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Sentinel node (SN) biopsy in breast cancer is still in a crucial stage of evaluation. Many teams have obtained excellent results using this method, with a detection rate always higher than 90 % and a false negative rate between 0 and 8 %, in prospective series. The main question is to know if lymphadenectomy can now be avoided when the SN is negative. The answer will come from the results of the two ongoing trials comparing sentinel node biopsy to axillary lymphadenectomy. But their results will be available only in two or three years. However, many teams, as at Institut Gustave Roussy, are now applying the technique routinely, because of the excellent results obtained during their learning curve. But there are some methodological differences between teams, which can influence the detection and false negative rates. Thus, several methodological standards remain to be defined. This review enable us to clarify a certain number of questions. Today, SN biopsy can only be performed by trained teams, with prospective evaluation of their results or participation in phase III trials. [Copyright &y& Elsevier]

Introduction: Basal cell carcinoma (BCC) accounts for 2 to 3 p. 100 of all vulvar malignancies., Patients and Methods: We report a retrospective study of 21 cases treated from 1937 to 1999., Results: Vulvar BCC's occurred in elderly patients (average age: 66 years), with mean delay to diagnosis of 5.5 years. Five patients were referred for recurrence. Lesions were located on the external hairy side of the labia majus, except one located on the internal side. In 4 cases a preexisting risk factor was identified: 2 patients had previously received radiation therapy and 2 other patients had multiple disseminated BCC. Mean BCC diameter was 2 cm. Pathological data were similar to skin BCC, with one case of mixed tumor (BCC and squamous cell carcinoma). The treatment was surgical excision for 19 BCCs. Local recurrence risk was high. Only one patient died of visceral dissemination of the disease., Discussion: More than 250 cases of vulvar BCC have been reported in the literature. Clinical, pathological and follow up data are similar to results in the present series. Treatment of choice consists of surgical excision with tumor-free margins. Because of local recurrence risk and possible association with other primary cancers in this age group, long term follow-up is necessary.

This study describes 64 cases of ovarian adenocarcinoma seen in the Gustave-Roussy Institut between 1978 and 1988 and who had a negative second-look laparotomy. The median age was 51 years (30-74). FIGO stages were: I: 7 (11%); II: 3 (5%); III: 39 (61%); IV: 3 (5%); and undetermined: 12 (19%). There were 53% of serous type, 14% of endometrioid type, 13% of undifferencied type, 8% of clear cells type, 3% of mucinous type, and 9% of mixed type tumors. There were 50% of grade 3 tumors. Initial debulking surgery was as complete as possible in 59 patients, with a residual tumor after surgery superior or equal to 2 cm in 25 patients. Post second-look surgery treatment (n = 57) consisted of chemotherapy (CT) alone in 22 patients (34%), radiotherapy (RT) alone in 31 patients (49%), and CT associated with RT in 4 patients (6%). Median follow-up is 100 months. The overall survival rates at 3 and 5 years were respectively 86 and 81%, and disease free survival rates 70 and 61%. Among the 64 patients, 26 relapsed (39%). Median time to relapse was 96 months. There is a statistical difference in the survival between patients who had no or inferior to 2 cm residual tumor and others. Residual tumor was the only factor to be significant in univariate and multivariate analysis of survival.

The aim of this study is to determine the diagnostic value of magnetic resonance imaging in the diagnosis of local recurrence of breast cancer. From 1991 to 1994, 61 women were studied prospectively using magnetic resonance imaging. All examinations were made on a 1.5 Testa machine with T1 weighted images and after gadolium-dota injection and dynamic images (T1 weighted sequences every 47 seconds during injection of a gadolinium-dota bolus). All the pre-injection, images in the dynamic series were subtracted from the images after injection. A surgical biopsy was obtained in 39 patients yielding a diagnosis of local recurrence (n = 28) or a benign lesion (n = 11). Among the 28 local recurrences, pathology examination reported invasive cancer in 22 and intra-ductal carcinoma in 6. In 22 patients with normal magnetic resonance imaging, follow-up examinations were performed every 6 months. There were no local recurrences within a delay of 6 to 36 months. Twenty-six of the 28 patients with a local recurrence, cystosteatonecrosis and surgery scar tissue less than 6 months old showed contrast uptake 1 min and 34 s after gadolinium injection during the dynamic sequence. This product uptake yielded nodular images within the invasive carcinomas and linear images in the intraductal cancers. In all cases, it is easier to visualize this contrast uptake in subtraction images. In conclusion, magnetic resonance imaging is a simple reliable method for the diagnosis of local recurrence of breast cancer.

An expert system (ES) for Diagnosis and Therapy of ovarian adenocarcinoma has been developed at the Institut Gustave-Roussy. From surgical and histological results, clinical examination and additional investigative reports, the system presents a synthesis and then determines the stage of the disease. The system than proposes therapeutic indications adapted to the characteristics of the illness and of the patient, and edits a report at the end of the ES consultation. This experience allowed us to specify the field of ES applications in oncology. As tools for diagnosis and therapy, they cannot act as a substitute for the know-how of the physician, as too many medical decisions remain difficult to formalize in the ES. On the other hand the use of artificial intelligence techniques appears to be useful for establishing coherent data bases, which are necessary pre-requisites for clinical research in oncology. The integration of the system in the Hospital Information System is the guarantee of its use in current clinical practice.

A strategy for the treatment of epithelial tumours of the ovary including two surgical operations is presented. The purpose of the first laparotomy is twofold: the extent of the lesions is accurately determined, and the tumour is excised as widely as possible. Another systematic ("second look") laparotomy enables the surgeon to evaluate the effectiveness of chemotherapy and to complete the tumoral excision if needed. Depending on the findings, supplementary total pelvic-abdominal radiotherapy (20 Gy) may be undertaken.

This study is devoted to the analysis of the surgical treatment of cancer of the uterine cervix, stage III. Three circumstances are evaluated: - Stage III with urinary disease the purpose of the surgical treatment is most often to save the renal function;--Recurrences after radiotherapy where surgery is the only possible treatment;--Stage III - Three attitudes are pointed out: Radical operation primary. Systematic surgery after preoperative radiotherapy. In the Institut Gustave-Roussy (IGR), Villejuif, exploaratory caeliotomy was performed after a preoperative irradiation of twenty Grays. The post-operative irradiation was then adapted according to the surgical evaluation.

The authors have studied retrospectively, a group of 69 patients with primitive carcinoma of the ovary who underwent at most one CT examination following the first surgical treatment. In 26 out of these, CT was done within the three months following a second surgical operation. Peritoneal metastases were inconsistently seen (5 true positive, 9 true negative, 0 false positive, 9 false negative). The sensitivity is 36%, the specificity 100% and the accuracy 65%. The score is better in the detection of lymphatic, hepatic and intestinal metastases.

Conservative treatment combining breast saving surgical procedures and radiotherapy, is considered as the best treatment for small breast cancers. The purpose of the study is to define the most appropriate surgical technique in order to reach both the complete resection of the primary and the best cosmetic result. Terms corresponding to the type of resection will be define in order to facilitate the comparison between the different studies on tumorectomies for breast cancer. Technical problems will be analyzed in the light of our experience of the conservative treatment especially in what concerns the cosmetic results.