A new intraoperative gamma camera for the sentinel lymph node procedure in breast cancer.

AIM: This study aimed at evaluating the performance of an intraoperative gamma camera, named CarolIReS, to detect axillary drainage and to assess the removal of sentinel lymph nodes (SLN) in breast surgery. PATIENTS AND METHODS: SLN biopsy was performed on 25 patients and the CarolIReS camera was used preoperatively to localize SLNs. During surgery, individual removal of SLNs was performed using a gamma probe and their activity was measured with a gamma ray counter. At the end of surgery, the CarolIReS camera was used again to check the quality of surgery which was followed by surgical excision for remaining SLNs. RESULTS: The detection efficiency of the CarolIReS camera was 2.2 cps/kBq for 99"Tc activity in SLNs. In one case, it allowed the detection of a residual SLN with a low activity (0.5 kBq) which was massively metastatic. CONCLUSION: Intraoperative cameras could be used to improve the efficiency of the SLN procedure.

Daily Practice Management of pT1a-b pN0 Breast Carcinoma: A Prospective French ODISSEE Cohort Study.

BACKGROUND: Most breast cancer (BC) tumors ≤10 mm have an excellent prognosis. The subgroups with a higher risk for distant recurrence requiring adjuvant systemic therapy are not precisely defined in current international guidelines. PATIENTS AND METHODS: The OBSERVATOIRE DES PETITS CANCERS DU SEIN HER2 +/- (ODISSEE) study was a prospective, multicenter, cohort study that aimed to describe the daily adjuvant management and outcome of 616 patients with unifocal, invasive pT1a-b pN0 nonmetastatic BC who underwent surgery. RESULTS: At the time of diagnosis, the median age of patients was 61 years. Tumor was detected on imaging or during a screening program in 397 patients (64.6%). Most patients (96%) underwent conservative surgery with sentinel node biopsy (89%), completed with axillary lymph node dissection in 15%. At inclusion, 82% of tumors were pT1b, 73% were pN0 (i-), 53% were Scarff-Bloom-Richardson Grade I, 91% were estrogen receptor (ER)-positive, 5% overexpressed/amplified HER2, and 5% were triple negative (TNBC). Adjuvant treatments were radiotherapy (95%), hormone therapy (82%), chemotherapy (7%), and trastuzumab (3.5%). In patients with TNBC and HER2-positive BC, chemotherapy and trastuzumab (if needed) were administered in 45% and 68%, respectively. After 5 years of follow-up, 7 patients had contralateral BC, 7 had locoregional recurrence, and 1 had distant metastasis. At 5 years, overall survival, disease-free survival, and recurrence-free survival were: 98.4% (96.9%-99.1%), 94.7% (92.4%-96.3%), and 97.1% (95.2%-98.2%), respectively. CONCLUSION: This prospective cohort study showed that in France, the routine practice in pT1a-b pN0 breast cancers follows international standard guidelines for practice including conservative surgery followed by radiotherapy and endocrine therapy for ER-positive patients. Adjuvant chemotherapy with or without trastuzumab was used but their benefit in breast cancer of ≤10 mm remains controversial.

[Perception of pT1a,b pN0 breast tumor prognosis by the French oncology community: Results of the EURISTIC national survey]. / Perception du pronostic des tumeurs mammaires pT1a,b pN0 par la communauté oncologique française : résultats de l'enquête nationale EURISTIC.

The prognosis of infracentimetric breast cancers (BC) is heterogeneous. The EURISTIC survey describes how French oncology specialists perceive the prognosis of pT1a,b pN0 BCs. A self-administered questionnaire has been sent to over 2000 French BC specialists. Six hundred and sixty-three physicians responded. Fifty-eight percent do not consider tumor size as a key prognostic criterion. They consider that the cutoff for poor prognosis is 22mm, 10mm and 7mm for hormone receptors (HRs)+, HER2+ and triple-negative (TN) tumors respectively. Eighty-three percent of respondents consider that a HR+ pT1a,b tumor has a good prognosis (21% and 8% for HER2+ and TN respectively). Factors perceived as most detrimental are: HER2 overexpression (29% of respondents); HR- (20%); high grade (20%); TN status (14%); high KI67 (5%); presence of lymphovascular invasion (3%); young age (2%) and high mitotic index (1%). For French specialists, immunohistochemical characteristics, in particular hormone and HER2 status, are strong prognostic factors in BCs below 1cm.

One case of fetal and neonatal variable thyroid dysfunction in the context of Graves' disease.

Cases of maternal thyroid dysfunction are not always clearly identified during pregnancy. We report here the case of a 36-year-old patient with a history of treated Graves' disease whose child successively presented with a hypo- and hyperthyroid dysfunction that was difficult to treat despite the administration of synthetic antithyroid drugs and beta-blockers. The patient's thyroid hormone levels were normal during pregnancy, while still secreting anti-TSH-receptor autoantibodies. With time, these antibodies went from an inhibiting to a stimulating activity. Fetal monitoring using only ultrasonography had been proposed to the patient. With such a follow-up associated with fetal blood sampling it would have been possible to treat already in utero the thyroid dysfunction. The management of such patients is not limited to the follow-up of the maternal thyroid hormones, but should also evaluate the activity of the anti-TSH-receptor autoantibodies around the 28th week of amenorrhea and their effect on fetal blood. Fetal and neonatal thyroid dysfunctions have a major impact, but they can be detected and treated in utero. The clinical, laboratory and ultrasound follow-up makes it possible to monitor patients who are at risk and to propose a therapeutic and obstetrical management.

Isolations of Corynebacterium kroppenstedtii from a breast abscess.

The recently described species Corynebacterium kroppenstedtii was isolated from a breast abscess in a 38-year-old woman on two occasions. We discuss the pathogenic role of this bacteria and the methods used for its isolation.