Gilles Body

Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy for Advanced Breast Cancer: Results of Ganglion Sentinelle et Chimiothérapie Neoadjuvante, a French Prospective Multicentric Study

PURPOSE To determine the detection rate, the false-negative rate, and the accuracy of sentinel lymph node (SLN) detection after neoadjuvant chemotherapy (NAC) for advanced breast cancer. PATIENTS AND METHODS A prospective multicentric study was initiated to evaluate the results of SLN biopsy with the combined method after NAC for advanced large operable breast cancer. RESULTS From September 2003 to March 2007, 195 patients enrolled from 12 institutions were found suitable for evaluation. The detection rate was 90% (176 of 195 patients), and the false-negative rate was 11.5% (six of 52 patients). Patients without axillary palpable nodes (N0) before NAC had a better detection rate compared with patients with axillary suspicious nodes (N1, 94.6% v 81.5%; P = .008). The false-negative rate was not correlated with clinical nodal status before NAC (9.4% v 15%; P = .66). CONCLUSION This study confirms the feasibility of SLN biopsy after NAC in the case of large operable breast cancer. The detection rate, false-negative rate, and accuracy do not differ from those obtained in the case of early breast cancer without NAC, thus demonstrating the feasibility of SLN biopsy after NAC.

Conservative treatment feasibility with induction chemotherapy, surgery, and radiotherapy for patients with breast carcinoma larger than 3 cm

Background. The traditional surgical treatment for operable breast carcinoma larger than 3 cm is mastectomy. To avoid mutilating surgery, the authors administered primary chemotherapy to 158 patients with operable nonmetastatic large breast carcinoma with a TNM classification of T2 greater than 3 cm and T3 with a lymph node status of NO‐N1. Conservative treatment was proposed for patients responding to the chemotherapy and whose tumor was reduced to 3 cm or less. The purpose of the study was to evaluate the feasibility and treatment results of this strategy.

Contrast-Enhanced Sonography Helps in Discrimination of Benign From Malignant Adnexal Masses

Objective. To investigate the potential efficacy of real‐time contrast‐enhanced power Doppler sonography in the differentiation of benign and malignant adnexal masses in a pilot study. Methods. Before surgical treatment, adnexal masses were prospectively evaluated with power Doppler sonography before and after injection of a contrast agent. Real‐time postinjection sequences were computerized with time‐intensity analysis software to determine an enhancement curve and contrast parameters. The intraobserver and interobserver reproducibilities of these criteria were assessed on a subsample. These contrast parameters were compared between benign and malignant tumors using logistic regression. Sensitivity and specificity were used to compare contrast parameters with sonographic and Doppler variables. Results. Ninety‐nine women were included, for a total of 101 adnexal masses. There were 23 cases of ovarian malignancies and 78 benign adnexal lesions. Our procedure had excellent intraobserver and interobserver reproducibility, with an average intraclass correlation coefficient of 0.92. The time before enhancement and intensity ratio did not reliably differentiate between the benign and malignant masses. Washout times and areas under the curves were significantly greater in ovarian malignancies than in other benign tumors (P < .001), leading to sensitivity estimates between 96% and 100% and specificity estimates between 83 and 98%. Contrast parameters had slightly higher sensitivity and slightly lower specificity when compared with transvaginal sonographic variables of the resistive index and serum cancer antigen 125 levels. Conclusions. Contrast‐enhanced power Doppler imaging may easily and precisely discriminate benign from malignant adnexal lesions. Larger studies are needed to determine the appropriate use and benefits of this new procedure.

Predictive factors for fibroids recurrence after uterine artery embolisation

Objectives  To assess clinical failure and symptom recurrence after uterine artery embolisation (UAE) and to define predictive factors.

Risk factors for cervical stenosis after laser cone biopsy

OBJECTIVE To evaluate the incidence of cervical stenosis after laser cone biopsy and to identify risks factors for this adverse outcome. METHODS Prospective study evaluating all patients (n = 375) treated by laser cone biopsy for suspected cervical intraepithelial neoplasia between 1 January 1990 and 31 December 1996. Patients were contacted by mail for a clinical evaluation, 37 +/- 26 months after surgery. Two hundred and thirty-eight patients (63%) reply to this clinical follow-up examination including colposcopy, cervical smear and evaluation of cervical stenosis. Cervical stenosis was defined as cervical os narrowing preventing the insertion of a cotton swab. RESULTS Forty patients (16.8%) had cervical stenosis at follow-up. The risk of postoperative cervical stenosis increases when patients were older (mean age of women with stenosis 42 years versus 35 years; P < 0.0001), when the depth of surgical excision increases (mean surgical specimen height 18.2 mm in women with stenosis versus 15.9 mm; P < 0.01), when preoperative junction was endocervical (2.5; 95% confidence interval (CI) 1.4-4.7), when vaginal packing was necessary (2.4; 95% CI 1.4-4.2), and when continuous laser mode was used (2.1; 95% CI 1.2-3.7). Stenosis incidence was lower when human papilloma virus (HPV) was present on cervical biopsy (0.47; 95% CI 0.3-0.8), when women were smokers (0.48; 95% CI 0.3-0.9), and when a Surgicel compress was placed in the excision site (0,4; 95% CI 0.2-0.8). Patient age was the only significant independent predictor of stenosis identified by a multivariate analysis using logistic regression. CONCLUSIONS Patient with advanced age should be counselled regarding the risks for cervical stenosis after laser cone biopsy. Other surgical options may be considered when patient age exceeds 40 years.

Prognostic significance of tumor phosphatidylcholine stearic acid level in breast carcinoma

The involvement of lipid enzymes in the action of oncogenes at the cell membrane level has suggested that membrane lipids could play a role in modulating the growth of tumors. We previously found that breast cancer patients with a low level of polyunsaturated fatty acids in their primary tumors phosphatidylethanolamine had a high risk of early occurrence of visceral metastasis. In the present study, we prospectively examined whether fatty acid composition of tumor membrane phosphatidylcholine had a prognostic significance in a series of 63 patients with a localized presentation of breast cancer. Membrane phospholipids were extracted from the carcinoma tissue obtained at the time of surgery, phosphatidylcholine was purified, and its fatty acids were analyzed by capillary gas chromatography. During the follow-up period, 20 patients developed metastasis. In these patients, the proportion of stearic acid containing phosphatidylcholine was significantly lower than it was in the tumors of the 43 patients who remained metastasis-free. Multivariate analysis according to Cox showed that low stearic acid level in tumor phosphatidylcholine and high mitotic index were independently predictive of subsequent metastasis. The predictive value of stearic acid level on metastasis risk was higher in node-positive patients than in node-negative patients, allowing individualization of a subgroup of low stearic acid level, node-positive patients with very poor prognosis. We concluded that stearic acid level in tumor membrane phosphatidylcholine is an independent intra-tumor marker of breast cancer prognosis. This finding is new evidence that tumors structural lipids are linked to the growth of breast cancer.

Pure flat epithelial atypia (DIN 1a) on core needle biopsy: study of 60 biopsies with follow-up surgical excision

Flat epithelial atypia (FEA) is recognized as a precursor of breast cancer and its management (surgical excision or intensive follow-up) remains unclear after diagnosis on core needle biopsy (CNB). The aim of this study was to determine the underestimation rate of pure FEA on CNB and clinical, radiological, and pathological factors of underestimation. 4,062 CNBs from 5 breast cancer centers, performed over a 5-year period, were evaluated. A CNB diagnosis of pure FEA was made in 60 cases (1.5%) (the presence of atypical ductal hyperplasia, lobular neoplasia, radial scars, phyllodes tumor, papillary lesions, ductal carcinoma in situ or invasive carcinoma at CNB were exclusion criteria), and subsequent surgical excision was systematically performed. The histological diagnosis was retrospectively reviewed using standardized criteria and the precise terminology of the World Health Organization by two pathologist physicians. At surgical excision, 6 (10%) ductal carcinoma in situ and 2 (3%) invasive carcinoma were diagnosed. The total underestimation rate was 13%. FEA was associated with atypical ductal hyperplasia in 10 (17%) cases and with lobular neoplasia in 2 (3%) at final pathology. Residual FEA was found in 14 (23%) cases. No clinical, radiological or pathological factors were significantly associated with underestimation. Our data highlight the importance of recognizing and diagnosing FEA in core needle biopsies. Thus, the presence of FEA on CNB, even in isolation, warrants follow-up excision.

Primary chemotherapy and radiosurgical breast-conserving treatment for patients with locally advanced operable breast cancers

PURPOSE The traditional surgical treatment for operable breast cancer larger than 3 cm is mastectomy. In order to avoid mutilating surgery, we administered primary chemotherapy to 80 patients with operable non metastatic large breast cancer T2 > 3 cm and T3, N0-N1. The purpose of the study was to evaluate the breast-conserving rate induced by this treatment strategy and determine if it is a safe alternative for women with locally advanced breast carcinomas that are responders to an induction chemotherapy. METHODS AND MATERIALS The mean age was 50.1 years. Forty-three patients were T2 > 3 cm, 37 were T3. Twenty-six were N0 and 54 were N1. Mean tumor size was 5.4 cm. Patients were treated with three courses of the MVCF regimen (Mitoxantrone, Vindesin, Cyclophosphamide, and 5 Fluorouracil) every 4 weeks and then with a radiosurgical combination. RESULTS The overall response rate to induction chemotherapy was 51% with 17.5% complete tumor regression. Twenty-one percent of the patients developed grade 3 or 4 chemotherapy toxic effects, all acceptable and reversible. Breast-conserving treatment was feasible in 42.5% (34/80). Twenty patients (25%) were treated with a radiosurgical combination (tumorectomy+radiation therapy), 14 (17.5%) with radiotherapy alone (external irradiation and brachytherapy). Age, tumor stage, histology, hormonal status, hormonal receptors rate had no influence on the frequency of the observed regressions. Isolated recurrences occurred in five patients, two conservatively treated and three treated with mastectomy. Metastatic relapses were observed in 20 patients (12% in the responders and 38.5% in the non responders to chemotherapy) (p < 0.02). Five-year actuarial survival was 73% and was significantly better for responders to the induction treatment. CONCLUSION These results suggest that primary chemotherapy and radiosurgical breast conserving treatment is a safe alternative to mastectomy for patients with locally advanced operable breast cancer. The long-term benefit of this strategy must be evaluated in well designed controlled trials.

Low body mass index is an independent predictive factor of local recurrence after conservative treatment for breast cancer

AbstractBackground. Obesity or increased body mass index (BMI) has been shown to have two important adverse effects related to breast cancer. First, several studies have identified an association between increased BMI and advanced stage breast cancer. Second, increased BMI has been shown to be associated with poorer prognosis. In a previous report, we had identified low BMI as a risk factor for local reccurence at five years. The objectives of this study were to evaluate the relationship between BMI and local control and to confirm this prognostic factor in a larger population with an important follow-up. Materials and methods. Between 1976 and 1988, 605 women with invasive breast carcinoma less than 4 cm in diameter underwent conservative surgery with axillary dissection and radiation therapy. The median follow-up time was 82 months. The risk of local recurrence and distant metastasis was evaluated by univariate retrospective analysis using Kaplan–Meier method for the main clinical and histologic factors. Those found to be significant were entered in a Cox model for multivariate analysis. Results. Since the beginning of the study, 80 patients had developed local recurrence. The 5 years and 10 years local control rates were 91 % and 83 %, respectively. Four parameters were independent predictive factors of local recurrence: Age lower than 40 years (HR = 2.42 95 % CI = [1.35–4.34]), BMI: elevation of one unit reducing the local recurrence of 0.92 95 %CI = [0.85–0.99], multifocality of the tumor on pathological examination (HR = 2.12 95 % CI = [1.16–3.88]) and positive axillary nodes HR = 0.54 95 % CI = [0.31–0.95]. Size of the breast was not a predictive factor for local cancer recurrence. Low BMI did not increase risk of distant. Conclusion. Our study offers new data concerning the possibility that thinness may be related to local recurrence of breast cancer.

Sonohysterography: a prospective survey of results and complications in 81 patients

PURPOSE To evaluate the sonohysterography (SHG) for the diagnosis of intrauterine abnormalities and describe complications and failure rate. STUDY DESIGN A prospective survey on 81 patients, (44 patients with menometrorrhagia, 30 with postmenopausal bleeding and 7 with infertility) was conducted. Histopathology and clinical survey, if sonohysterography was normal, were the gold standards. RESULTS Pathology has been performed in 55 cases. There were four failures (cervical stenosis), one severe complication (endometritis), one pelvic pain. Sensitivity and specificity of sonography were 56 and 83%; for sonohysterography 88 and 98%; and for hysteroscopy 78 and 97%. Sonohysterography was accurate for the diagnosis of the submucous myoma component. CONCLUSION Sonohysterography is available in uterine pathology, easy, safe and cheap, but sonographists and patients should be informed of the little risks of such examination technique.