Julia Arfi-Rouche

Variability and errors when applying the BIRADS mammography classification

To standardize mammographic reporting, the American College of Radiology mammography developed the Breast Imaging Reporting and Data System (BIRADS) lexicon. However, wide variability is observed in practice in the application of the BIRADS terminology and this leads to classification errors. This review analyses the reasons for variations in BIRADS mammography, describes the types of errors made by readers with illustrated examples, and details BIRADS category 3 which is the most difficult category to use in practice.

A retrospective, matched paired analysis comparing bendamustine containing BeEAM versus BEAM conditioning regimen: results from a single center experience

Abstract The combination of carmustine, etoposide, aracytin, and melphalan(BEAM) conditioning regimen in autologous stem-cell transplantation (ASCT) is widely used in patients with relapsed/refractory non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma. It is also an option in patients with very-high risk aggressive NHL in first complete remission (CR). Recently, a phase Ib–II feasibility study using bendamustine replacing carmustine (BCNU) was reported. We report herein a safety and efficacy analysis of bendamustine-EAM (BeEAM) with a control BEAM counterpart paired cohort (1/2). One hundred and two patients were analyzed. Overall survival (OS) and progression-free survival (PFS) were not reached and seemed to be comparable between both groups. However, grade III or greater diarrhea was significantly higher in BeEAM patients (44 vs. 15%, p = .002). The median number of days with fever >38 °C was significantly higher in BeEAM group (5.5 vs. 2, p < .001). This case-control study suggests that BeEAM followed by ASCT using bendamustine at 100 mg/m2/d is effective but has a different toxicity profile than the BEAM regimen.

Improving digital breast tomosynthesis reading time: A pilot multi-reader, multi-case study using concurrent Computer-Aided Detection (CAD)

PURPOSE Evaluate concurrent Computer-Aided Detection (CAD) with Digital Breast Tomosynthesis (DBT) to determine impact on radiologist performance and reading time. MATERIALS AND METHODS The CAD system detects and extracts suspicious masses, architectural distortions and asymmetries from DBT planes that are blended into corresponding synthetic images to form CAD-enhanced synthetic images. Review of CAD-enhanced images and navigation to corresponding planes to confirm or dismiss potential lesions allows radiologists to more quickly review DBT planes. A retrospective, crossover study with and without CAD was conducted with six radiologists who read an enriched sample of 80 DBT cases including 23 malignant lesions in 21 women. Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) compared the readings with and without CAD to determine the effect of CAD on overall interpretation performance. Sensitivity, specificity, recall rate and reading time were also assessed. Multi-reader, multi-case (MRMC) methods accounting for correlation and requiring correct lesion localization were used to analyze all endpoints. AUCs were based on a 0-100% probability of malignancy (POM) score. Sensitivity and specificity were based on BI-RADS scores, where 3 or higher was positive. RESULTS Average AUC across readers without CAD was 0.854 (range: 0.785-0.891, 95% confidence interval (CI): 0.769,0.939) and 0.850 (range: 0.746-0.905, 95% CI: 0.751,0.949) with CAD (95% CI for difference: -0.046,0.039), demonstrating non-inferiority of AUC. Average reduction in reading time with CAD was 23.5% (95% CI: 7.0-37.0% improvement), from an average 48.2 (95% CI: 39.1,59.6) seconds without CAD to 39.1 (95% CI: 26.2,54.5) seconds with CAD. Per-patient sensitivity was the same with and without CAD (0.865; 95% CI for difference: -0.070,0.070), and there was a small 0.022 improvement (95% CI for difference: -0.046,0.089) in per-lesion sensitivity from 0.790 without CAD to 0.812 with CAD. A slight reduction in specificity with a -0.014 difference (95% CI for difference: -0.079,0.050) and a small 0.025 increase (95% CI for difference: -0.036,0.087) in recall rate in non-cancer cases were observed with CAD. CONCLUSIONS Concurrent CAD resulted in faster reading time with non-inferiority of radiologist interpretation performance. Radiologist sensitivity, specificity and recall rate were similar with and without CAD.

Helping patients make informed decisions. Two-year evaluation of the Gustave Roussy prostate cancer multidisciplinary clinic

Highlights • The initial treatment decision for newly diagnosed non-metastatic prostate cancer is complex.• Specialist multidisciplinary consultations focus on shared decision-making.• The Gustave Roussy PCMC rendered high patient satisfaction and promoted active participation.• Information offered at the Gustave Roussy PCMC strongly influenced final treatment decisions.

Tumeurs rénales du sujet jeune : expérience monocentrique

Objectifs Étudier la faisabilité, la sécurité et l’efficacité de la prostatectomie totale laparoscopique (PT) de rattrapage de la récidive du cancer de prostate (CaP) après traitement focal par photothérapie dynamique (VTP) ou HIFU avec Focal One. Méthodes Cinq patients ont été opérés par PT pour récidive de cancer de prostate confirmé par biopsie après traitement focal (un VTP et 4 HIFU). La durée opératoire, les pertes sanguines, le taux de transfusion, la durée de sondage, les résultats fonctionnels, et les résultats oncologiques à court terme ont été rapportés. Résultats L’âge médian était de 61 ans. Le PSA médian avant traitement était de 2,7 ng/mL (0,65—5,85). Le délai médian entre le traitement focal et la PT était de 11 mois. Le temps opératoire médian était de 120 min. La durée médiane d’hospitalisation était de 9 jours, la durée médiane de sondage urinaire était de 11 jours. Après un suivi médian de 8 mois, Le PSA postopératoire était indétectable et le stade était pT2c pour tous les patients, le score de Gleason était 3 + 3 et 3 + 4 pour 1 et 4 patients, respectivement. Un patient présentait une marge positive focale et aucun n’a eu de traitement adjuvant. À 6 mois, tous les patients étaient continents, pour les deux patients avec IIEF > 17 en préopératoire, le score IIEF était supérieur à 17. Conclusion Dans notre expérience, la PT laparoscopique est faisable, sûre et efficace en traitement de rattrapage du traitement focal du cancer de prostate localisé. Les résultats oncologiques et fonctionnels à court terme sont prometteurs, des études complémentaires sont nécessaires. Déclaration d’intérêts Les auteurs n’ont pas transmis de déclaration de conflits d’intérêts.