Long term improved quality of life by a 2-week group physical and educational intervention shortly after breast cancer chemotherapy completion. Results of the 'Programme of Accompanying women after breast Cancer treatment completion in Thermal resorts' (PACThe) randomised clinical trial of 251 patients.

BACKGROUND: Quality of life (QoL) after breast cancer is nowadays a major challenge. Complementary interventions are necessary because of frequent depression symptoms after treatment and also to favour return to activity. Besides, radio-chemotherapy has side-effects like weight gain and fatigue. Several strategies including group behavioural-educational interventions, physical training and/or dietary education, have been tested to answer these difficulties with moderate success in the long run. METHODS: Two hundred and fifty-one non-metastatic patients were accrued after chemotherapy in a prospective randomised multicenter trial between 2008 and 2010, testing a 2-week intervention in SPA centres. Intervention comprised group physical training, dietary education and physiotherapy. Selected patients were in complete remission. QoL was evaluated with SF36 questionnaire, anxiety and depression with the hospital anxiety and depression (HAD) one. Anthropometric measures and QoL evaluations were obtained before randomisation and every 6 months during 3 years. RESULTS: Two hundred and twenty patients were evaluable at 1 year. Intervention increased SF36 score by 9.5 points (p=0.000006), 4.6 (p=0.032) and 6.2 (p=0.028) respectively at 6, 12 and 24 months. Effect size (ES) was 0.63 [0.37; 0.90], 0.29 [0.03; 0.55] and 0.41 [0.04; 0.78]. Anxiety score was shortly minored by intervention (6-month ES=-0.24 [-0.42; -0.05]) and depression score more durably: ES=-0.45 [-0.72; -0.18], -0.34 [-061; -0.08], and -0.26 [-0.63; 0.11] at 6, 12 and 24 months. CONCLUSION: This 2-week group intervention seemed to durably influence QoL of breast cancer patients treated by chemotherapy. Differences, smaller at 12 months than at six, suggest that a second but shorter intervention could help maintain the 6-month benefits.

[Non-palpable breast lesions and core needle biopsy with Mammotome 11G: is surgery required in patients with atypical ductal hyperplasia?]. / Lésions mammaires impalpables et macrobiopsies stéréotaxiques avec le Mammotome 11 G: faut-il opérer après diagnostic d'hyperplasie canalaire atypique?

Atypical ductal hyperplasia (ADH) of the breast is a difficult histologic diagnosis. It is usually found, but not always, on clusters of microcalcifications. The subsequent risk of breast carcinoma is 4 to 5 times more important and the carcinoma can arise in the same breast or in the contralateral breast. Diagnosis can be establish on core needle biopsy with Mammotome 11G. The risk of under-estimation (ductal carcinoma in situ or invasive carcinoma) is about 20%. This risk is drastically decreased if the target (the calcifications) is completely removed by the Mammotome. This study includes 62 cases of ADH found on 633 calcifications biopsied by Mammotome 11G. In 31 cases, surgery was performed and ADH was confirmed in 25 cases (6 cases was under-estimated). In the other 31 cases, all calcifications were removed, there was no other risk factor and follow-up was suggested. Like after surgery, yearly bilateral mammography during about 20 years is recommended. In this last group, there was no false-negative result, median follow-up: 35,5 months (22-62).

[Malignancy in ACR 3 category mammographic lesions, masses and calcifications]. / Les opacités et les microcalcifications de la classification ACR 3 liées à un cancer.

At screening mammography, lesions must be assigned to BI-RADS classification. Category 3 is used for nonpalpable probably benign lesions. This category is defined either by a subset of lesions that are so likely to be benign that follow-up is a reasonable alternative to immediate biopsy, or by a less than 2% malignancy rate for American BI-RADS, or than 5% for French ANAES. The initial work-up to analyze the lesion must be complete, not only with four screening standard views but with magnification views and sonography if necessary. The risk of malignancy is very low and the pronostic factors are the same as in screening detected carcinomas.

[Stereotactic 11-gauge directional vacuum-assisted breast biopsy: experience with 249 patients]. / Macrobiopsies stéréotaxiques par système à aspiration 11-G: à propos de 249 patientes.

PURPOSE: To assess the value of percutaneous vacuum-assisted core biopsy to improve the diagnosis of non palpable mammographic abnormalities. MATERIALS AND METHODS: A total of 252 core biopsies using an 11G Mammotome((R))were performed in 249 patients. Stereotactic localization was performed in the prone position on a dedicated digital Fischer table. RESULTS: Fifty-one, or 25%, of 200 clusters of microcalcifications corresponded to carcinomas: 126 benign lesions, 23 atypical hyperplasia and LCIS, 31 DCIS, 15 invasive ductal carcinomas, and 4 false negative biopsies. In these 4 last cases, surgery was performed because radiographs of the core biopsy showed no microcalcifications; carcinoma was confirmed at histology of the surgical specimen. Using the BI-RADS system, 7 lesions were category 3, 175 lesions were category 4, and 18 lesions were category 5. From a total of 52 masses, 31 were benign lesions, 2 were borderline lesions, and 19 were invasive carcinomas. From these, 5 lesions were category 3, 31 were category 4, and 16 were category 5. Diagnostic surgical biopsy was avoided in 161 cases (63%), in 152 cases for benign lesions including 151 lesions classified as category 4 lesions and in 9 cases for multifocal or recurrent malignant lesions. CONCLUSION: When technical pitfalls are avoided and when presence of microcalcifications in the core biopsy sample is verified, vacuum assisted core biopsy with Mammotome((R)) 11G provides accurate diagnosis of non-palpable mammographic abnormalities.

[Impalpable breast abnormalities. Contribution of cytologic puncture under stereotaxic guidance. Apropos of 159 cases]. / Anomalies mammaires impalpables. Apport de la ponction cytologique par repérage stéréotaxique. A propos de 159 cas.

The authors report the results of a cooperative study of X ray guided fine needle aspiration for the cytologic diagnosis of non palpable breast lesions. They discuss the limits of this method. In 60% of 159 cases cytologic examination was diagnosis. In their series, no false positive was reported but in 64 cases no sufficient material was obtained.

[Surgical technic for the excision of subclinical radiologic anomalies of the breast]. / Technique chirurgicale pour l'exérèse des anomalies radiologiques infracliniques du sein.

Routine mammography screening can detect radiologically evident but subclinical breast anomalies. Insofar as these anomalies can correspond to carcinoma, either in situ or invasive, surgeons are increasingly forced to operate on non-palpable breast lesions. A regulated and strict surgical technic is necessary to ensure exeresis of a radiologically detected focus, while avoiding sufficient adjacent healthy parenchyma and thus reducing the esthetic prejudice to a minimum. Technical artifices are described to assist compliance with these imperatives. First, the periareolar incision is chosen, as a principle, for its cosmetic qualities. Insofar as it provides an often limited approach it can be extended radially. The latter is concealed during closure without major alteration to the areola. Second, the radiating exeresis assists detection and is safer. It also provides glandular reconstruction of good esthetic quality and facilitates follow up surveillance.

[Breast hamartomas. Mammographic and histologic aspects. Apropos of 5 cases]. / Hamartomes mammaires. Aspects mammographiques et histologiques. A propos de 5 observations.

Five observations of hamartomas are reported, and compared with the data in the literature. We recall the principal radiological and histological aspects.

[In situ breast carcinoma developing in a fibroadenoma. Apropos of 4 case reports]. / Carcinomes mammaires in situ développés dans un fibro-adénome. A propos de 4 observations.

There were 4 cases of fibro-adenoma which, when examined histologically, showed a lobular or canalicular carcinoma in situ. These are reported. The results as compared with those in the literature suggest to the authors that fibro-adenoma should be removed.

[Significance of preclinical radiologic abnormalities of the breast. Apropos of 87 histological verifications]. / Signification des anomalies radiologiques infra-cliniques du sein. A propos de 87 vérifications histologiques.

This retrospective study was carried out on 80 patients who had abnormalities discovered on mammography without any associated clinical signs. In some patients bilateral abnormalities were found so that 87 biopsies were carried out and this gave the result that 45 of the lesions were shown to be benign, 18 lesions were borderline and 24 lesions (27.6%) were of carcinomata. The frequency of these lesions goes up to 32% if areas of microcalcification only are considered. These tumours diagnosed in this sort of way, whether they are canal lesions or lobular lesions, usually show favourable histological features as far as invasion, size and lymphatic involvement is concerned. Borderline lesions are a histological group with as yet no fully evaluated significance but it has seemed to us interesting to describe them.