Analysis of a continuous series of 34 young patients with early-stage cervical cancer selected for a vaginal radical trachelectomy: should "staging" conization be systematically performed before this procedure?

OBJECTIVE: Vaginal radical trachelectomy (VRT) is the most widely evaluated form of conservative management of young patients with early-stage (IB1) cervical cancer. Patients with nodal involvement or a tumor size greater than 2 cm are not eligible for such treatment. The aim of this study is to report the impact of a "staging" conization before VRT. METHODS: This is a retrospective study of 34 patients potentially selected for VRT for a clinical and radiologic cervical tumor less than 2 cm. Among them, 28 underwent finally a VRT (20 of them having a previous conization before this procedure) and 6 patients with macroscopic cervical cancer, confirmed by punch biopsies, "eligible" for VRT (<2 cm) had undergone "staging" conization (without further VRT) to confirm the tumor size and lymphovascular space involvement (LVSI) status. RESULTS: Six patients having "staging" conization before VRT had finally been deemed contraindications to VRT due to the presence of a histologically confirmed tumor greater than 2 cm and/or associated with multiple foci of LVSI. Among 28 patients who underwent VRT, 1 received adjuvant chemoradiation (this patient recurred and died of disease). Two patients treated with RVT (without postoperative treatment) recurred. Ten pregnancies (9 spontaneous and 1 induced) were observed in 9 patients. Among 4 patients with macroscopic "visible" tumor who do not underwent a "staging" conization before VRT, 2 recurred. Among 11 patients who underwent VRT and having LVSI, 3 recurred. CONCLUSIONS: These results suggest that if a conization is not performed initially, it should then be included among the staging procedures to select patients for VRT.

Radiofrequency thermal ablation of breast cancer local recurrence: a phase II clinical trial.

BACKGROUND: The role of radiofrequency (RF) ablation to treat local recurrence of breast cancer is unknown. METHODS: We conducted a two-stage phase II clinical trial. Eligible patients had a histologically confirmed noninflammatory and < or =3 cm ipsilateral breast tumor recurrence. The tumor site was identified by intraoperative sonography. A LeVeen needle electrode (RadioTherapeutics Corp, Mountain View, Calif) was inserted into a single site within the tumor and radiofrequency ablation was performed using a RF-2000 generator (RadioTherapeutics Corp). After completion of radiofrequency, a mastectomy was performed. Conventional staining and nicotinamide adenine dinucleotide-diaphorase (NADH-diaphorase) cell viability staining were performed. RESULTS: During the first stage, procedures were uneventful. Conventional, cytokeratin, and NADH-diaphorase staining identified persistent viable tumor cells in the RF-ablated region in three patients. This phase II trial was stopped after completion of the first stage because of insufficient efficacy. CONCLUSION: We demonstrate in this study that RF ablation is a potential technique to destroy local recurrence of breast tumors but the technique we tested in this phase II clinical trial had insufficient efficacy to recommend its use in routine.

Evaluation of tumor angiogenesis of breast carcinoma using contrast-enhanced digital mammography.

OBJECTIVE: The purpose of this article is to assess the accuracy of contrast-enhanced digital mammography in the detection of breast carcinoma and to correlate the findings on the images with those of histologic analysis using microvessel quantification. SUBJECTS AND METHODS: Twenty patients with a suspicious breast abnormality underwent contrast-enhanced digital mammography using a full-field digital mammography unit that was modified to detect iodinated enhancement. For each patient, a total of six contrast-enhanced craniocaudal views were acquired from 30 seconds to 7 minutes after the injection of a bolus of 100 mL of an iodinated contrast agent. Image processing included a logarithmic subtraction and the analysis of enhancement kinetic curves. Contrast-enhanced digital mammography findings were compared with histologic analysis of surgical specimens, including intratumoral microvessel density quantification evaluated on CD34-immunostained histologic sections obtained from all patients. RESULTS: An area of enhancement was depicted on contrast-enhanced digital mammograms in 16 of the 20 histologically proven breast carcinomas. Excellent correlation was seen between the size of enhancement and the histologic size of tumors, which ranged from 9 to 22 mm. Early enhancement with washout was observed in four cases, early enhancement followed by a plateau in four cases, gradual enhancement in seven cases, and unexpected decrease of enhancement in one case. Intratumoral microvessel density ranged from 11.7 to 216.6 microvessels per square millimeter. A poor correlation was found between data measured on contrast-enhanced digital mammography and intratumoral microvessel density measured on CD34-immunostained histologic sections. CONCLUSION: Contrast-enhanced digital mammography is able to depict angiogenesis in breast carcinoma. Breast compression and projective images acquisition alter the quantitative assessment of enhancement parameters.