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Resume Introduction L’IRM mammaire est l’examen de reference pour le depistage chez les patientes a haut risque genetique de cancer du sein. Sa sensibilite et sa specificite, pouvant etre limitees par le rehaussement physiologique glandulaire, il est actuellement recommande d’effectuer l’IRM de depistage dans la deuxieme semaine du cycle menstruel, ce qui peut compliquer programmation. L’objectif de notre etude etait d’evaluer l’interpretation (ou la performance) de l’IRM realisee hors de la periode souhaitee. Methodes Nous avons analyse les IRM consecutives realisees a l’Hopital Tenon chez les patientes a haut risque genetique, sans antecedent de cancer du sein, entre 2006 et 2016. Nous avons analyse le taux de rehaussement genant l’interpretation (RG) – c’est-a-dire les rehaussements de types III et IV –, le taux d’explorations supplementaires realisees (IRM et biopsie) et la survenue d’evenement d’intervalle dans 2 groupes selon les conditions de realisation de l’examen : programmation adequate (j7–j14) et programmation inadequate (en dehors de la periode recommandee). Resultats Au total, 126 IRM ont ete etudiees, realisees chez 62 patientes porteuses d’une mutation genetique predisposant au cancer du sein (BRCA 1 ou 2 : 91 %, autre : 9 %), d’âge moyen 34,5 ans, en programmation adequate (n = 84), et inadequate (n = 42). Le taux de RG etait comparable dans les 2 groupes (respectivement 31 % et 35,7 %, p = 1), ainsi que la realisation d’explorations complementaires (respectivement 31 % et 45 %, p = 0,11). Conclusion Nos resultats suggerent que la programmation de l’IRM de depistage pourrait etre simplifiee dans la population specifique des patientes indemnes a haut risque genetique de cancer du sein.

Objective We aimed to evaluate the impact of the sentinel lymph node (SLN) biopsy on adjuvant therapy, recurrence and survival in early endometrial cancer (EC). Study design We retrospectively included all patients who underwent SLN biopsy for EC between February 2007 and March 2018. Results Of the 249 EC patients included, the overall SLN detection rate was 91 %. SLNs were positive in 36 (14.4 %) cases. Nine of the 13 preoperative low-risk patients with positive SLNs were re-operated and 22 % presented positive non-SLNs. No second surgery was required for the 10 patients upstaged to intermediate risk after negative SLN biopsy. Nine of the 11 preoperative intermediate-risk patients with positive SLNs were re-operated and 33 % presented positive non-SLNs. Eleven of the 24 preoperative high-risk patients with negative SLNs were re-operated and 27 % presented positive non-SLNs. For the whole population, 3-year overall survival was 99 % (CI 95 % (97−1)) and 3-year recurrence-free survival (RFS) was 92 % (CI 95 % (0.87−0.95)). Conclusion Our study supports the feasibility of the SLN procedure for assessing risk recurrence in patients with early-stage EC. SLN biopsy should lead to major reductions in secondary staging and better adaptation of adjuvant therapy.

Introduction The effect of coronavirus disease (COVID-19) on pregnancy outcome in women with sickle cell disease (SCD) is unknown. Objectives To analyze the severity of the SARS-CoV-2 infection in pregnant women with SCD and its impact on pregnancy. Methods This retrospective cohort study included SCD pregnant women tested positive for COVID-19 between March 2020 – February 2021. The primary endpoint was the severity of the COVID-19 infection. Secondary endpoints were pregnancy complications and fetal outcomes. Results During the study period among 82 pregnant women with SCD, 8 have presented symptoms suggestive of COVID-19 and were tested positive. A common mild clinical presentation was observed in 6 women (75%), one woman was asymptomatic and one required oxygen. The latter was admitted to the Intensive Care Unit and a cesarean section was performed in the context of an ongoing vaso-occlusive crisis and acute chest syndrome together with incidental preeclampsia. Labor was induced in another patient who developed a vaso-occlusive crisis after COVID-19 remission. Fetal outcomes were good with an average Apgar score of 10 and normal umbilical blood pH at birth. Two newborns were small-for-gestational-age as expected on the ultrasound follow-up before occurrence of COVID-19. Conclusion COVID-19 infection in our population of pregnant women with SCD had typical presentation and rarely triggered a sickle cell crisis or other complications. Fetal outcomes were good and did not seem to be directly influenced by the SARS-CoV-2 virus. Further studies are required to confirm these observations as compared to the population of women with SCD without COVID-19 infection.

Artificial Intelligence (AI), a concept which dates back to the 1950s, is increasingly being developed by many medical specialties, especially those based on imaging or surgery. While the cognitive component of AI is far superior to that of human intelligence, it lacks consciousness, feelings, intuition and adaptation to unexpected situations. Furthermore, fundamental questions arise with regard to data security, the impact on healthcare professions, and the distribution of roles between physicians and AI especially concerning consent to medical care and liability in the event of a therapeutic accident.

Intramyometrial ectopic pregnancies are rare, and various management modalities have been described. We report a patient with intramyometrial pregnancy who was successfully treated by in situ injection of methotrexate (MTX) after the failure of 2 intramuscular injections of MTX. We emphasize the difficult management of intramyometrial pregnancy and show that in situ MTX injection may be indicated for this particular type of ectopic pregnancy.