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Background: In breast cancer patients, neoadjuvant chemotherapy (NAC) allows to obtain pathological complete response (pCR). In case of initially involved node before NAC, pCR after NAC could make it possible to avoid axillary surgery. The aim of our study was to address parameters to build a tool able to accurately select patients at a high probability of axillary pCR after NAC. Method: GANEA 3 was a French prospective multi institutional cohorts of breast cancer patients with a proven axillary involved node treated with NAC (NCT03630913). Initially involved node was clipped before treatment. Each patient received, before and after NAC, a bilateral mammography, a Magnetic Resonance Imaging (MRI), an axillary sonography. After NAC breast, conservative or radical, and axillary surgery, were performed. Breast surgery allowed to measure breast tumor residual and to perform a Sataloff classification. Targeted axillary detection (TAD) was defined as the combination of the resection of the clipped node and SLN dissection. Axillary clipped node, sentinel lymph node (SLN) and axillary lymph node dissection (ALND) were always performed. ALND allowed to assess the false negative rate (FNR) of axillary clipped node and SLN dissection. A total of 500 included patients is planned to close this still ongoing trial. Results : From January 2019 to March 2022, 405 patients were included from 18 institutions. We present here the results of the 260 first patients, who experienced a complete treatment with NAC courses and post NAC breast and axillary surgery. Among these patients, SBR grade was III in 52%, OR and PR were positive in 59% and 46% respectively, HER2 was overexpressed in 40%, 26% were triple negative and pCR was present in 28%. FNR of the SLN detection was 21.1%, 9% for the clipped node alone and 6% for the TAD. Histopronostic grading, progesteron receptors, HER2 expression, MRI results and Sataloff grading of breast residual tumor were indepently linked with global pCR (breast and axilla) in multivariate analysis. The Area Under the Curve (AUC) model was 0.91 with 82% correctly patients classified. The false negative rate of no pCR classified patients was 14%. Conclusion : Intermediate results of Ganea 3 trial showed that operable breast cancer patients with an initially involved axillary node treated with NAC, showed that TAD allows to reduce the FNR of axillary surgery. Patients with histopronostic grade 3, negative progesteron receptors, HER2 overexpression, a normal MRI after NAC and a breast Sataloff A, have a low risk of axillary tumour residual burden and could be safely spare from any axillary surgery. Large prospective trials are needed to confirm the safety of this surgical de-escalation. Citation Format: Céline Renaudeau, Pierre Gimbergues, Eugénie Guillot, Marie-Pierre Chauvet, Marian Gutowski, Eva Jouve, Philippe Rauch, Monique Cohen, Christelle Faure, Marie-Martine Padeano, Vivien Ceccato, Catherine Uzan, Anne-Sophie Bats, Hélène Charitansky, Pierre-François Dupré, Augustin Reynard, Séverine Alran, Cécile Bendavid-Athias, Loïc Campion, Isabelle Doutriaux, Jean-Marc Classe. Axillary surgery de-escalation after neoadjuvant chemotherapy in breast cancer patients with initially involved node: the GANEA 3 trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-09-01.

Resume Introduction: Les recommandations francaises actuelles concernant la prise en charge des lesions cervicales lie a une infection au papilloma virus humain (HPV) ne concernent que la population generale. Les patientes immunodeprimees, de maniere acquise ou innee semblent presenter un risque accru de lesions HPV induites. L’objectif de cette revue est de resumer les differentes donnees existantes concernant le risque de lesions HPV induites chez les patientes immunodeprimees afin d’en preciser les modalites de prise en charge. Materiel et Methodes: La base de donnees Medline a ete exploree a travers le portail Pubmed, ainsi que les recommandations des differentes societes savantes internationales. Resultats: Les situations a risque accru de lesion retrouve sont quel que soit le traitement : infection par le Virus de l’Immunodeficience Humaine (VIH), greffes, lupus. Les patientes atteintes de maladie inflammatoire chronique de l’intestin (MICI) et d’arthrite rhumatoide presentent un risque accru uniquement lorsqu’un traitement immunosuppresseur est necessaire. Le depistage de lesions intra-epitheliales dysplasique chez les patientes VIH+ doit etre plus soutenue qu’en population generale. Par manque de donnees, les recommandations concernant les autres pathologies ont ete extrapolees a partir de la prise en charge des patientes VIH+. La vaccination anti-HPV est efficace au sein de ces populations, particulierement dans les moments ou le systeme immunitaire est le plus performant. Conclusion: Certaines populations sont plus a risque de lesions HPV induite du fait d’une reponse immunitaire incomplete et doivent beneficier d’un depistage soutenu. Par ailleurs la vaccination anti-HPV doit etre encouragee.

Resume Objectif Nous ne disposons pas, en France, d’un parcours identifie pour la formation en chirurgie cancerologie gynecologique. Les quatre societes savantes francaises competentes : la SFOG, Le CNGOF, la SFCO et la SCGP soutenus par le CNU de gynecologie-Obstetrique et d’UNICANCER se sont entendues pour materialiser ce parcours et l’attester par une certification decernee par un jury national. Materiel et methodes Le comite national de certification en cancerologie gynecologique, constitue de dix membres, representant les six organismes concernes, s’est fixe cinq objectifs : la definition des criteres d’eligibilite des centres pour la formation ; la determination d’un cahier des charges a remplir par le candidat ; la determination d’un cursus fleche pour la formation en chirurgie cancerologique gynecologique ; la determination des acquis necessaires pour la certification d’un candidat deja en exercice et l’organisation pratique de la certification. Resultats Les criteres d’agrement des centres pour la formation, incluent 150 prises en charge de cancers gynecologiques, dont 100 chirurgies d’exerese, comprenant vingt cancers de l’ovaire de stades avances. Pour une certification a l’issue du cursus etabli par le comite ou par validation des acquis pour un praticien en exercice, un candidat doit valider un logbook et remplir un cahier des charges comportant quatre volets : formation theorique et pratique ; recherche et publications ; enseignements et souscription a une demarche de formation continue. Les elements du logbook et du cahier des charges accomplis seront evalues par un score. Une premiere session de certification est prevue pour la fin 2021.

s Introduction During the COVID-19 pandemic, teleconsultation was implemented in clinical practice to limit patient exposure to COVID-19 while monitoring their treatment and follow-up. We sought to examine the satisfaction of patients with breast cancer (BC) who underwent teleconsultations during this period. Methods Eighteen centres in France and Italy invited patients with BC who had at least one teleconsultation during the first wave of the COVID-19 pandemic to participate in a web-based survey that evaluated their satisfaction (EORTC OUT-PATSAT 35 and Telemedicine Satisfaction Questionnaire [TSQ] scores) with teleconsultation. Results Among the 1299 participants eligible for this analysis, 53% of participants were undergoing standard post-treatment follow-up while 22 and 17% were currently receiving active anticancer therapy for metastatic and localised cancers, respectively. The mean satisfaction scores were 77.4 and 73.3 for the EORTC OUT-PATSAT 35 and TSQ scores, respectively. In all, 52.6% of participants had low/no anxiety. Multivariable analysis showed that the EORTC OUT-PATSAT 35 score correlated to age, anxiety score and teleconsultation modality. The TSQ score correlated to disease status and anxiety score. Conclusion Patients with BC were satisfied with oncology teleconsultations during the COVID-19 pandemic. Teleconsultation may be an acceptable alternative follow-up modality in specific circumstances.

Adipose tissue is a major component of breast stroma. This study focused on delineating the effects of adipose stem cells (ASCs) derived from breast of healthy women and cancer patients with normal or tumor breast cells.The ASCs were induced to differentiate into adipocytes, and the subsequent adipocyte conditioned media (ACM) were evaluated for their fatty acid profile, adipokine secretion and influence on proliferation, migration and invasion on tumoral (MCF-7 and SUM159) and normal (HMEC) human breast cell lines.An enrichment of arachidonic acid was observed in ACM from tumor tissues. Adipose tissues from tumor free secrete twice as much leptin than those from proximal or distal to the tumor. All ACMs display proliferative activity and favor invasiveness of SUM159 cells compared to MCF-7 and HMEC. All ACMs induced lipid droplets accumulation in MCF-7 cells and increased CD36 expression in tumor cells.We conclude that among secreted factors analyzed, only arachidonic acid and leptin levels did discriminate ASCs from tumor-bearing and tumor-free breasts emphasizing the importance that other cell types could contribute to the adipose tissue secretome in a tumor context.

Our aim was to assess the opinion of a panel of experts and obtain a consensus on the management of endometrial cancer in France and French Switzerland. A Delphi survey was carried out among a panel of French and French-speaking Swiss experts. The first questionnaire included 65 questions divided into eight categories: characterization of experts, histo-molecular characteristics and radiological data of endometrial cancer, and management of low-risk, intermediate-risk, intermediate–high-risk, high-risk, and metastatic cancers. The experts were asked to reply on a 9-point scale, both on the validity and the clarity of each question. After the answers were analyzed, a second questionnaire was sent to the same experts. The study took place between December 2021 and March 2022. Further, 58 (57.4%) of the 101 experts responded in the first round, and 39 recommendations were obtained (60%). Six questions were voted redundant and 20 discordant. These questions were reformulated, and, at the end of the second round, 17 recommendations were validated (85%). In total, the study presents an analysis of 56 questions and related responses. Expert advice helps to clarify non-consensual issues, standardize the management of endometrial cancer, and optimize clinical practices.

The latest European recommendations of the European Societies of Gynecological Oncology (ESGO), Radiotherapy and Oncology (ESTRO) and Anatomopathology (ESP) concerning the management of patients with endometrial cancer were published in 2021. On behalf of the French Society of Gynecologic Oncology (SFOG) and the SFOG campus, we wish to summarize for the French-speaking readership the main measures with a more specific application for France. We also incorporate data from a Delphi survey conducted with a panel of French and French-speaking Swiss experts. The data presented in this article relate to histo-molecular characteristics, radiological data of endometrial cancer, and management of low-risk, intermediate-risk, intermediate-high-risk, and metastatic cancers. The aim of this review article is to show the application of the latest international recommendations to clinicians and pathologists for the implementation of these recommendations.

FERTILITY PRESERVATION BEFORE OVARIAN MALIGNANCY TREATMENT While most ovarian epithelial malignancies affect postmenopausal women, 12% occur in reproductive age patients. In addition, borderline ovarian tumors and rare non epithelial ovarian tumors are diagnosed in young patients as well. The prognosis of early-stage epithelial tumors, non-epithelial and frontier tumors is good. Increased knowledge in this specific field now allows the development of fertility preservation strategies. They include conservative surgery when applicable, associated with oocyte and / or ovarian tissue cryopreservation. Indications remain limited, and any decision must be validated by a multidisciplinary expert committee. The different strategies depend on specific tumoral or genetic context.PRÉSERVATION DE LA FERTILITÉ AVANT TRAITEMENT D’UN CANCER DE L’OVAIRE Le cancer épithélial de l’ovaire atteint en majorité les patientes ménopausées. Cependant, 12 % des patientes ont moins de 44 ans. Les tumeurs frontières de l’ovaire et les tumeurs rares non épithéliales sont diagnostiquées plus fréquemment chez les femmes en âge de procréer. Le pronostic des stades précoces et des tumeurs non épithéliales est favorable. Les avancées scientifiques permettent de développer des stratégies de préservation de la fertilité, qui reposent d’abord sur la possibilité d’une chirurgie conservatrice et sur la préservation de gamètes ou de tissus germinaux. Les indications restent néanmoins limitées, et toute décision doit être discutée en réunion de concertation pluridisciplinaire (RCP) de recours. Les différentes stratégies dépendent du contexte tumoral ou génétique.

Introduction Pelvic lymph node dissection has been the standard of care for patients with early cervical cancer. Sentinel node (SN) mapping is safe and feasible and may increase the detection of metastatic disease, but benefits of omitting pelvic lymph node dissection in terms of decreased morbidity have not been demonstrated. Materials and methods In an open-label study, patients with early cervical carcinoma (FIGO 2009 stage IA2 to IIA1) were randomly assigned to SN resection alone (SN arm) or SN and pelvic lymph node dissection (SN + PLND arm). SN resection was followed by radical surgery of the tumour (radical hysterectomy or radical trachelectomy). The primary end-point was morbidity related to the lymph node dissection; 3-year recurrence-free survival was a secondary end-point. Results A total of 206 patients were eligible and randomly assigned to the SN arm (105 patients) or SN + PLND arm (101 patients). Most patients had stage IB1 lesion (87.4%). No false-negative case was observed in SN + PLND arm. Lymphatic morbidity was significantly lower in the SN arm (31.4%) than in the SN + PLND arm (51.5%; p = 0.0046), as was the rate of postoperative neurological symptoms (7.8% vs. 20.6%, p = 0.01, respectively). However, there was no significant difference in the proportion of patients with significant lymphoedema between the two groups. During the 6-month postoperative period, the difference in morbidity decreased over time. The 3-year recurrence-free survival was not significantly different (92.0% in SN arm and 94.4% in SN + PLND arm). Conclusion SN resection alone is associated with early decreased lymphatic morbidity when compared with SN + PLND in early cervical cancer.

BackgroundAlmost half of the patient with initially metastatic axillary node, treated with neoadjuvantchemotherapy (NAC) for a large operable breast cancer, has no axillary lymph node involvementat the time of surgery after NAC. Sentinel lymph node detection (SLND), performed after NAC,has a high false negative rate (FNR) when compared to FNR after primary surgery. GANEA 3 isa French prospective multi institutional ongoing trial, aimed at assessing the impact of targeting,before NAC, the initially positive node and removing it after NAC. The main objective of GANEA3 trial is the accuracy of this initially positive node to predict pathological status of the otheraxillary nodes after NAC. A total of 385 patients are required.ObjectiveThe current abstract assessed preliminary results of the detection rate of the clipped node and thedifferent methods to find it during axillary surgery based on the first 41 patients.Patients and MethodThis study is part of GANEA 3 Trial validated by scientific national board (clinicialtrials.gov:NCT03630913).Inclusion criteria: TNM stage T1-T3 N1 infiltrating breast carcinoma, indication of NAC, andsigned consent form,Exclusion criteria: more than 5 suspicious axillary nodes, inflammatory cancer, local relapse,mental disorder, pregnancy or no contraceptive method, contra-indication to NAC, NACinterrupted due to progressive disease.Design: Patients treated for an early breast cancer with NAC, axillary sonography with fine needlecytology before NAC to select patients with a proven lymph node involvement. Initially positive node identification warranted, for example with a clip. After NAC patients underwent the removalof the clipped node, a SLN detection with the combined method (patent blue and technetium) andan axillary lymph node dissection (ALND). In order to find the clipped node, during surgery thesurgeon attempted to find it with palpation and sonography. Each surgical specimen was then x-rayed before pathological examination.Studied parameters were clipped node and SLND detection rate, and the methods used to find theclipped node.ResultsFrom January 2019, to November 2019, 41 patients were enrolled, from 13 institutions, withinitially positive axillary node clipped, NAC courses and surgery after NAC.Median age was 53 (31-75), pathological subtype infiltrative ductal carcinoma (n=40) andinfiltrative lobular carcinoma (n=1), a median of 7 courses of NAC (1-16).SLN detection rate was 90% (37/41). A median number of 2 sentinel nodes were removed (1-7).The clipped node was removed in 100% of cases. The clipped node was identified by thesurgeon palpation (n=11), an axillary wire (n=13), per operative axillary sonography (n=4),surgical specimen radiography (n=11), the pathologist (n=2).The clipped node was part of SLN in 29 cases (70%). It was part of axillary lymphadenectomyspecimen in 6 cases (14.5%) and was find alone as an isolated node in 6 cases (14.5%).ConclusionThe clipped node was always found after NAC. It was mostly always part of SLN or ALNDspecimens. Further studies are needed in order to help the surgeon to remove only the clippednode. Citation Format: Celine Renaudeau, Roman Rouzier, Pierre Gimbergues, Marian Gutowski, Eva Jouve, Philippe Rauch, Charles Coutant, Christelle Faure, Catherine Uzan, Pierre-François Dupré, Vivien Ceccato, Charlotte N'go, Augustin Reynard, Isabelle Doutriaux, Loic Campion, Jean-Marc Classe. Axillary surgery after neoadjuvant chemotherapy in patients treated for an operable breast cancer with a proven initially positive axillary node: Preliminary results of identification and removal of the initially positive axillary node [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-43.

Resumen El cancer de endometrio (CE) es el cancer ginecologico mas frecuente, tanto en Francia como en el resto de los paises occidentales. El diagnostico se suele establecer en un contexto de metrorragias posmenopausicas, despues de realizar una biopsia de endometrio. Despues de la menopausia, se debe investigar cualquier metrorragia o un grosor endometrial superior a 4 mm. La histologia, la exploracion fisica y las imagenes obtenidas por resonancia magnetica permiten determinar los grupos con riesgo de recidiva, asi como las modalidades del tratamiento inicial, a menudo quirurgico. La histerectomia con anexectomia bilateral es la intervencion de referencia, completada segun los casos por una exploracion ganglionar. El examen definitivo de las piezas operatorias permite redefinir los grupos en funcion del riesgo de recidiva, de acuerdo con los criterios establecidos en 2009 por la European Society for Medical Oncology, asi como la indicacion de los tratamientos adyuvantes (radioterapia, braquiterapia, quimioterapia). Es necesario saber identificar a las familias que presentan un riesgo genetico de CE (sindrome de Lynch) para adaptar su vigilancia, asi como a las pacientes aptas para una estrategia de preservacion de la fertilidad. la vigilancia es clinica. En la actualidad, son varias las lineas terapeuticas en desarrollo: antiangiogenicos, terapias dirigidas (via de senalizacion PI3K-AKT-mTOR), inmunoterapias (tumor con inestabilidad de los microsatelites). Con estas terapias, deberia mejorar el pronostico de las pacientes que presentan un CE.

Resumen La linfadenectomia lumboaortica (LLA) o vaciamiento ganglionar lumboaortico es una tecnica dirigida a extirpar el tejido ganglionar a nivel laterocavo, precavo, interaortocavo, preaortico, lateroaortico supra e inframesenterico y del promontorio. En muchos casos, si las condiciones especificas de la paciente lo permiten, esta intervencion se puede efectuar por laparoscopia (reestadificacion del cancer de ovario en estadio precoz, estadificacion preterapeutica en el cancer de cuello de utero). Sin embargo, en caso de carcinomatosis, si la intervencion esta indicada, el estandar sigue siendo la laparotomia. En ginecologia, en ausencia de contraindicaciones debidas a caracteristicas propias de las pacientes, esta intervencion esta indicada en el cancer de ovario en estadio precoz (excepto en los tumores mucinosos) y avanzado, en la estadificacion del cancer de cuello de utero avanzado (por laparoscopia) y en algunos canceres de endometrio con riesgo de extension lumboaortica. Este tipo de cirugia requiere determinados conocimientos tecnicos, sobre todo en caso de adenopatias voluminosas o fijas, con un equipo sanitario y de anestesia entrenado para controlar los posibles riesgos vasculares.

International audience; IntroductionIn France, participation in the organized breast cancer screening program remains insufficient. A personalized approach adapted to the risk factors for breast cancer (RBC) should make screening more efficient. A RBC evaluation consultation would therefore make it possible to personalize this screening. Here we report our initial experience.Material and methodThis is a prospective study on women who were seen at the RBC evaluation consultation and analyzing: their profile, their risk assessed according to Tyrer Cuzick model (TC) ± Mammorisk© (MMR), the existence of an indication of oncogenetic consultation (Eisinger and Manchester score), their satisfaction and the recommended monitoring.ResultsAmong the women who had had a TCS and/or MMR evaluation of SCR (n = 153), 76 (50%) had a high risk (n = 67) or a very high risk (n = 9). Almost half (47%) had a possible (15%) or certain (32%) indication to an oncogenetic consultation. Regarding this consultation, 98% of women were satisfied or very satisfied. In total, 60% of women had a change in screening methods.ConclusionThis RBC evaluation consultation satisfies women and for a majority of them, modifies their methods of breast cancer screening.; IntroductionL’adhésion en France au programme de dépistage organisé du cancer du sein demeure insuffisante. Une approche personnalisée adaptée aux facteurs de risque de cancer du sein (RCS) permettrait une meilleure efficience du dépistage. Une consultation d’évaluation du RCS permettrait donc de personnaliser ce dépistage. Nous rapportons ici notre expérience initiale.Matériel et méthodeIl s’agit d’une étude prospective portant sur les femmes ayant été vues à la consultation d’évaluation du RCS et analysant : leur profil, leur risque évalué selon les modèles de Tyrer Cuzick (TC) ± Mammorisk© (MMR), l’existence d’une indication de consultation d’oncogénétique (scores d’Eisinger et de Manchester), leur satisfaction et la surveillance préconisée.RésultatsParmi les femmes ayant eu une évaluation du RCS par le modèle TC et/ou MMR (n = 153), 76 (50 %) avaient un risque élevé (n = 67) ou très élevé (n = 9). Près de la moitié (47 %) avait une indication possible (15 %) ou certaine (32 %) à une consultation d’oncogénétique. Concernant cette consultation, 98 % des femmes étaient satisfaites ou très satisfaites. Au total, 60 % des femmes ont eu un changement des modalités de surveillance.ConclusionCette consultation d’évaluation du RCS satisfait les femmes et pour une majorité d’entre elles, modifie les modalités de leur surveillance mammaire.

Resumen Las lesiones intraepiteliales del cuello uterino tienen relacion con el virus del papiloma humano (VPH) y actualmente, por ejemplo en Francia, se detectan mediante frotis cervicouterino (en espera de la puesta en marcha de la deteccion precoz virologica organizada). Se distinguen las lesiones escamosas de bajo grado, que no se consideran lesiones premalignas pero en las que predominan los VPH de alto riesgo, lo cual justifica un seguimiento, de las lesiones de alto riesgo escamosas, que tienen riesgo de degeneracion maligna y requieren un tratamiento y vigilancia. Las recomendaciones francesas precisan las indicaciones terapeuticas, que privilegian, en caso de lesion de bajo grado, una vigilancia y, en caso de lesion de alto grado, un tratamiento (o bien destruccion en las lesiones menos graves, poco amplias y claramente identificadas, o bien, con mayor frecuencia, exeresis con control colposcopico [para preservar al maximo el cuello], que permite un analisis exhaustivo de estas lesiones). Actualmente, el pilar de la vigilancia de estas lesiones es la prueba del VPH, que por regla general se realiza inicialmente 6 meses despues del tratamiento y se propone despues a largo plazo. Aparte, estan las lesiones de adenocarcinoma in situ, mas raras, de deteccion y diagnostico mas dificiles, cuyo tratamiento es la histerectomia, con la opcion, en las pacientes con un proyecto de embarazo, de tratamiento de exeresis con la condicion de retirar todas las lesiones y de aceptar el principio de una vigilancia prolongada.

Resumen La tumefaccion mamaria es un aumento o una inflamacion de la mama que corresponde en la mayoria de los casos a una lesion benigna. Sin embargo, puede revelar la presencia de un cancer subyacente. Ante cualquier tumefaccion de la mama se debe realizar un manejo diagnostico para descartar un tumor maligno.

Riassunto La tumefazione mammaria e un aumento o un rigonfiamento del seno corrispondente, nella maggior parte dei casi, a una lesione benigna. Tuttavia, puo rivelare un cancro sottostante. Una procedura diagnostica per eliminare un tumore maligno deve essere eseguita di fronte a qualsiasi tumefazione del seno.

Resume Objectifs Editer, par le College national des gynecologues et obstetriciens francais (CNGOF), des recommandations fondees sur les preuves disponibles dans la litterature pour la prise en charge des tumeurs frontieres de l’ovaire (TFO) de stade precoce. Methodes Recherche bibliographique en langue francaise et anglaise effectuee par consultation des bases de donnees Pubmed, Cochrane, Embase et des recommandations internationales. Resultats Dans la prise en charge chirurgicale des TFO a un stade precoce, si une chirurgie sans risque de rupture tumorale avec extraction protegee des pieces operatoires est possible, la voie cœlioscopique est recommandee par rapport a la laparotomie (Grade C). Dans les TFO, il est recommande de prendre toutes les dispositions pour eviter la rupture tumorale, y compris la decision peroperatoire de laparoconversion (Grade C). Dans les TFO, une extraction de la piece operatoire a l’aide d’un sac endoscopique est recommandee (Grade C). En cas de TFO de stade precoce, uni- ou bilaterale, suspectee a l’imagerie preoperatoire chez une patiente menopausee et/ou sans de desir de preservation de fertilite et/ou de la fonction endocrine, il est recommande de realiser une annexectomie bilaterale (Grade B). En cas de TFO de stade precoce sereuse bilaterale avec desir de preservation de la fertilite et/ou de la fonction endocrine, il est recommande de realiser une kystectomie bilaterale dans la mesure du possible (Grade B). En cas de TFO de stade precoce mucineuse avec desir de preservation de la fertilite et/ou de la fonction endocrine, il est recommande de realiser une annexectomie unilaterale (Grade C). En cas de TFO de stade precoce endometrioide avec desir de preservation de la fertilite et/ou de la fonction endocrine, il n’est pas possible d’etablir une recommandation de choix de traitement entre kystectomie et annexectomie unilaterale. En cas de TFO de stade precoce mucineuse a l’analyse histologique definitive chez une femme ayant eu une kystectomie initiale, avec ou sans desir de preservation de la fertilite et/ou de la fonction endocrine, une reprise chirurgicale pour une annexectomie unilaterale est recommandee (Grade C). En cas de TFO de stade precoce sereuse a l’analyse histologique definitive chez une femme ayant eu une kystectomie initiale, avec desir de preservation de la fertilite et/ou de la fonction endocrine, il n’est pas recommande de reprise chirurgicale pour annexectomie en l’absence de lesion suspecte residuelle lors de la chirurgie et/ou a l’imagerie postoperatoire (echographie par referent ou IRM pelvienne) (Grade C). Une omentectomie est recommandee afin de realiser une stadification initiale chirurgicale complete lorsqu’une TFO est diagnostiquee a l’examen extemporane ou suspectee sur les elements radiologiques preoperatoires (Grade B). Il n’existe pas de donnees dans la litterature permettant de recommander le type d’omentectomie a realiser. Si une chirurgie de restadification est decidee pour une TFO a un stade presume precoce, une omentectomie est recommandee (Grade B). Des biopsies peritoneales multiples sont recommandees afin de realiser une stadification initiale chirurgicale complete lorsqu’une TFO est diagnostiquee a l’examen extemporane ou suspectee sur les elements radiologiques preoperatoires (Grade C). En cas de chirurgie de restadification pour une TFO a un stade presume precoce, l’exploration de la cavite abdominale doit etre complete et des biopsies peritoneales doivent etre realisees sur les zones suspectes ou de facon systematique (Grade C). Une cytologie peritoneale premiere est recommandee afin de realiser une stadification initiale chirurgicale complete lorsqu’une TFO est suspectee sur les elements radiologiques preoperatoires (Grade C). En cas de chirurgie de restadification pour une TFO a un stade presume precoce, une cytologie peritoneale premiere est recommandee (Grade C). Concernant les TFO sereuses ou mucineuses de stade precoce, il n’est pas recommande de realiser une hysterectomie a titre systematique (Grade C). Concernant les TFO de stade precoce de type endometrioide, et en l’absence de desir de conserver la fertilite, il est recommande de realiser une hysterectomie en chirurgie initiale ou si une chirurgie de restadification est indiquee (Grade C). Concernant les TFO de stade precoce de type endometrioide, en cas de desir de preservation de la fertilite, l’uterus peut etre conserve sous reserve d’une bonne evaluation de l’endometre par imagerie et prelevement endometrial (Grade C). Concernant les TFO de stade precoce, quel que soit le type histologique, il est recommande d’evaluer l’aspect macroscopique de l’appendice lors de la chirurgie (initiale ou de restadification si indiquee) (Grade B). Concernant les TFO de stade precoce, quel que soit le type histologique, il est recommande de ne realiser une appendicectomie qu’en cas d’aspect macroscopiquement pathologique de l’appendice (Grade C). Concernant les TFO de stade precoce, quel que soit le type histologique, la lymphadenectomie pelvienne et/ou lombo-aortique n’est pas recommandee dans le cadre d’une chirurgie initiale ou d’une chirurgie de restadification (Grade C). En cas de TFO diagnostiquee sur histologie definitive, l’indication de chirurgie de restadification doit etre discutee en Reunion de Concertation Pluridisciplinaire. Pour les TFO presumees de stade precoce, il est recommande de privilegier la voie cœlioscopique pour realiser une chirurgie de restadification (Grade C). Une chirurgie de restadification est recommandee en cas de TFO sereuse avec aspect micropapillaire et une inspection de la cavite abdominale non satisfaisante lors de la chirurgie initiale (Grade C). Une chirurgie de restadification est recommandee en cas de TFO mucineuse si seule une kystectomie a ete realisee ou que l’appendice n’a pas ete visualise, il sera alors realise une annexectomie unilaterale (Grade C). Si une chirurgie de restadification est decidee dans la prise en charge d’une TFO presumee de stade precoce, les gestes a realiser sont les suivants : une cytologie peritoneale (Grade C), une omentectomie (il n’existe pas de donnees dans la litterature permettant de recommander le type d’omentectomie a realiser) (Grade B), une exploration complete de la cavite abdominale avec biopsies peritoneales sur les zones suspectes ou de facon systematique (Grade C), la visualisation de l’appendice ± l’appendicectomie en cas d’aspect macroscopique pathologique (Grade C), une annexectomie unilaterale en cas de TFO mucineuse (Grade C).

International audience; Objective - In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies, the SFOG, the CNGOF, the SFCO and the SCGP, supported by the CNU of Obstetrics &Gynaecology- and UNICANCER, agreed to materialize this course and attest it by a certification awarded by a national jury. Material and methods - The national committee of certification in gynaecological oncology made up of 10 members, representing the 6 concerned organizations, set itself 5 objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification. Results - Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including 20 advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including 4 parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021. Conclusion - The optimisation of the surgical management of patients treated for gynaecological cancer is achieved through the identification of a training course and the certification, by a national jury, of the skills of surgeons who have completed it.

To evaluate the effectiveness and obstetric outcomes after laser conization for cervical intraepithelial neoplasia.This retrospective study included 757 patients who underwent laser conization between 2014 and 2020. Patients with a diagnosis of invasive lesions or adenocarcinoma in situ were excluded. Histological data from the conization specimen, pre and postoperative histological and virological data (Human PapillomaVirus (HPV) test) and obstetric outcomes were collected from the medical record. The primary endpoint was the negative surgical margin rates after laser conization. The secondary endpoint were the size of the operative specimen, the postoperative virological test results (3 to 6 months after surgery), factors associated with negative or positive margin and postoperative obstetric outcomes (prematurity). Patient characteristics and outcomes were compared using Student's t-test, χ² test, or Fisher exact test. Values of p ≤ 0.05 were considered significant.This study included 757 patients. Negative surgical margins were obtained in 76.1% of the cases and were associated with more negative HPV tests at 6 months (64.9% vs. 52.5%, p = 0.006) and fewer repeat surgeries (0.2% vs. 2.2%, p = 0.013) than for patients with positive margins. Among the patients under 43 years at the time of conization, 71 achieved a pregnancy with a term22 weeks, and of these 66 (93%) delivered at term (≥37 weeks).Laser conization appears to be an effective technique for the management of cervical intraepithelial neoplasia both in terms of the quality of the resection margins and the obstetric prognosis.

International audience

Background: The objective of this work was to describe the technique of exclusive lipofilling in breast reconstruction after total mastectomy, to evaluate the satisfaction and quality of life of the patients, and to explore current literature on the subject. Methods: We conducted a retrospective observational multicentric study from January 2013 to April 2020. The modalities of surgery, esthetic result, and patient satisfaction were evaluated with the breast reconstruction module of BREAST-Q. Results: Complete data were available for 37 patients. The mean number of sessions was 2.2 (standard deviation 1.1), spread over an average of 6.8 months (SD 6.9). The average total volume of fat transferred was 566.4 mL. The complication rate was 18.9%. No severe complication was observed (Clavien–Dindo 3/4). Two patients were diagnosed with recurrence, in a metastatic mode (5.4%). The average satisfaction rate was 68.4% (SD 24.8) for psychosocial well-being and 64.5% (SD 24.1) for sexual well-being. The satisfaction rate was 60.2% (SD 20.9) for the image of the reconstructed breast and 82.7% (SD 21.9) for locoregional comfort. Conclusions: Breast reconstruction by exclusive lipofilling after total mastectomy provides satisfactory quality of life scores. The simplicity of the surgical technique and equipment required, and the high satisfaction rate confirm that lipofilling should be included in the panel of choice of breast reconstruction techniques.

INTRODUCTION: Organized and individual breast screening have been accompanied by an increase in the detection of "atypical breast lesions "(ABL). Recently, the NOMAT multicenter study proposed a predictive model of the risk of developing breast cancer after detection of an ABL in order to avoid surgical removal of "low-risk" lesions. It also aimed to provide information on psychological experience, in particularly anxiety, to assist in the shared medical decision process. METHODS: Three hundred women undergoing surgery for ABL were included between 2015 and 2018 at 18 French centers. Women completed questionnaires before and after surgery assessing their level of anxiety (STAI-State, STAI-Trait), their level of tolerance to uncertainty, their perceived risk of developing a breast cancer, and their satisfaction with the management care. RESULTS: One hundred nighty nine patients completed the STAI-Status before and after surgery. Overall, a decrease in anxiety level (35.4 vs 42.7, p

International audience; (1) Background: although most patients with epithelial ovarian cancer (EOC) undergo radical surgery, patients with early-stage disease, borderline ovarian tumor (BOT) or a non-epithelial tumor could be offered fertility-sparing surgery (FSS) depending on histologic subtypes and prognostic factors. (2) Methods: we conducted a systematic review to assess the safety and fertility outcomes of FSS in the treatment of ovarian cancer. We queried the MEDLINE, PubMed, Cochrane Library, and Cochrane (“Cochrane Reviews”) databases for articles published in English or French between 1985 and 15 January 2021. (3) Results: for patients with BOT, FSS should be offered to young women with a desire to conceive, even if peritoneal implants are discovered at the time of initial surgery. Women with mucinous BOT should undergo initial unilateral salpingo-oophorectomy, whereas cystectomy is an acceptable option for women with serous BOT. Assisted reproductive technology (ART) can be initiated in patients with stage I BOT if infertility persists after surgery. For patients with EOC, FSS should only be considered after staging for women with stage IA grade 1 (and probably 2, or low-grade in the current classification) serous, mucinous or endometrioid tumors. FSS could also be offered to patients with stage IC grade 1 (or low-grade) disease. For women with serous, mucinous or endometrioid high-grade stage IA or low-grade stage IC1 or IC2 EOC, bilateral salpingo-oophorectomy and uterine conservation could be offered to allow pregnancy by egg donation. Finally, FSS has a large role to play in patients with non- epithelial ovarian cancer, and particularly women with malignant ovarian germ cell tumors.

"Robots set up in the operating theater. The patient's benefit after a minimally invasive approach stimulated the robotic approach of abdominal and thoracic surgical procedures. Although much more expensive, the robots improve the vision of the operating field, the precision of the gestures with a faster training course for the surgeon who operates more comfortably. Surgeons eager for technological progress quickly adopted this technique in urology and gynecology and then in thoracic and digestive procedures. In France, the support for this innovation by academic and medical institutions is limited by several factors including the supremacy of Intuitive which imposes its prices, the absence of scientifically proven superiority, the absence of surveys under the responsibility of scientific societies and the lack of criteria concerning the surgeon training.""Les robots s’installent au bloc opératoire. Les bénéfices de l’approche mini-invasive abdominale et thoracique ont stimulé l’approche robotique. Bien que beaucoup plus coûteux, les robots améliorent la vision du champ opératoire, la précision des gestes avec un apprentissage plus rapide pour le chirurgien qui opère plus confortablement. Les chirurgiens avides de progrès technologiques s’emparent rapidement de cette technique en urologie et en gynécologie puis en thoracique et en digestif. Le monopole imposé par la société Intuitive qui impose ses prix, l’absence de supériorité démontrée scientifiquement, de registres sous la responsabilité de sociétés scientifiques et de critères concernant la formation des chirurgiens à cette nouvelle technique ne favorise pas le soutien des institutions françaises pour accompagner cette innovation."

Resumen La incidencia de las displasias durante el embarazo esta estimada en un 1%, y la del cancer del cuello uterino, en una de cada 10.000. El inicio del embarazo constituye un momento ideal para realizar un frotis cervicouterino (FCU) si no se realizo recientemente y para sensibilizar a las pacientes en la necesidad de efectuar esta deteccion precoz. Para las lesiones de neoplasia intraepitelial, en ausencia de sospecha de invasion en la colposcopia, el tratamiento puede diferirse al posparto, siempre bajo una estricta vigilancia. Para las lesiones invasivas, el estudio debe completarse con una resonancia magnetica (RM) lumbopelvica para definir mejor el tamano de la lesion. El tratamiento depende del subtipo histologico, del estadio de la lesion, de la afectacion ganglionar, siempre que se puedan obtener estos datos (linfadenectomia pelvica por via laparoscopica hasta las 20-24 semanas de amenorrea [SA] para los tumores menores de 4 cm o por RM en caso de termino del embarazo mas avanzado), y del termino del embarazo. La pareja debe saber que el embarazo por si mismo no cambia el pronostico del tumor. Para estos tumores invasivos, el objetivo consiste en aplicar el tratamiento mas parecido al de las pacientes no embarazadas y, si es posible, mantener la gestacion. El tratamiento debe basarse en un acuerdo multidisciplinario que incluya a los oncologos con experiencia en el tratamiento de los canceres durante el embarazo. El College National des Gynecologues Obstetriciens Francais (CNGOF) establecio una serie de recomendaciones en 2008 para las lesiones precancerosas y cancerosas diagnosticadas durante el embarazo, y el Institut National du Cancer (INCa) publico en 2016 recomendaciones relacionadas con el tratamiento de los FCU anormales. Este articulo esta basado en estas recomendaciones, y ofrece los datos mas recientes de la literatura.

Vulvar cancer is a rare disease, which represents 4% of gynecological tumors with an incidence of 0.5 to 1.5 per 100,000 women per year in France. Vulvar cancers are induced in 30 to 69% of cases by the presence of papillomavirus (HPV), in particular HPV 16 and 18, and can also occur in an inflammatory context. The diagnosis is made by histological examination of a vulvar biopsy. The histological subtype is a squamous cell carcinoma in 90% of cases. The 5-year survival of patients with vulvar cancer ranges from 86% for localized stages (FIGO I and II) to 57% for advanced stages (FIGO III and IVA), and 17% in case of metastatic disease (FIGO IVB). The treatment of vulvar cancer is mainly surgical, but radiotherapy and chemotherapy have become more important in recent years. Management has evolved into a personalized multidisciplinary approach, where each therapeutic decision must be discussed in a multidisciplinary consultation meeting. Surgical excision with tumor- free margins is central in the management of early stages. The indication for radiotherapy and brachytherapy should be discussed in the event that the excisional margins are positive in early stages. Radiotherapy is indicated in cases of lymph node involvement or in a neoadjuvant situation if the tumor is not immediately resectable. In this situation, it can be associated with chemotherapy. Chemotherapy alone is the treatment of diseases that are metastatic at the time of diagnosis.

The objective of this systematic review was to summarize our current knowledge of the role of immunohistochemistry (IHC) markers for identifying mismatch repair-deficient (MMRd) tumors in endometrial cancer (EC). Identification of MMRd tumors, which occur in 13% to 30% of all ECs, has become critical for patients with colorectal and endometrial cancer for therapeutic management, clinical decision making, and prognosis. This review was conducted by two authors applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the following terms: “immunohistochemistry and microsatellite instability endometrial cancer” or “immunohistochemistry and mismatch repair endometrial cancer” or “immunohistochemistry and mismatch repair deficient endometrial cancer”. Among 596 retrieved studies, 161 fulfilled the inclusion criteria. Articles were classified and presented according to their interest for the diagnosis, prognosis, and theragnostics for patients with MMRd EC. We identified 10, 18, and 96 articles using IHC expression of two, three, or four proteins of the MMR system (MLH1, MSH2, MHS6, and PMS2), respectively. MLH1 promoter methylation was analyzed in 57 articles. Thirty-four articles classified MMRd tumors with IHC markers according to their prognosis in terms of recurrence-free survival (RFS), overall survival (OS), stage, grade, and lymph node invasion. Theragnostics were studied in eight articles underlying the important concentration of PD-L1 in MMRd EC. Even though the role of IHC has been challenged, it represents the most common, robust, and cheapest method for diagnosing MMRd tumors in EC and is a valuable tool for exploring novel biotherapies and treatment modalities.