A. Langer

A single-institution study of 117 pregnancy-associated breast cancers (PABC): Presentation, imaging, clinicopathological data and outcome.

BACKGROUND This retrospective single-institution study was designed to describe the main clinical, radiological and histological features, as well as the outcome of pregnancy-associated breast cancer (PABC), with a special emphasis on imaging and diagnostic difficulties. MATERIAL AND METHODS We reviewed all breast cancers diagnosed during pregnancy or during the 12 months following delivery at our institution, between 1993 and 2009. Out of a total of 16,555 new cases of breast cancer observed during this period, 117 PABC (0.7%) were diagnosed. RESULTS Mean age at diagnosis was 33.7 years. Most cancers (81.2%) were diagnosed after delivery. Intermediate or high family risk was frequent (27.5%). The most common mode of presentation was a palpable mass (89.7%). Mean time to diagnosis was 5.8 months. Sensitivity for mammography was 80.9% and for ultrasound 77%. Most prognostic factors were unfavourable: frequent lymph node involvement (51.8%), high-grade tumours, hormone receptor negativity (45.9%) and HER2 positivity (38.7%). Treatments generally included surgery (61.7% mastectomies), radiotherapy (96%) and chemotherapy (79.6%). Overall 5-year survival was 81.8%. CONCLUSION PABC is an uncommon but aggressive form of breast cancer and must be considered in the presence of any breast abnormality during pregnancy or the months following delivery. Mammography and ultrasound should both be performed at the slightest clinical suspicion. Radiologists must be aware that masses may lack typical malignant ultrasound characteristics. Biopsies should be largely performed.

Exploration des seins denses en mammographie : techniques et limites

Mammographic evaluation of dense breasts: techniques and limits Breast density is a radiological concept based on the proportion of radiopaque glandular tissue relative to radiolucent fatty tissue. Mammographic evaluation of dense breasts is more difficult, related to technical difficulties, with decreased rates for detection and characterization of breast lesions, resulting in reduced sensitivity with increased number of interval cancers at routine follow-up when compared to radiolucent breasts. We will review the definition of dense breasts and their frequency, especially their relationship with the age of patients. We will discuss the current technical problems and the impact of breast density on the efficacy of conventional mammography. We will discuss the value of digital mammography, the role of computer assisted diagnosis (CAD) systems and tomosynthesis in the evaluation of dense breasts.

Quand et comment realiser un prelevement sous TDM d’un rehaussement vu a l’IRM ?

Objectifs Connaitre les techniques et les indications des reperages TDM pre-operatoires de rehaussements mammaires occultes. Connaitre les types et les indications des prelevements guides par TDM. Points cles Le reperage TDM pre-operatoire des lesions mammaires vues en imagerie de contraste est une technique facile a realiser, rapide et fiable. Le reperage TDM pre-operatoire necessite une bonne cooperation avec le chirurgien et le pathologiste. Les biopsies guidees sous TDM n’ont pas fait leur preuve d’efficacite en raison de l’absence de contention du sein. Les cytoponctions guidees sous TDM ont une faible sensibilite et une specificite correcte. Resume Rappel de la technique de la TDM mammaire utilisee pour les actes interventionnels. Presentation de notre experience de reperages TDM pre-operatoires de rehaussements mammaires anormaux a partir de 64 procedures (techniques de reperage, resultats). Technique, resultats et limites des prelevements guides par TDM.

SEIN-WS-17 Interet du scanner mammaire pour les recidives et les cancers controlateraux apres traitement conservateur

Objectifs Apprecier la valeur de la TDM mammaire apres traitement conservateur, devant une image mammographique et echographique ambigue. Materiels et methodes Etude retrospective des TDM mammaires effectuees chez 383 patientes entre 1992 et 2004 pour exploration de 405 anomalies mammographiques et/ou echographiques. Deux cent quarante-quatre anomalies ont ete operees ou biopsiees et 161 surveillees. Resultats Cent quatre-vingt-sept carcinomes sont diagnostiques (carcinomes canalaires in situ : 21 cas, cancers infiltrants 166 cas) correspondant a 137 recidives locales et 50 cancers controlateraux. Dans les recidives locales, 9 faux negatifs de la TDM sont observes : sensibilite 93,4 %, specificite 88 %, VPP 90 %, VPN 92 %. Pour les carcinomes controlateraux, aucun faux negatif n’est observe : sensibilite 100 %, specificite 70 %, VPP 62,5 %, VPN 100 %. L’irradiation entraine une diminution des prises de contrastes malignes, et une diminution encore plus franche des prises de contrastes benignes. Les lesions invasives comportent une grande part de lesions T0 (47 % dans les recidives, 68,4 % dans les carcinomes controlateraux). Le surcout des TDM pour un carcinome diagnostique et le surplus d’irradiation seront abordes. Conclusion Devant une petite cible ambigue mammographique et echographique, la TDM mammaire est un examen commode et efficace pour l’aide au diagnostic precoce d’une recidive ou d’un petit carcinome controlateral.

SEIN-WP-2 Fibromatose mammaire : revue de la litterature, a propos de 6 cas

Objectifs pedagogiques Decrire les aspects cliniques, mammogra-phiques, echographiques et histologiques des fibromatoses mammaires. Messages a retenir La fibromatose du sein est une tumeur benigne rare localement infiltrante, de presentation clinique et radiologique souvent suspecte. La fibromatose du sein expose au risque de recidive locale, moins important que dans les formes extra mammaires. Le diagnostic et le traitement reposent sur la biopsie chirurgicale. Une resection en marges saines diminue le risque de recidive locale.