Psychometric properties of the French Hot Flash Related Daily Interference Scale (HFRDIS).

OBJECTIVE: Hot flashes are one of the major symptoms of climacteric syndrome. Despite the high prevalence of these symptoms, few questionnaires assessing the impact of hot flashes on quality of life have been validated. The aim of this study was to validate a French version of the Hot Flash Related Daily Interference Scale (HFRDIS) in a sample of French women. METHODS: In this prospective study, data were obtained from two groups of women aged between 40 and 60 years from both women without breast cancer and women under hormone therapy for breast cancer between March 2021 and February 2022. Translation was made by an official English-French translator using the forward-backward method. RESULTS: One hundred and sixty-seven women completed the HFRDIS questionnaire. The scree plots confirmed unidimensional structure. Cronbach's α coefficient was 0.92 [0.90-0.94] similar to the original version. The intra-class correlation coefficients of each item ranged between 0.58 and 0.71 Concordance of the scores of each item with those obtained during the validation of the original version of the HFRDIS was confirmed. CONCLUSION: The validation results show that the French version of the HFRDIS questionnaire is a valid tool to evaluate the impact of hot flashes on the daily life activities of patients.

Potential histological discordance revealed by second review in the national rare gynecological cancer network (TMRG).

INTRODUCTION: Since 2010, the network of rare malignant tumors of the ovary (TMRG) was developed to optimize the management of patients, also allowing a histological second opinion of rare ovarian tumors. The aim of this work was to study the contribution of second opinion to improve histological diagnostic accuracy on ovarian rare malignant tumors included in the TMRG database. MATERIAL AND METHODS: Histological data of patients diagnosed with a rare ovarian tumor included in TMRG network over a one-year period (2018) were collected. Initial diagnoses were compared with second opinion from national gynecological pathologist experts. The modalities of histological second opinion requests were studied, as well as the histological characteristics of the tumors. The discordances were classified as minor (if the modification of histological diagnosis did not change patient management) and major (if the patient management can be modified). RESULTS: Of 1185 included patients, 937 matched the inclusion criteria. Full concordance between primary diagnosis and expert second opinion was reached in 611 cases (65,3%), minor discordance was seen in 114 (12,2%) and major discordance in 209 (22,3%) of cases. In systematic review requested by the network, 26% (n = 137) of cases were reported with a change in histological diagnosis, while the change concerned 44% (n = 186) of cases for a second opinion spontaneously requested by the initial pathologist. The discrepancies concerned all categories of ovarian tumors, with a majority of mucinous tumors (43% of major discordances), followed by stromal and sex-cord tumors (13.8% of major discordances) and clear cell tumors (12,4% of major discordances). CONCLUSION: This analysis confirms the diagnostic difficulty of ovarian tumors, due to their rarity and morphological heterogeneity. French pathologists are aware of these difficulties and spontaneously refer ovarian tumors with unusual histology for a second opinion and collaborate with rare tumor networks for systematic review.

HPV ctDNA detection of high-risk HPV types during chemoradiotherapy for locally advanced cervical cancer.

BACKGROUND: Chemoradiotherapy (CRT) is the standard of care for patients diagnosed with locally advanced cervical cancer (LACC), a human papillomavirus (HPV)-related cancer that relapses in 30%-60% of patients. This study aimed to (i) design HPV droplet digital PCR (ddPCR) assays for blood detection (including rare genotypes) and (ii) monitor blood HPV circulating tumor DNA (HPV ctDNA) levels during CRT in patients with LACC. METHODS: We analyzed blood and tumor samples from 55 patients with HPV-positive LACC treated by CRT in a retrospective cohort (n = 41) and a prospective cohort (n = 14). HPV-ctDNA detection was carried out by genotype-specific ddPCR. RESULTS: HPV ctDNA was successfully detected in 69% of patients (n = 38/55) before CRT for LACC, including nine patients with a rare genotype. HPV-ctDNA level was correlated with HPV copy number in the tumor (r = 0.41, P < 0.001). HPV-ctDNA positivity for HPV18 (20%, n = 2/10) was significantly lower than for HPV16 (77%, n = 27/35) or other types (90%, n = 9/10, P = 0.002). HPV-ctDNA detection (positive versus negative) before CRT was associated with tumor stage (P = 0.037) and lymph node status (P = 0.02). Taking into account all samples from the end of CRT and during follow-up in the prospective cohort, positive HPV-ctDNA detection was associated with lower disease-free survival (DFS) (P = 0.048) and overall survival (OS) (P = 0.0013). CONCLUSION: This is one of the largest studies to report HPV-ctDNA detection before CRT and showed clearance of HPV ctDNA at the end of treatment in most patients. Residual HPV ctDNA at the end of CRT or during follow-up could help to identify patients more likely to experience subsequent relapse.

Successful external cephalic version is an independent factor for caesarean section during trial of labor - a matched controlled study.

INTRODUCTION: To assess the mode of delivery and Caesarean Section (CS) rate after successful External Cephalic Version (ECV). MATERIAL AND METHODS: A matched case-control study. Data were gathered from a tertiary care university hospital register from 1996-2015. All pregnant women who delivered after successful External Cephalic Version (ECV). Among 643 women who attempted ECV, we identified 198 with successful ECVs and compared them with the next two women who presented for labor management with spontaneous cephalic presentation, matching for delivery date, maternal age, parity, body mass index, and delivery history using univariate and stepwise logistic regression. The main outcome measure was the risk of caesarean. RESULTS: The caesarean section rate was higher after successful ECV (respectively 20.7% versus 7.07%, P<0.05). Caesarean section for abnormal fetal head position (forehead, bregma, face) was higher after successful ECV (28.6% versus 0%). After adjustment for matching and confounding variables (variation of the caesarean section rate over the study period, gestational maternal complications, antepartum fetal complications, term of delivery, induction of labor, oxytocin use for dystocia, neonatal cephalic perimeter), a successful ECV increased the risk of caesarean section (adjusted OR 3.17, 95% CI 1.86-5.46). By stratifying on week, a trend for increased risk for caesarean section was observed at the week after ECV and at post term (28.6% before 37+6, 14.8% at 38+0-38+6, 13.8% at 39+0-39+6, 14.2% at 40+0-40+6 and 33.3% beyond 41+0 weeks' gestation, P=0.06). CONCLUSIONS: Women who have a successful ECV are at increased risk of caesarean section compared with women who experience spontaneous cephalic presentation.

[Molecular characterization of breast cancer in clinical practice]. / Caractérisation moléculaire des cancers du sein en pratique clinique.

Breast cancer involves various types of tumors. The objective of this review was to provide a summary of the main methods currently available in clinical practice to characterize breast cancers at a molecular level and to discuss their prognostic and predictive values. Hormonal receptors expression and the HER2 status are prognostic markers and can also predict the response to targeted therapies. Their analysis through immunohistochemistry is systematical. Ki67 is an effective prognostic marker, but its reliability is debated because of its low reproducibility between laboratories and between pathologists. Commercial genomic signatures are all considered valid prognostic tools and may guide physicians to make therapeutic choices. These signatures are costly and should therefore be restricted to situations in which the use of chemotherapy remains equivocal.

[Delay of professional activity recovery after implant based breast augmentation surgery: Influence of healthcare coverage]. / Délai de reprise de l'activité professionnelle après chirurgie d'augmentation mammaire par prothèse: impact de la prise en charge par la sécurité sociale.

AIM OF THE STUDY: The main goal is to determine if the delay before going back to work after implant-based breast augmentation surgery is influenced by the healthcare coverage criteria. MEANS AND METHODS: In this retrospective, single center based study, patients who underwent implant-based breast augmentation surgery (excluding reconstructive surgery) in the past 3 years with a minimum follow-up of 1 month were questioned by telephone. Patients who had early postoperative complications, or no professional activity, were excluded. The demographic and perioperative data were collected and two groups were compared: those who were covered by the healthcare system and those who were not. RESULTS: Sixty patients were included. The two groups were comparable concerning the demographic (age, BMI, children, work intensity, smoking status, comorbidity) and surgical data (surgical approach, type, volume and position of the implant, operative time and drainage). There was a significant difference between the groups concerning the delay of return to work (P=0.0001): 18.4 days for reimbursed patients versus 9.45 days for patients without healthcare coverage. CONCLUSION: For the same implant-based breast augmentation surgery, and for the same population, the duration of postoperative recovery period doubles for the patients for whom surgery is reimbursed by the healthcare system.

Impact of axillary dissection in women with invasive breast cancer who do not fit the Z0011 ACOSOG trial because of three or more metastatic sentinel lymph nodes.

AIM: The objective of this study was to determine the effects of axillary lymph node dissection (ALND) versus sentinel lymph node biopsy alone (SLNB) on the survival of patients with 3 or more metastatic lymph nodes (MLN) in invasive breast cancer. METHODS: Data of 9521 patients with invasive T1-2M0 breast carcinoma and initial treatment with SLNB completed or not by ALND and 3 or more MLN were extracted from the SEER database. Univariate and multivariate analyses were performed. RESULTS: Overall, 9521 patients were included in the study. SLNB-alone compared with ALND did not result in different overall survival (OS) or specific survival (SS) for patients with 3 or more MLN (p = 0.46 and 0.58, respectively). In subgroup analyses, OS was comparable between SLNB-alone and ALND when patients had only 3 or more than 3 MLN. When patients had 3 MLN, the 5-year SS was significantly better for patients with ALND compared with SLNB-alone: 91.5% and 85.1%, respectively (p = 0.02). The Hazard Ratio (HR) for OS comparing SLNB-alone with ALND adjusting for age, adjuvant radiotherapy, tumor size, estrogen receptor status, grade and tumor type resulted in an HR of 1.05 (95% CI, 0.72-1.54, p = 0.77). CONCLUSION: In conclusion, patients with a T1-T2 invasive breast cancer and at least 3 MLN do not benefit from ALND after SLNB for specific and overall survival, thus limiting ALND to a staging procedure. A subgroup of patients with 3 MLN had a better SS with ALND, possibly due to an under-staging of the SLNB-alone group.

Association of the number of sentinel lymph nodes harvested with survival in breast cancer.

AIMS: In patients with breast cancer, the association between the number of sentinel lymph node (SLN) removed and survival is poorly known. Our objective was to evaluate this association on disease-specific survival (DSS). METHODS: Data of 144 517 patients with invasive T1-3M0 breast carcinoma and initial treatment with SLN biopsy were extracted from the SEER database. Univariate and multivariate analyses were performed. RESULTS: The number of SLNs harvested and the completion of axillary lymph node dissection (ALND) were not associated with DSS improvement for patients without metastatic nodes. After adjustment, patients with three SLNs had a better DSS than did other groups (HR of 0.73 CI 95% [0.60-0.88], p = 0.001). This result was mainly driven by the group of patients with one metastatic LN. When patients had two or more metastatic LNs, there was no difference in DSS according to the number of SLNs or to completion of ALND. CONCLUSIONS: The number of SLN harvested was associated with DSS. According to DSS, the optimal number of SLNs harvested was three in this large series, thereby calling into question the understaging or undertreatment of SLN biopsy in which only one or two SLNs are harvested but also the therapeutic effect of completion ALND.

Lymphatic and nerve distribution throughout the parametrium.

BACKGROUND: Our objective was to concomitantly assess distribution of lymphatic and nerve structures in the parametrium. METHODS: Twenty hemipelvises from ten fresh cadavers were dissected to differentiate between, three different parts of the parametrium: the lateral parametrium, the proximal and the distal part of the posterior parametrium. Histologic and immunofluorescence analyses of nerve and lymphatic structures were performed using NSE and LYVE-1 staining, respectively. The percentage of structures was independently scored as 0 (0%), 1 (1-20%), 2 (20-50%), 3 (50-80%), 4 (>80%). RESULTS: The lateral parametrium and the proximal part of the posterior parametrium contained both nerve (scored 2.25 and 2.50, respectively) and lymphatic (scored 2.50 and 2.00, respectively) structures. The distal part of the posterior parametrium also contained numerous nerve structures (scored 2.00) but lymphatic structures were rare (scored 0.88). No difference in nerve distribution was found according to the parts of parametrium while a significantly lower distribution of lymphatic vessels was observed in the distal part of the posterior parametrium (p=0.03). CONCLUSION: The distal part of the posterior parametrium is of high nerve density and low lymphatic density raising the issue as to whether it should be removed during radical hysterectomy.

[Interest of a thrombin and fibrinogen combipatch in preventing breast cancer seroma after lymph node dissection]. / Intérêt d'un combipatch de thrombine et de fibrinogène dans la prévention des lymphocèles après curage axillaire.

OBJECTIVE: To evaluate the effect of combipatch TachoSil(®) in the prevention of seromas after axillary dissection in local breast cancer. PATIENTS ET MÉTHODES: A retrospective, case-control study conducted between January 2007 and December 2009, in two departments of Obstetrics and Gynecology of the AP-HP. Sixty-six patients (45 in the control group and 22 in the group TachoSil(®)) who have undergone an axillary dissection alone, with establishment of a redon or with lumpectomy, were included. The total amount of lymph drained during the stay, the number of days of drainage, duration of hospitalization, the number of lymphoceles and the number of retrievals performed at the waning of hospitalization were collected. RESULTS: The population was similar in age, body mass index (BMI), clinical and pathological data. There was no significant difference in terms of total volume of lymph drained (268.2 ± 220.7 mL without TachoSil(®) and 228.6 ± 128.8 mL with TachoSil(®), P = 0.89) and the number of days of drainage (3.9 ± 1.6 days without TachoSil(®) and 3.1 ± 0.9 days with TachoSil(®), P = 0.10). The duration of hospitalization was significantly higher in the group TachoSil(®) (5 ± 1.6 days with TachoSil(®) and 3.8 ± 1.1 days without TachoSil(®), P = 0.006). CONCLUSION: This study shows no benefit of combipatch (TachoSil(®)) in prevention of seromas after axillary lymph node dissection. A randomized study with large effective is necessary.

[Uterine ishtmique transmural hernia: results of its repair on symptoms and fertility]. / Hernie transmurale isthmique de l'utérus : résultats de l'isthmorraphie sur la symptomatologie et la fertilité

OBJECTIVE: To study the effect of the surgical repair (isthmorraphy) of the large scar dehiscence after cesarean on symptoms and fertility for women who desire pregnancy. PATIENTS AND METHODS: In this retrospective study, 14 symptomatic patients, who desire a new pregnancy underwent a surgical repair by laparotomy, laparoscopic or vaginal technique. Five women experienced failure of Assistance Reproductive Technique (IVF or ICSI) for idiopathic secondary infertility. The dehiscent scars were evaluated by ultrasound, hysterography, hysteroscopy and magnetic resonance imaging. OUTCOME: Symptoms improvement was found in 92% of case. Ten pregnancy (71%) was obtained after surgical repair, 6 spontaneous and 4 after Assistance Reproductive Technique. Among the 5 women initially followed in the reproductive unit, 4 became pregnant, 3 after IVF or ICSI and 1 spontaneous. No operative complication occurred. The subsequent pregnancy was unremarkable with no uterine rupture. DISCUSSION: Large scar defect after cesarean can take shape of a complete absent of the anterior wall of the uterus. No incident has been proved in this condition. There is a lack of data concerning these isthmocele. The experience of hysteroscopic repair cannot be applied to these real large diverticule of the scar cesarean. The results of this study suggest a link between the isthmocele and reversible symptoms after surgery. The first results concerning the subsequent fertility after surgical repair seem interesting CONCLUSION: When a large scare defect (isthmocele) is found in symptomatic woman (pelvic pain, bleeding uterine, infertility), a surgical repair can be proposed, especially for woman who desire a new pregnancy.

Incidence of pre- and postoperative urinary dysfunction associated with deep infiltrating endometriosis: relevance of urodynamic tests and therapeutic implications.

Although many series have been published on the management of digestive or urinary deep infiltrating endometriosis (DIE), few data exist on pre- and postoperative urinary dysfunction (UD) and urodynamic tests. Hence, the objective of this review was to evaluate the pre- and postoperative incidence of UD and the contribution of urodynamic tests as well as their therapeutic implications. Studies published between January 1995 and April 2012, available in the databases Medline, Embase or the Cochrane Library and responding to a key word algorithm were selected. Studies were classified according to their level of evidence in the Canadian Task Force classification. Sixty-three studies were included in this review. The incidence of preoperative UD is unknown in patients with DIE without colorectal involvement but ranges from 2% to 48% in patients with colorectal endometriosis. About half of all the patients had abnormal urodynamic test results. DIE surgery is associated with a risk of urinary dysfunction mainly corresponding to de novo voiding dysfunction in 1.4% to 29.2% of cases with a mean value of 4.8%. The rate of persistent voiding dysfunction ranges from 0 to 14.7% with a mean value of 4.6%. Risk factors of postoperative UD are the need for partial colpectomy, parametrectomy and patients requiring colo-anal anastomosis. For patients with urinary tract endometriosis, the incidence of preoperative UD is comprised between 24.4% and 79.2% with a rate of postoperative voiding dysfunction ranging from 0% to 16.9% with a mean value of 11.1%. Prevention of postoperative UD is based on nerve-sparing surgery. Treatment of voiding dysfunction requires self-catheterization. There is a lack of data on medical treatment and surgical techniques to manage postoperative UD. More effort needs to be made to detect preoperative UD associated with DIE. Preoperative evaluation by urodynamic tests and possibly electrophysiology could be of interest especially in patients with risk factors. The current review underlines the difficulties of establishing clear recommendations due to heterogeneity of the studies and the absence of a consensual definition of UD.

[Diagnosis of lobular neoplasia in situ on percutaneous breast biopsy: surgical indication]. / Diagnostic de néoplasie lobulaire in situ sur biopsies percutanées: considérations chirurgicales.

UNLABELLED: The arrival of modern imagery techniques has generated an increase in diagnosed lobular intra epithelial neoplasia (LIN) cases. The aim of this research is to define standards to assess the reliability of surgical action currently advised after diagnosing LIN on percutaneous breast biopsy. MATERIALS AND METHODS: This retrospective research was conducted from January 1999 to December 2008 on 24 patients. After performing of mammotome procedure on micocalcifications, each diagnosed LIN case was reviewed by two anatomopathologists. The extent and type of LIN (1 and 2) tumor was defined. A further analysis of the surgically removed material was carried out. RESULTS: The study has indicated three cases of underestimation (12.5%). It was CCIS. The analysis of mammotome procedure shown that the extent and type of LIN were inconstant. CONCLUSIONS: The rate of underestimation is low but it appears that the extend and type of LIN's tumor on mammotome procedure is not available for the surgical decision.

[Management of pregnancies with a previous cesarean]. / Gestion des grossesses avec un utérus cicatriciel : état des connaissances.

The cesarean rate in France has reached 21% in 2010. With a maintained fertility rate, management of a pregnant woman with a previous caesarean scar is becoming a daily situation for most obstetrical teams. Considering the small rate of vaginal birth after cesarean (VBAC), we will try to establish an up-to-date review of the benefits and risks of encouraging trial of VBAC. This information can help professionals provide adequate counselling women or couples.

Use of laparoscopy in unexplained infertility.

OBJECTIVE: The use of laparoscopy in unexplained infertility work-up is still a subject of debate, although laparoscopy remains the gold standard for diagnosis and treatment of several pelvic pathologies. The objective of this study was to assess the rates and types of pelvic pathologies observed during diagnostic laparoscopy, and the pregnancy rate in couples with unexplained infertility following laparoscopy. STUDY DESIGN: Prospective study, from November 2003 to October 2009, including 114 infertile, spontaneously ovulating women with normal clinical examination, ovarian reserve assessment, pelvic ultrasound scan and patent tubes on hysterosalpingography. Semen analyses were normal according to the World Health Organization criteria. After three cycles of ovulation induction with or without intra-uterine insemination and no pregnancy, women were referred for diagnostic laparoscopy. RESULTS: Laparoscopy revealed pelvic pathology in 95 patients. Endometriosis, pelvic adhesions and tubal disease were observed and treated in 72, 46 and 24 patients, respectively. Following laparoscopy, bilateral and unilateral tubal patencies were observed in 107 and five patients, respectively. Pregnancy was observed in 77 out of 102 patients who tried to conceive after surgery, 35 of whom conceived using their own tubes. CONCLUSION: Diagnostic laparoscopy should be strongly considered in unexplained infertility work-up, and tubal efficiency should not be underestimated.

[Efficacy of systematic information and prescription of vaccine to implement the recommendations to prevent post-partum pertussis: A limited impact]. / Efficacité d'une stratégie d'application des recommandations vaccinales anticoqueluche en post-partum : un impact limité

OBJECTIVES: Despite official recommendations in 2004, antipertussis vaccine coverage in post-partum remains low. Measures used to date to improve the appliance of these recommendations were not implemented. The purpose of this study was to evaluate the effectiveness of a strategy of education and systematic prescription of antipertussis vaccine, on immunization coverage of mothers in the post-partum. PATIENTS AND METHODS: This was an analytical, interventional, monocentric study conducted on delivered patients, hospitalized between July 10th and 31st, 2009 in our establishment. Oral (twice: midwife and doctor) and written information about pertussis and order of vaccine were delivered in post-partum. RESULTS: No patient had reliable information on her vaccination status during hospitalization. According to the patients, information by midwife was provided in 70% of cases. At 6 weeks, the immunization coverage was 16% (10/61 patients), including 8% related to the intervention (vaccinated during postpartum) and 11% for fathers (7/61 fathers) with 7% newly vaccinated. Lack of time, omission in proliferation of information context in puerperium and low socio-economic backgrounds may have influenced the non-vaccination. However medical information is so far still perfectible as evidenced by the rate of patients actually sensitized and postponement vaccination after breastfeeding despite official recommendations. DISCUSSION AND CONCLUSION: Antipertussis vaccination care should also involve physicians before, during and after pregnancy, and pediatricians.

[Primary breast angiosarcoma: two case reports]. / Angiosarcome mammaire primitif: à propos de deux cas.

Primary angiosarcoma is a rare type of breast cancer, the diagnosis is difficult to establish and it has the worst prognostic of all breast malignancies. Two cases of primary breast angiosarcoma have been observed at the centre Henry Kaplan of Tours and at the hospital La Source of Orleans since 2001. Based on a literature review, we analyse the epidemiological, pathological, clinical, diagnostic and treatment aspect of this type of cancer. Mastectomy is the reference treatment and the benefit of radiotherapy and chemotherapy remains to be demonstrated.

Mastectomies after vacuum core biopsy procedure for microcalcification clusters: value of clip.

PURPOSE: The study was performed to substantiate the value of detecting clips in mastectomy specimens as a guide to taking pathological samples. MATERIAL AND METHODS: We performed a retrospective review of 4 cases of mastectomy required after biopsies of microcalcifications. In each case a metallic clip had been inserted at the end of the vacuum core biopsy procedure. RESULTS: The study included 7 microcalcification clusters with a mean size of 6.7mm corresponding to multifocal or relapsing ductal carcinoma in situ. Gross examination of the mastectomy specimens revealed no evidence of tumoral lesions or fibrous scar tissue. Radiographic examination of the serial slices did not detect any microcalcifications, but confirmed the presence of the clip in the 7 clusters in 4 cases. Histological examination was performed on the areas identified by the clips and detected scar tissue indicating the location of the biopsies and tumoral lesions in all the specimens. CONCLUSION: In the pathological management of mastectomy specimens following vacuum core biopsies, gross examination may reveal no abnormalities and slice radiography may fail to detect microcalcifications. In such cases, radiography of the serial slices allows localisation of the metallic clips inserted during the vacuum-assisted biopsy procedure and remains the only way for the pathologist to select mastectomy specimens for microscopic analysis.

[Hepatic splenosis: a rare etiology of hepatic nodules]. / Splénose hépatique: une étiologie rare de nodules hépatiques.

Splenosis is the autotransplantation of splenic tissue, generally after traumatic splenic rupture. Usually, the peritoneal surface is affected. The viscera are rarely involved in this graft. We report a case of intrahepatic splenosis, which presented as a liver tumour on imagery in a 55-year-old man followed for lung carcinoma and chronic hepatitis C and who had undergone a splenectomy for trauma 22 years before. The different characteristics and diagnostic methods of 16 cases of hepatic splenosis are presented from the literature. These different reports emphasize the necessity of considering splenosis in the differential diagnosis of hepatic tumours.