situ carcinoma are fare. Therefore, surgical intervention remains necessary whatever the MRI outcomes.

[Management system for patients requiring stereotactic macrobiopsies of the breast: report on 100 patients]. / Mise en place de la prise en charge des macrobiopsies stéréotaxiques mammaires: évaluation sur 100 patientes.

PURPOSE: The authors describe and evaluate the management system for patients requiring large core vacuum-assisted biopsies at a dedicated breast center. This process includes mandatory review of all requests by a multidisciplinary team. MATERIAL: and method. Patients were provided questionnaires to evaluate their degree of satisfaction with the management process. Results from biopsy and surgery were retrospectively reviewed. RESULTS: From the 100 patients included in the study (106 macrobiopsies), 95,28% of biopsies were informative. The degree of correlation between the histological diagnosis from biopsy and surgery was 86,95% for the 46 operated cases. The degree of acceptability by patients as well as medical and non-medical staff was satisfactory. CONCLUSION: The original feature of this process is the retrospective review of all charts after the histological results becomes available for final validation of the biopsy results and management. The results of the biopsy and the post biopsy management are provided by the initial referring physician, allowing optimal patient care and follow-up.

[Process management in a radiology department. Impact on the quality system]. / Management en processus d'un département d'imagerie médicale. Impact sur le système qualité

The purpose of this work was the transition from a mode of management combining TQM (Total Quality Management) based on the European model "EFQM", and quality assurance based on the ISO 9001-1994 certification model, to the ISO 9001-2000 certification model which imposes process management and integrates both management and quality assurance. In order to visualize the inter-relation between processes, a processes-map was made. That is to say a representation of the organization in terms of inputs and outputs. Those processes were divided step by step, from general to final processes which were translated into an algorithmic approach. Subsequently, two external auditors were asked to evaluate the new quality system. They used three quality standards (IOS 9001-2000, MFQ and ANAES) in order to determine the adaptation score of the quality system. Finally, the implementation of the department documentation system on an intranet was evaluated by means of two questionnaires: a qualitative one, dealing with staff acceptability, and a quantitative one, dealing with research effectiveness.

[Comparison of accreditation procedures, ISO 9000 certification procedures and total quality management. Personal experiences and application of quality assurance in a department of radiology and medical imaging]. / Comparaison des procédures d'accréditation, de certification ISO 9000 et d'évaluation en qualité totale. Expérience personnelle et application à la gestion de la qualité d'un département de radiologie et imagerie médicale.

Management of quality assurance protocols in a radiology department can be done by using several tools or models. Some are specific like accreditation manuals issued by some organizations, others like the ISO 9000 certification and the Total Quality management are more general and already well known by manufacturers. In order to implement a process of quality improvement, we have reviewed three models of quality assurance: evaluation in total quality based on the European model "EFQM", accreditation based on booklets from French cancer centers and Canadian radiology centers and, finally, accreditation based on the ISO 9002 certification model. Based on results of our comparative study, these three tools of quality management are not contradictory and may be complementary. However, they can be compared in terms of constraints they impose, of their historical background, of the criteria evaluated as well as the role of different teams. In conclusion, we suggest that directors of radiology department interested in implementing a quality assurance program first evaluate their department using the Canadian accreditation model issued in 1993 which is useful to become familiar with this new concept of quality. In a second step, a self assessment using the EFQM has to be done in collaboration with all members of the administration board in order to integrate all parameters and to share this protocol with all decision makers. The last step is to consolidate the organization of the quality assurance protocols by means of the ISO 9002 certification.

[From accreditation to certification. Quality management in a radiology department]. / De la certification à l'accréditation expérience de la gestion de la qualité dans un service de radiologie et d'imagerie médicale.

The leaders of a radiology department started a quality process based on ISO 9001 certification and the total quality management program. The purpose of this work is to match the conformity of this quality system to ANAES recommendations. If the concordance is obvious, the advantages of using quality insurance to get an accreditation are important. In conclusion, a quality process is proposed, it includes a quality insurance manual of ISO 9001 norm, the total quality management in the first point of the norm and the ANAES recommendations spread over the 20 points of the norm.

[Radiologic analysis of known-interval cancers after 2 years of organized mass screening for breast cancer in Ille-et-Vilaine]. / Analyse radiologique des cancers d'intervalle connus apres deux ans de campagne de dépistage de masse organisé (DMO) du cancer du sein en Ille-et-Vilaine.

The first thirty-two known interval breast cancers (appearing within the first or second year after a negative screen) occurring during a two-year breast screening round were reviewed and the radiograms analyzed. Five classes were established: true interval cancers (13/32 cases), radiologically occult cancers (2/32), cancers with no specific sign (7/32), false negative cancers (5/32) and unclassifiable cancers (5/32). In more than 50% of the cases, there was no abnormality on the initial radiographic test, although the literature reports that the rate of false-negatives in interval cancers is less than 20%. Standard classification (by at least 3 readers) is very important to provide a possible explanation of cancer development. Action should be initiated to reduce their number.

[Aspects and value of MRI in the diagnosis and follow-up of common microbes infectious spondylodiscitis. Apropos of 25 clinically and biologically suspected patients]. / Aspects et intérêt de l'IRM dans le diagnostic et le suivi des spondylodiscites infectieuses à germes banals. A propos de 25 patients suspects cliniquement et biologiquement.

This work is about 25 patients clinically and biologically suspected of spondylodiscitis (27 levels). All of them had a MRI exam before disco-vertebral needle biopsy and treatment. The results are compared to those of literature. Each infectious spondylitis case (19 cases) had a new MRI exam each three months. This study conclude to the great sensibility of MRI (89%) in the diagnosis of infectious spondylitis and to the limited interest of it in the follow-up of spondylodiscitis.

[Evaluation of the scanner and radiography in rheumatic pelvispondylitis]. / Evaluation du scanner et de la radiographie dans la pelvispondylite rhumatismale.

We studied 20 normal subjects and 20 suffering from sacro-iliitis. The performance of the two techniques were compared in studying reports ROC curve from several readers. We assessed the performance of each technique and each sign: CT scan appears as a better technique than plain films. Some signs present a poor interest: osteophytes seen on CT or plain films, subchondral cysts seen on CT. In other respects, articular cartilage erosions, subchondral sclerosis are main signs as much on CT as on plain films. In conclusion, CT scan allowed an accurate analysis of sacro-iliitis. It has a better diagnostic value than plain films and, in case of doubt, should be performed to increase diagnosis sensibility and specificity.

[Study of the correlation between magnetic resonance imaging and surgery in the diagnosis of chronic Achilles tendinopathies]. / Etude de la corrélation entre l'examen par résonance magnétique et la chirurgie dans le diagnostic des tendinopathies chroniques d'Achille.

Eighteen cases of chronic lesions of the heel cord were evaluated by MRI and operated. The sensitivity of MRI is high in detecting intratendinous lesions (positive predictive value of 0.94); this sensitivity is linked with an unsurpassed anatomical precision. The specificity in the diagnosis of intratendinous lesions is limited as regards partial rupture versus chronic inflammation. This technique can be improved by systematically making fine cuts in the transverse plane, absolutely perpendicular to the heel cord.

[Nipple discharge without palpable tumor. Apropos of 46 cases]. / Les écoulements mamelonnaires sans tumeur palpable. A propos de 46 cas.

The authors report 46 cases of nipple discharge without any palpable lesion. The diagnostic is made, most of the time, by 3-views bilateral mammograms. The place of other examinations (ultrasonography, galactography) is reported. The cytology of the discharge, as well as its macroscopic appearance (bloody, serous or greenish), determine the surgical indications. Quadrantectomy centered around the discharging duct, is the procedure of choice in this disease, at the interface between diagnostic and treatment, in fact, if benign tumors (papillomas) or non tumoral diseases (fibrocystic mastopathy and duct ectasia) predominate, invasive or in-situ malignant lesions represent 13 p. cent of these 46 discharges, justifying the significance of this clinical sign.

[Recurrent postoperative sciatica. Prospective evaluation of magnetic resonance imaging and x-ray computed tomography with iodine injection]. / Sciatique post-opératoire récidivée. Evaluation prospective de l'imagerie par résonance magnétique et de la tomodensitométrie avec injection iodée.

The respective performance of MRI and CT were studied prospectively in 80 cases. Surgery was indicated in 56 patients after MRI examination and 21 patients after CT; the 21 patients were included in the 56. Among these patients, 45 were reoperated and 11 preferred the medical treatment. Surgery confirmed the diagnosis for 44 patients (from the 45), and the only discordance was the presence of ligament calcification, associated to a disc protrusion not seen on MRI. Surgery confirmed also the diagnosis for the 21 cases diagnosed by CT after iodine injection. However, among the 24 cases of fibrosis diagnosed by CT after i.v. injection were found: 19 recurrent disc protrusions, 4 disc protrusions with fibrosis, and 1 disc protrusion at a level above the operated disc.

[Modern imaging in radioanatomic study of the shoulder]. / Apport de l'imagerie moderne à l'étude radioanatomique de l'épaule.

The authors describe the most appropriate imaging technique or techniques for assessment of each anatomical structure in the shoulder: the head of the humerus, socket, acromion, joint space, labrum, musculotendinous structures of the supraspinatus, subscapularis and long biceps muscles. The techniques used are the most useful view of standard X-rays, as well as arthropathy, CT scan, arthroscan, ultrasonography and MRI. This is a preliminary study to assessment of shoulder lesions. In the shoulder, radiologists are frequently required to identify the anatomical disorder as exactly as possible without falling into the traps associated with all forms of imaging even the most sophisticated.

MRI anatomy of the nerves of the upper limb.

In view of the good anatomic definition of the images obtained by magnetic resonance imaging (MRI), we have defined MRI sections allowing study of the nerves of the upper limb.

[Role of MRI in the study of the Achilles tendon and patellar tendon]. / Place de l'IRM dans l'étude du tendon d'Achille et du tendon rotulien.

The possibilities of MRI and radiography with mammogram to diagnose mechanical tendinitis have been prospectively evaluated in thirty sportsmen. Sixteen had Achilles tendon lesion, fourteen had patellar ligament lesion. Each patient included in the study was programmed for radiography with mammogram and MRI of the pathologic tendon and the controlateral tendon. These examinations were separately interpreted by two reviewers who had no knowledge of pain location. The number of tendinitis diagnosis based on X-ray and MRI was approximatively the same. But the microtearings were more often diagnosed on MRI data than on X-ray data (10/1). Eight patients underwent an operation. The surgery findings always confirmed the MRI diagnoses. MRI seems to be the examination of choice to evaluate the tendon injuries and particularly microtearings before surgery.

[Comparison of MRI and scanning coupled with myelography in the diagnosis of cervicobrachial neuralgia]. / Comparaison de l'IRM et du scanner couplé à la myélographie dans le diagnostic des névralgies cervico-brachiales.

A prospective study was undertaken to compare the accuracy of surface coil magnetic resonance imaging (MRI) and computed tomography with myelography (CTM) in the determination of cervical radiculopathy with or without myelopathy. Twenty five patients underwent both imaging studies. The separately imaging diagnosis and the surgical findings were the basis of this study. The based-MRI and based-CTM predictions were not significant. MRI predicted two disc herniations that CTM did not predict. CTM predicted a combination of disk herniation and stenosis and one more lateral stenosis that MRI did not predict. Among the fourteen patients who underwent surgery, one underwent surgery only on based-MRI prediction, it was a disc herniation; one patient was operated on only on based-CTM prediction, it was a stenosis. In these operated patients, the predictive value of the both imaging modalities was not significant. In this report the diagnostic assessment of MRI and CTM was overall the same. The major advantages of MRI were its ability to display all the cervical spine, to study the disk pathology and to delineate a signal alteration within cord substance but the disadvantage was the difficulty to characterize the osteophytes made of cortical bone which did not give signal.