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The article presents a study which examines whether intravenous contrast ultrasound is superior in determining the difference between benign and malignant adnexal masses with complex ultrasound morphology compared with gray-scale or power Doppler ultrasound. It assesses the intravenous contrast ultrasound characteristics obtained by contrast-tuned imaging (CnTI) and the contrast medium SonoVue. Results show that ultrasound contrast examination is not superior to conventional ultrasound.

A letter to the editor is presented in response to the article on ovarian cancer diagnosis, published in the previous issue.

Human papillomaviruses (HPVs) are responsible for >99% of cervical cancers. Molecular diagnostic tests based on the detection of viral DNA or RNA have low positive predictive values for the identification of cancer or precancerous lesions. Triage with the Papanicolaou test lacks sensitivity; and even when combined with molecular detection of high-risk HPV, this results in a significant number of unnecessary colposcopies. We have developed a broad-range detection test of HPV transcripts to take a snapshot of the transcriptome of 16 high-risk or putative high-risk HPVs in cervical lesions (HPVs 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, and 82). The purpose of this novel molecular assay, named HPV RNA-Seq, is to detect and type HPV-positive samples and to determine a combination of HPV reads at certain specific viral spliced junctions that can better correlate with high-grade cytology, reflecting the presence of precancerous cells. In a proof-of-concept study conducted on 55 patients, starting from cervical smears, we have shown that HPV RNA-Seq can detect papillomaviruses with performances comparable to a widely used HPV reference molecular diagnostic kit; and a combination of the number of sequencing reads at specific early versus late HPV transcripts can be used as a marker of high-grade cytology, with encouraging diagnostic performances as a triage test., (Copyright © 2019 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate feasibility, SLN detection rate, and SLN location of lymphoscintigraphy in sentinel lymph node (SLN) biopsy for early cervical cancer., Methods: Ancillary analysis of data from the multicenter prospective SENTICOL study (January 2005-June 2007) of patients with early cervical cancer (FIGO stage IA with emboli to IB1) was conducted. Preoperative lymphoscintigraphy was performed after intracervical administration of 60 or 120 MBq of (99m)Tc-labeled radiocolloid on the day before (long protocol) or morning of (short protocol) surgery. SLNs were identified intraoperatively using combined radioactivity/patent blue detection. SLNs were sampled electively and routine bilateral pelvic lymphadenectomy was performed by laparoscopy. A centralized review of lymphoscintigraphies was performed to assess feasibility, detection rates, and anatomic SLN location., Results: Of 139 patients included in the SENTICOL study, 133 received radiocolloid injection, and 131 (98.5 %) underwent preoperative lymphoscintigraphy, with the long protocol in three-fourths of cases. The lymphoscintigraphic detection rate was 87.8 %, with a median of 2 (1-4) SLNs per patient. By multivariate analysis, factors independently associated with lymphoscintigraphic SLN detection were age [odds ratio (OR) 0.91, 95 % confidence interval (95 % CI) 0.87-0.96; P < 0.001], and protocol (long vs. short; OR 8.23, 95 % CI 1.87-36.25; P = 0.005). Bilateral SLN identification by lymphoscintigraphy occurred in 67 % of cases and was independently influenced by age (OR 0.95, 95 % CI 0.92-0.98, P < 0.001) and protocol (OR 5.42, 95 % CI 2.21-13.27; P < 0.001). Although 60.5 % of preoperative SLNs were in the external iliac territory, unusual drainage patterns included the common iliac (19.6 %), para-aortic (10.8 %), and parametrial (6 %) basins., Conclusions: Our study demonstrates the feasibility and good detection rate of preoperative lymphoscintigraphy, with better detection in younger patients and with the long protocol. The high proportion of SLN basins in unexpected territories is of interest to guide intraoperative detection. Further studies are needed to better evaluate preoperative detection and to assess the contribution of lymphoscintigraphy to intraoperative detection.

Background: Complete node dissection for tumor-positive sentinel lymph nodes (SLN) is becoming more controversial. Nevertheless, current practice guidelines still recommend complete axillary lymph node dissection (ALND) for breast cancer patients whose SLN contains a metastatic tumor. The Helsinki breast cancer nomogram developed by Meretoja TJ et al. aims to predict the risk of positive non-sentinel lymph nodes in patients with minimal sentinel node involvement, it uses tumor diameter and multifocality. The purpose of this study was to test the accuracy of the nomogram among patients with micrometastatic SLN-positive biopsy findings., Methods: The Helsinki nomogram was used to calculate risk of metastases for 49 consecutive patients with SLN micrometastases or isolated tumor cells (ITC) who underwent complete ALND. The nomogram was evaluated by calculating the area under the receiver-operator characteristic (ROC) curve., Results: The area under the ROC curve for the nomogram applied to all patients with micrometastases and ITC was 0.72 (range 0.60-0.85) (0.791 in the original publication)., Conclusions: The Helsinki breast cancer nomogram is a useful tool for patients with minimal sentinel node involvement., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: In breast reconstruction, complementary surgery on the contralateral breast is sometimes necessary to obtain a satisfactory aesthetic result. This complementary mammoplasty for symmetry gives the surgeon the opportunity to verify the state of the mammary glandular tissue to rule out a possible occult tumour in the contralateral breast. Our objective was to determine the prevalence of borderline lesions and of in situ and invasive carcinoma in specimens of the contralateral breast in a mammoplasty for symmetry in patients with breast cancer., Methods: We conducted a retrospective study of 145 breast reconstructions with mammoplasty for symmetry conducted at the Tours Regional Teaching Hospital in France., Results: The glandular histologic result after mammoplasty was normal in 45.5% of patients, with benign pathologies in 38.9% and borderline lesions in 15.6% of patients. No invasive or in situ carcinoma was detected., Conclusion: Systematic histologic analysis of glandular mammary tissue sampled after reduction mammoplasty in the particular context of breast reconstruction after breast cancer makes it possible to discover lesions that were not seen in presurgical evaluation. The early management of these borderline occult lesions could reduce the incidence of breast cancer in these at-risk patients.

Aims: To determine factors predictive of the presence of residual tumor on the specimen from mastectomy performed after conservative treatment for breast cancer in order to limit potentially unnecessary mastectomies (free of residual lesions)., Materials and Methods: 294 patients treated in 2 expert centers for breast cancer with breast-conserving therapy (BCT) followed by mastectomy, according to French recommendations, were investigated between January 1, 1998 and January 1, 2005. Patients with residual tumor on the mastectomy specimen were compared with patients whose mastectomy specimens did not reveal any residual tumor. All the clinical risk factors (age, previous history of breast cancer, tumor focality) and histological risk factors (tumor size, histological type, positive margins, estrogen and progesterone receptor expression, histological grade) for residual tumor after BCT were compared between the 2 patient groups., Results: Of the 294 patients studied, 202 (68.71%) mastectomies had residual tumor and 92 (31.29%) were tumor-free. Four predictive factors for residual tumor were found in the univariate analysis: age under 45 years (p=0.01), absence of estrogen receptor expression (p=0.05), positive margins (p=0.01), and presence of lymph node metastases (p=0.05). The multivariate analysis revealed only 2 independent risk factors that were significantly associated with increased risk of residual tumor on the mastectomy specimen: age under 45 years (p=0.05) and presence of positive margins on the lumpectomy specimen (p=0.05)., Conclusion: Young age of patients (under 45-years-old) and presence of positive margins on the operative specimen are independent risk factors of residual tumor after conservative treatment of breast cancer.

This project was designed to evaluate an ovine model for the use of contrast agent to visualize the microcirculation of normal ovaries. Intraovarian vascularization was investigated in eight ewes by using contrast-enhanced power Doppler after intravenous injection of Sonovue at five different times during each of ten normal estrous cycles. Sheep under general anesthesia underwent transvaginal B mode and power Doppler ultrasound examination of both ovaries, then received two successive doses of 5 ml of Sonovue, one dose for each ovary. Each ovary was monitored after the contrast injection, and a 3-min video clip was stored for each side. The video clip was used to derive time-intensity curves, which were then used to derive the contrast parameters. A total of 108 doses of contrast agent were used; 93% of the injections were available for contrast enhancement analysis. The optimal dose was determined on the first two sheep. Enhancement was strongest and longest with the 5-ml dose. In one sheep, enhancement of both ovaries remained weak irrespective of the period of the cycle. No adverse side effects of Sonovue were seen in the sheep. Contrast injection improved visualization of ovarian microcirculation by 248% (95% confidence interval [CI], 210 to 285%) for 74.2 sec (95% CI, 68.2 to 80.2 sec). Ovaries on the side of ovulation had a stronger enhancement compared with the ovary with no ovulation (368% versus 175%, P < 0.001), but the enhancement time was the same. We concluded that the sheep is an excellent animal model to illustrate microcirculation enhancement by using Sonovue to demonstrate ovarian vascular changes.

Background: This study was designed to determine the crude cumulative live-birth rates in a cohort initiating frozen donor semen treatment until completion., Methods: This cohort study included 588 couples with primary infertility in one University Hospital centre. The treatment sequence involved first artificial insemination (AID) followed by IVF if necessary (IVF-D). Live birth, drop-out for personal or medical reasons and recourse to IVF-D were recorded for all patients. Live births and drop-out were expressed both as rates per cycle and crude cumulative rates., Results: At the completion of AID and IVF-D cycles, 406 couples in the cohort (69%) achieved a live-birth and 182 couples (31%) discontinued treatment. In most cases, couples stopped treatment for personal reasons (74%) whereas fewer couples were denied further treatment for medical reasons (26%)., Conclusions: This is the first report on the crude cumulative live-birth rate in a cohort after AID and IVF-D cycles. Although calculation based on crude cumulative live-birth rate shows lower results in comparison with life table analysis, this method allows patients to obtain an insight into their actual chances of achieving a successful pregnancy.