Nathalie Seince

Prevalence and predictive factors for the detection of carcinoma in cavity margin performed at the time of breast lumpectomy

Margin resection status is a major risk factor for the development of local recurrence in breast conservation therapy for carcinoma. Tumor bed excision sent as separate orientated cavity margins represents a tool to verify the completeness of the carcinoma resection. We aimed to (1) determine the prevalence of positive cavity margin and its influence on subsequent surgical treatment and (2) identify potential predictive factors for positive cavity margins. From 2003 to 2006, 107 (57 years; 30–88) consecutive patients who underwent a lumpectomy for carcinoma with four orientated cavity margins for carcinoma were selected. Preoperative clinical, radiological and histological data, perioperative macroscopic characteristics and definitive histological analysis results were recorded. Lumpectomy or cavity margins were considered as positive when the distance from carcinoma to the margin was less than or equal to 3 mm. Histological examination of cavity margins showed carcinoma in 38 patients (35%), therefore modifying subsequent surgical therapy in 33 cases. Examination of the cavity margins led (1) to avoiding surgical re-excision in 20 cases (lumpectomy margins were positive and the cavity margins negative), (2) to performing a mastectomy or a re-excision in 13 cases (carcinoma was detected in the cavity margins although the lumpectomy margins were negative or tumor size was superior to 3 cm). Between preoperative and perioperative parameters, US scan and macroscopic size of the tumor were predictive factors for positive cavity margins whereas characteristics of the carcinoma determined on biopsy samples and macroscopic status of the lumpectomy margins were not. Our study confirms that the systematic practice of cavity margin resection avoids surgical re-excision and reduces the likelihood of underestimating the extent of the tumor.

Accouchement différé d'une grossesse gémellaire

We report the observation of a primigravid patient, presenting a spontaneous twin pregnancy bichorionic and biamniotic. After expulsion of the first twin at 20 weeks and two days, expectancy is adopted and the second twin is born at 31 weeks and three days. In front of this not so frequent obstetrical situation and the absence of consensus, we discuss three points: cerclage, tocolysis and the prophylactic antibiotherapy. We specify that the attempt at differed childbirth is aimed at improving the foetal prognosis of the second twin by bringing it into the viable term, as well as obtaining a survival with the least possible number of sequels.