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GANEA2 study was designed to assess accuracy and safety of sentinel lymph node (SLN) after neo-adjuvant chemotherapy (NAC) in breast cancer patients. Early breast cancer patients treated with NAC were included. Before NAC, patients with cytologically proven node involvement were allocated into the pN1 group, other patient were allocated into the cN0 group. After NAC, pN1 group patients underwent SLN and axillary lymph node dissection (ALND); cN0 group patients underwent SLN and ALND only in case of mapping failure or SLN involvement. The main endpoint was SLN false negative rate (FNR). Secondary endpoints were predictive factors for remaining positive ALND and survival of patients treated with SLN alone. From 2010 to 2014, 957 patients were included. Among the 419 patients from the cN0 group treated with SLN alone, one axillary relapse occurred during the follow-up. Among pN1 group patients, with successful mapping, 103 had a negative SLN. The FNR was 11.9% (95% CI 7.3–17.9%). Multivariate analysis showed that residual breast tumor size after NAC ≥ 5 mm and lympho-vascular invasion remained independent predictors for involved ALND. For patients with initially involved node, with negative SLN after NAC, no lympho-vascular invasion and a remaining breast tumor size 5 mm, the risk of a positive ALND is 3.7% regardless the number of SLN removed. In patients with no initial node involvement, negative SLN after NAC allows to safely avoid an ALND. Residual breast tumor and lympho-vascular invasion after NAC allow identifying patients with initially involved node with a low risk of ALND involvement.

Robots are being used in the operating room to aid in surgery, prompting changes to workflow and adaptive behavior by the users. This case study presents a methodology for examining human-robot team interaction in a complex environment, along with the results of its application in a study of the effects of experience and workplace culture, for human-robot team interaction in the operating room. The analysis of verbal and non-verbal events in robotic surgery in two different surgical teams (one in the US and one in France) revealed differences in workflow, timeline, roles, and communication patterns as a function of experience and workplace culture. Longer preparation times and more verbal exchanges related to uncertainty in use of the robotic equipment were found for the French team, who also happened to be less experienced. This study offers an effective method for studying human-robot team interaction and has implications for the future design and training of teamwork with robotic systems in other complex work environments.

Many components of mitogenic signalling pathways have been identified over the past 15 years, including the large family of protein kinases. Dysregulation of these biological processes may play an important role in the growth and survival of cancer cells. The 20 members of the fibroblast growth factor (FGF) family transduce a variety of biological signals via distinct transmembrane tyrosine kinase receptors (FGFR1 – FGFR4) encoded by four closely related genes (Powers et al, 2000). Mature FGFR proteins, which act as membrane-spanning tyrosine kinase receptors, have an extracellular ligand-binding domain, a transmembrane domain and a split intracellular tyrosine kinase domain (Green et al, 1996). Fibroblast growth factor -mediated signals have mitogenic, angiogenic and hormone regulatory effects and play key roles in a wide variety of crucial biological activities requiring cell growth, differentiation, migration and chemotaxis. Molecular anomalies of FGFR genes (inappropriate expression, single nucleotide polymorphism (SNP), splice variations, genomic alterations) have been described in several types of human cancer (bladder, cervical, colorectal carcinomas and multiple myeloma) and in skeletal deformities (achondroplasia, Crouzon syndrome and thanatophoric dysplasia type II) (Muenke and Schell, 1995; Avet-Loiseau et al, 1998; Cappellen et al, 1999; Vajo et al, 2000. Bange et al, (2002) recently studied the role of an SNP responsible for a missense mutation (G388R) in the transmembrane domain of FGFR4, in the progression and prognosis of nodepositive breast cancer. This G → A transition changes the sense of codon 388 from Gly (GGG) to Arg (AGG). The authors concluded that the G388R mutation in heterozygous or homozygous state was significantly over-represented in node-positive breast cancer patients with early relapse, but has no role in tumour formation, making this SNP a prognostic marker. On a worldwide basis, they found that allele distribution in normal controls and breast cancer patients did not differ significantly, showing an estimated 45.4% for the Gly/Gly allele, 45.7% for the Gly/Arg allele, and 8.9% for the Arg/Arg allele (Bange et al, 2002). No relationship has been found between this SNP and the prognosis for node-negative breast cancer. Our aim was to confirm the findings of Bange et al on a larger cohort, using an improved PCR – RFLP analysis and a reinforced and more adapted statistical analysis for investigating the possible association between G388R mutation and early cancer progression. Screening was conducted in a cohort of node-positive breast cancer patients who received different adjuvant therapies (endocrine (n=67), or chemotherapeutic (n=72)) and in a cohort of node-negative breast cancer patients (n=95). These cohorts were followed up, respectively, for median periods of 89 and 87 months. PCR – RFLP analysis was modified to make molecular screening more convenient and less time-consuming. Curves for disease-free survival (DFS) were plotted according to the Kaplan – Meier method, and the log-rank test was used for comparisons between groups, as in the study of Bange et al, (Kaplan and Meier, 1958; Cox and Oakes, 1984). Statistical analysis was reinforced by using three other nonparametric linear rank tests (Breslow, Peto – Prentice and Tarone – Ware) (Breslow, 1970; Peto and Peto, 1972; Tarone and Ware, 1977; Prentice, 1978).