Search

Aim To evaluate the use of pre-cryoablation biopsy for small renal masses (SRMs) and the effects of increasing up take on histological results of treated SMRs. Method From 2015 to 2019, patients with sporadic T1N0M0 SRMs undergoing percutaneous, laparoscopic or open cryoablation from 14 European institutions within the European Registry For Renal Cryoablation (EuRECA) were included for the retrospective analysis. Univariate and multivariate logistic models were used to evaluate the trends, histological results and the factors influencing use of pre-cryoablation biopsy. Results 871 patients (Median [IQR] age, 69[14], 298 women) undergoing cryoablation were evaluated. The use of pre-cryoablation biopsy has significantly increased from 42% (65/156) in 2015 to 72% (88/122) in 2019 (p1 are factors associated with lower likelihood to not have received a pre-cryoablation biopsy (p Conclusion An increased use of pre-cryoablation biopsy was observed and cryoablation patients treated with a benign histology is more likely to have presented in periods where pre-cryoablation biopsy is not as prevalent. Comparative studies are needed to draw definitive conclusions on the effect of pre-cryoablation biopsy on SRM treatments.

Resume Contexte La biopsie retroperitoneale percutanee sous controle scanographique est une technique mini-invasive permettant la realisation de prelevements cibles au sein de l’espace retroperitoneal afin d’en permettre l’analyse histologique. Elle est rapidement realisable sous anesthesie locale et constitue une alternative interessante a la biopsie chirurgicale. Objectif A travers une video de procedure commentee etape par etape et une fiche de synthese nous proposons un support pedagogique pour la formation des jeunes medecins a la biopsie retroperitoneale sous controle scanographique. Methodes Dans cette video pedagogique, nous detaillons les objectifs de la biopsie retroperitoneale sous controle scanographique, les precautions a prendre avant la procedure, le materiel necessaire, la technique de biopsie scanoguidee. La fiche de synthese est indissociable de la video pedagogique. Conclusion Ce support pedagogique pourra constituer l’etape initiale de la formation a la biopsie retroperitoneale sous controle scanographique avant mise en pratique en accompagnement par un operateur experimente.

Resume Contexte Le drainage abdominal percutane sous controle scanographique est une technique mini-invasive permettant l’evacuation de collections intra-abdominales. Il est rapidement realisable sous anesthesie locale et constitue une alternative interessante au drainage chirurgical. Le drainage par la technique de Seldinger, par opposition au drainage par ponction directe, est base sur la mise en place au prealable d’un guide via un trocart/catheter de petit calibre dans la collection. Cette technique presente donc l’avantage principal d’etre plus sure que la ponction directe, en particulier pour les collections profondes et/ou proches de structures a risque. Objectif A travers une video de procedure commentee etape par etape et une fiche de synthese nous proposons un support pedagogique pour la formation des jeunes medecins au drainage scanographique par la technique de Seldinger. Methodes Dans cette video pedagogique, nous detaillons les objectifs du drainage sous controle scanographique, les precautions a prendre avant la procedure, le materiel necessaire, la technique de mise en place du drain ainsi que la prise en charge apres l’intervention. La fiche de synthese est indissociable de la video pedagogique. Conclusion Ce support pedagogique pourra constituer l’etape initiale de la formation au drainage scanographique par technique Seldinger avant mise en pratique en accompagnement par un operateur experimente.

Background: The prognosis of Sezary syndrome (SS) and mycosis fungoides (MF) depends on lymph node (LN) involvement. The usefulness of LN image-guided core-needle biopsies (CNBs), instead of surgical sampling, has been poorly evaluated. Objectives: To determine the prognostic value of LN CNB in MF/SS. Methods: A retrospective search was conducted to identify all LN biopsy specimens of MF/SS between 2008 and 2019. Biopsies were staged according to the International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer (ISCL/EORTC) criteria. We performed immunolabelling and determined the tumour clone frequency (TCF) by high-throughput sequencing of the T-cell receptor beta locus. Results: We included 119 consecutive biopsies from 100 patients, 45 with MF and 55 with SS. N1, N2 and N3 stages were diagnosed in 34 (29%), 26 (22%) and 59 (49%) cases, respectively. The TCF, Ki67 index, and percentage of cells positive for thymocyte selection-associated high mobility group box protein (TOX), programmed cell death protein 1 (PD1), killer cell immunoglobulin-like receptor 3DL2 (KIR3DL2) and cluster of differentiation (CD)30 were all positively correlated with the N stage. Median overall survival (OS) for N1/N2 vs. N3 patients was 42 months (range 26–not reached) vs. 14 months (range 5–30), respectively (p 75 years, LN short-axis diameter >15 mm, N3 stage, presence of large-cell transformation, TOX >60%, PD1 >25%, Ki67 >30%, KIR3DL2 >15%, CD30 >10% and TCF >25% were identified as adverse prognostic factors. In multivariate analyses, only an age >75 years and Ki67 index >30% were associated with reduced OS. We developed a new prognostic index associating the N stage and the Ki67 index, which better discriminates N3 patients with poor prognosis. Conclusions: CNB allows an objective assessment of the LN involvement in MF/SS, relevant for staging and prognosis.

Objectives Environmental contamination by patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through respiratory droplets suggests that surfaces and equipment could be a medium of transmission. We aimed to assess the surface and equipment contamination by SARS-COV-2 of an emergency department (ED) during the coronavirus infectious disease-2019 (COVID-19) outbreak. Methods We performed multiple samples from different sites in ED patients care and non-patient care areas with sterile premoistened swabs and used real-time reverse transcriptase polymerase chain reaction (RT-PCR) to detect the presence of SARS-CoV-2 ribonucleic acid (RNA). We also sampled the personal protective equipment (PPE) from health care workers (HCWs). Results Among the 192 total samples, 10 (5.2%) were positive. In patient care areas, 5/46 (10.9%) of the surfaces directly in contact with COVID-19 patients revealed the presence of SARS-CoV-2 RNA, and 4/56 (7.1%) of the surfaces that were not directly in contact with COVID-19 patients were positive. SARS-CoV-2 RNA was present only in the patients’ examination and monitoring rooms. Before decontamination SARS-CoV-2 RNA was present on the saturation clip, the scuff for blood pressure measurement, the stretcher, the plastic screens between patients and the floor. After decontamination, SARS-CoV-2 RNA remained on the scuff, the stretcher and the trolleys. All samples from non-patient care areas or staff working rooms were negative. Only one sample from the PPE of the HCWs was positive. Conclusions Our findings suggest that surfaces and equipment contamination by SARS-CoV-2 RNA in an ED during the COVID-19 outbreak is low and concerns exclusively patients’ examination and monitoring rooms, preserving non-patient care areas.

The COVID-19 pandemic has deeply impacted the activity of interventional oncology in hospitals and cancer centers. In this review based on official recommendations of different international societies, but also on local solutions found in different expert large-volume centers, we discuss the changes that need to be done for the organization, safety, and patient management in interventional oncology. A literature review of potential solutions in a context of scarce anesthesiologic resources, limited staff and limited access to hospital beds are proposed and discussed based on the literature data.

Introduction Le pronostic du mycosis fongoide (MF) et du syndrome de Sezary (SS) est associe au degre d’envahissement ganglionnaire (stade N), qui est evalue par l’examen d’un ganglion reseque ou d’une micro-biopsie. L’identification morphologique des cellules tumorales est difficile dans les stades precoces de l’atteinte ganglionnaire. L’objectif de l’etude est d’evaluer l’interet pronostique de marqueurs immunohistochimiques (IHC) et moleculaires dans les atteintes ganglionnaires des MF/SS. Materiel et methodes Tous les patients atteints de MF/SS, suivis a l’hopital Saint-Louis, avec une adenopathie mesurant ≥ 1,5 cm et ayant fait l’objet d’une biopsie ganglionnaire entre 01/2008 et 12/2018 ont ete inclus. Le stade N a ete evalue selon l’ISCL/EORTC a l’aide d’une coupe HES et des anticorps anti-CD20, CD3, CD4, CD7, et CD8. Des IHC pour TOX, PD1, KIR3DL2, CD30, et Ki67 ont ete realisees. Le pourcentage de cellules positives par rapport a l’ensemble des cellules de la coupe a ete determine pour chaque IHC. La frequence du clone tumoral (TCF) a ete evaluee par sequencage haut debit du gene du TCRβ. L’association a la survie globale a ete analysee en uni- (log-rank) et multivarie (Cox). Resultats Cent dix neuf biopsies (53 MF/66 SS) ont ete incluses dont 34 au stade N1, 26 au stade N2 et 58 au stade N3. Plus l’envahissement ganglionnaire evalue par le stade N etait important, plus le pourcentage de cellules TOX+, PD1+, KIR3DL2+, CD30+, ainsi que le Ki67 et le TCF etaient eleves. Les variables TOX, PD1, KIR3DL2, Ki67 et TCF etaient correlees entre elles (0,55 ; p 75 ans (p 15 mm (p 60 % (p 25 % (p = 0,039), Ki67 > 30 % (p 15 % (p = 0,015), CD30 > 10 % (p = 0,016) et TCF > 25 % (p 30 % etait associe a une diminution de l’OS (p = 0,022). En combinant le statut N et Ki67 au seuil de 30 %, l’OS mediane etait de 42 mois pour les biopsies N1/N2 (IQR, 26-NA), 30 mois (IQR, 17–39) pour les biopsies N3 avec Ki67 30 % (IQR, 2–12) (p Discussion Les microbiopsies radioguidees permettent une evaluation de l’envahissement ganglionnaire dans les MF/SS, pertinente pour le pronostic. L’indice de proliferation Ki67 ganglionnaire > 30 % est associe de maniere independante a la survie globale. La combinaison du statut N ISCL/EORTC et du statut Ki67 discrimine des patients N3 ayant une evolution plus ou moins agressive.

Resume Le prelevement du ganglion sentinelle reste en 2017 la technique de reference chez les patientes presentant un carcinome mammaire stade T0, T1 ou T2, N– clinique et echographique. L’exploration pre-therapeutique des aires ganglionnaires est indispensable avant chirurgie. L’echographie est le meilleur outil pour detecter des ganglions anormaux. Les signes evocateurs de ganglion suspect sont un cortex epaissi focalement ou de facon diffuse, de plus de 3 mm, la disparition du hile graisseux, la forme ronde du ganglion et l’irregularite du cortex en rapport avec une rupture capsulaire. Le creux axillaire et plus particulierement l’etage I de Berg doivent etre explores en premier lieu car c’est majoritairement le premier site d’atteinte ganglionnaire. Les vaisseaux axillaires doivent etre suivis, puis les vaisseaux mammaires externes jusqu’au niveau de l’union des quadrants externes du sein. L’atteinte ganglionnaire peut se propager aux espaces de Berg II, III puis a la region sus-claviculaire. La chaine mammaire interne doit etre exploree, notamment en cas d’atteinte axillaire, de lesion mammaire profonde ou des quadrants internes et devant un cancer du sein localement avance. Une preuve histologique par cytoponction ou microbiopsie doit etre systematiquement realisee devant un ganglion axillaire suspect avant d’indiquer un curage axillaire.

Purpose The purpose of this study was to determine the efficacy of salvage cryotherapy for intra-prostatic and local extraprostatic recurrences after curative treatment of prostate adenocarcinoma. Material and method Twenty-eight men (mean age, 69 ± 6 [SD] years; range: 51–82 years) treated with cryoablation for prostatic (N = 21) or extraprostatic (N = 7) recurrent prostate cancer after radiotherapy with or without associated prostatectomy were included. Technical success, complication and recurrences were reported. Biological recurrence was defined as an elevation ≥ 2 ng/mL of prostate specific antigen (PSA) serum level after the treatment. Results The mean follow-up was 18 months. Among the 21 patients with intraprostatic recurrence, 14 had successful cryotherapy with a mean decrease in serum prostate-specific antigen (PSA) levels of − 5.7 ± 2.6 (SD) ng/mL (range: − 2.1 to − 16.9 ng/mL). Four patients (19%) had early progression and three patients (14%) had delayed biological recurrence (mean time: 15 months). Among the 7 patients with extraprostatic recurrence, 2/7 (291%) had successful cryotherapy with a decrease in PSA serum level of − 2.7 ± 1.6 (SD) ng/mL (range: − 0.5–− 5.5 ng/mL) and 4/7 (57%) had early biological recurrence after cryotherapy that required androgen deprivation therapy, whereas 1/7 (4%) was lost to follow-up. No major complications were observed for both intra- and extraprostatic recurrence. Conclusion Salvage cryoablation of locally recurrent prostate cancer after curative treatment is feasible and safe when the half prostate is treated. It could delay initiation of androgen deprivation therapy in these patients.

For lymph node (LN) pathological analyses, whole excision has long been recommended for detection of lymphoma, although complications such as infection, hypertrophic scar, lymphorrhoea and lymphoedema may occur1. For the patients, surgical LN excision requires general anesthesia during a surgery stay, with high cost for public health insurance, for private health insurance, and out of pocket. The development of percutaneous image-guided core-needle biopsy (CNB) to replace surgical LN excision has made short-time intervention using advanced medical technology a valuable opportunity. Image-guided CNB enables a precise selection of the biopsy site, based on the size and the depth of the abnormal LN, and imaging characteristics2. This article is protected by copyright. All rights reserved.

Initial histopathological analysis of a pulmonary lesion is mandatory whenever a lung cancer is suspected in order to determine the optimal diagnostic strategy. Adequate material must be obtained for a definite histological diagnosis (preferable to a cytological one) and in some cases (mainly in adenocarcinoma) molecular analysis. The two main methods to obtain adequate biopsy samples are flexible bronchoscopy and computed tomography (CT)-guided lung biopsy. Flexible bronchoscopy is a valuable method for proximal tumors. On the other hand, CT-guided lung biopsy is more accurate for peripheral tumors. CT-guided lung biopsy is a reliable procedure that conveys a 90% sensitivity for the diagnosis of lung cancer. When performed in a secured environment after contraindications evaluation, its severe complications rate is low, mainly consisting of pneumothorax requiring chest tube placement and hemoptysis.

Resume Devant une lesion pulmonaire suspecte de neoplasie primitive, l’obtention d’une preuve anatomo-pathologique est necessaire afin de determiner la strategie therapeutique. Des prelevements adequats doivent permettre un diagnostic histologique de certitude (de preference a un diagnostic cytologique) et, dans certains cas (en particulier pour l’adenocarcinome), une analyse moleculaire. Les deux principales methodes permettant d’obtenir des echantillons tissulaires adaptes sont la bronchoscopie souple et la biopsie guidee par tomodensitometrie (TDM). La bronchoscopie souple est une methode interessante pour les tumeurs proximales. La biopsie pulmonaire guidee par TDM est quant a elle plus adaptee pour les tumeurs peripheriques. Il s’agit d’une procedure fiable, presentant une sensibilite de 90 % pour le diagnostic de cancer broncho-pulmonaire. Lorsqu’elle est effectuee dans un environnement securise apres evaluation des contre-indications, son taux de complications severes est faible. Celles-ci se limitent principalement au pneumothorax necessitant la mise en place d’un drain thoracique, et a l’hemoptysie.

Objectifs La strategie de prise en charge des oncocytomes reste heterogene de par la crainte d’une croissance tumorale alterant le parenchyme renal restant et de la meconnaissance d’une tumeur mixte. L’objectif de ce travail etait d’evaluer les strategies de prise en charge et l’evolution clinique et radiologique d’une cohorte d’oncocytomes biopsies. Methodes Nous avons revu retrospectivement tous les dossiers de biopsies renales realisees dans deux centres universitaires francais entre 2009 et 2019. Tous les cas d’oncocytomes identifies sur la biopsie renale ont ete extraits. Les donnees suivantes ont ete analysees : âge de la population, terrain genetique, taille de la tumeur sur imagerie et modalites de prise en charge de l’oncocytome. Resultats Cinquante-deux patients ont ete identifies, âge moyen au diagnostic 63 ans, dont un syndrome de Birt–Hogg–Dube. Au total, 18 patients ont ete traites d’emblee (12 par chirurgie partielle et 6 par traitement ablatif percutanee) et 34 n’ont pas eu de traitement actif immediat (25 surveilles et 9 abstentions therapeutiques). La croissance tumorale de l’oncocytome a pu etre evaluee en moyenne a 2 mm par an. La correspondance histologique des biopsies des oncocytomes par rapport a la piece definitive etait de 79 % (1 cellule claire grade 2 et 2 tumeurs hybrides retrouvees). Chez les 25 patients ayant eu une surveillance initiale 5 ont finalement subi un traitement actif (3 cryotherapies, 1 nephrectomie partielle et 1 nephrectomie elargie) motive a chaque fois par croissance tumorale (moyenne 5,2 mm/an). Conclusion Dans notre cohorte, la croissance tumorale etait faible et la surveillance le traitement de choix, cette attitude therapeutique etant adaptee en fonction de la croissance tumorale (plus de 5 mm par an dans notre cohorte) et du terrain particulier (âge jeune, forme familiale connue) faisant craindre une tumeur mixte.

Background Interventional radiology includes a range of minimally invasive image-guided diagnostic and therapeutic procedures that have become routine clinical practice. Each procedure involves a percutaneous needle insertion, often guided using computed tomography (CT) because of its availability and usability. However, procedures remain complicated, in particular when an obstacle must be avoided, meaning that an oblique trajectory is required. Navigation systems track the operator’s instruments, meaning the position and progression of the instruments are visualised in real time on the patient’s images. A novel electromagnetic navigation system for CT-guided interventional procedures (IMACTIS-CT®) has been developed, and a previous clinical trial demonstrated improved needle placement accuracy in navigation-assisted procedures. In the present trial, we are evaluating the clinical benefit of the navigation system during the needle insertion step of CT-guided procedures in the thoraco-abdominal region. Methods/design This study is designed as an open, multicentre, prospective, randomised, controlled interventional clinical trial and is structured as a standard two-arm, parallel-design, individually randomised trial. A maximum of 500 patients will be enrolled. In the experimental arm (navigation system), the procedures are carried out using navigation assistance, and in the active comparator arm (CT), the procedures are carried out with conventional CT guidance. The randomisation is stratified by centre and by the expected difficulty of the procedure. The primary outcome of the trial is a combined criterion to assess the safety (number of serious adverse events), efficacy (number of targets reached) and performance (number of control scans acquired) of navigation-assisted, CT-guided procedures as evaluated by a blinded radiologist and confirmed by an expert committee in case of discordance. The secondary outcomes are (1) the duration of the procedure, (2) the satisfaction of the operator and (3) the irradiation dose delivered, with (4) subgroup analysis according to the expected difficulty of the procedure, as well as an evaluation of (5) the usability of the device. Discussion This trial addresses the lack of published high-level evidence studies in which navigation-assisted CT-guided interventional procedures are evaluated. This trial is important because it addresses the problems associated with conventional CT guidance and is particularly relevant because the number of interventional radiology procedures carried out in routine clinical practice is increasing. Trial registration ClinicalTrials.gov identifier: NCT01896219. Registered on 5 July 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2049-6) contains supplementary material, which is available to authorized users.

The nodal status in breast cancer is a major prognostic factor in terms of survival. It also plays a role in the therapeutic decision-making process. Therefore, the evaluation of lymph node involvement in breast cancer is imperative in establishing a personalized treatment scheme. The sentinel lymph node procedure has proved successful for small breast tumors (T1-T2), limiting axillary lymphadenectomy and its side effects without changing overall survival. Even so, a substantial number of women must undergo axillary lymphadenectomy during a second surgery when the analysis of the sentinel node discloses major nodal involvement. Imaging can improve patient selection, especially those who appear eligible for immediate axillary lymphadenectomy. Ultrasound is able to depict morphological abnormalities in the lymph nodes such as cortical thickening, peripheral vascularization, hilar infiltration and loss of the kidney-shaped appearance of a normal node. When ultrasound is negative, the risk of massive nodal involvement is limited, thus allowing the oncologist to take an approach with the sentinel lymph node procedure. Magnetic resonance imaging (MRI) can also be useful in detecting pathological lymph nodes, particularly with diffusion-weighted MRI sequence.

Resume Le statut ganglionnaire est un facteur pronostique majeur dans le cancer du sein en termes de survie. Il intervient egalement dans la decision therapeutique. L’evaluation ganglionnaire est donc primordiale. La technique du ganglion sentinelle a pris le pas sur le curage pour les petites tumeurs (T1-T2) limitant les effets secondaires du curage sans modifier la survie. En revanche, un nombre non negligeable de femmes doivent subir un curage dans un second temps lorsque l’atteinte ganglionnaire est importante sur le ganglion sentinelle. L’imagerie pourrait ameliorer la selection des patientes, notamment celles devant beneficier d’un curage d’emblee. L’echographie est en effet capable de detecter les atteintes ganglionnaires importantes devant des anomalies morphologiques telles que l’epaississement cortical, la vascularisation peripherique, l’infiltration hilaire et la perte de l’aspect reniforme du ganglion. Lorsque l’echographie est negative, le risque d’atteinte massive est limite, permettant la technique du ganglion sentinelle. L’IRM est egalement performante, notamment grâce a la sequence de diffusion pour detecter les adenopathies.

SPIRIT 2013 checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 122 kb)

Resume Les biopsies percutanees guidees en imagerie chez les patients suivis en oncologie permettent de faire le diagnostic des lesions tumorales malignes avec une grande precision. Les performances des biopsies percutanees sont ameliorees par un bon conditionnement des prelevements. Les risques de la biopsie percutanee sont limites et les complications sont generalement benignes. Ces risques peuvent etre limites par l’utilisation d’astuces telle que les introducteurs a bout mousse, les hydrodissections et un bon positionnement des patients. La discussion entre cancerologue, chirurgien et radiologue en RCP permet de bien definir les indications pour ameliorer les strategies therapeutiques.

The term “second look” lesions in MRI refers to lesions detected by MRI that were not initially seen on mammography or ultrasound. The objectives of our study were to analyse the displacement of targets between MRI and ultrasound; to define discriminating BIRADS morphological criteria to predict benign or malignant character and better establish the indications of second look ultrasound and biopsy; and to analyse the agreement between ultrasound and MRI in terms of morphological criteria. A retrospective and monocentric review was performed of the records of consecutive patients with breast abnormalities (mass or non-mass) initially detected by MRI that were not initially seen on mammography or ultrasound. All patients with abnormalities found during the performance of second look ultrasound and biopsied were included in the study. All lesions were documented using the BIRADS lexicon for MRI and ultrasound. Of 100 included patients, 108 lesions were detected by MRI, found via second look ultrasound and biopsied between January 2008 and 2010. All of the included patients were followed-up for a variable period, from 2 to 5 years. Eighty-two upon 108 biopsied lesions (76%) were benign and 26/108 lesions (24%) were malignant. This study confirmed the switch from procubitus to decubitus essentially displaces the tumour in the antero-posterior direction. It showed that the risk factors were not reliable criteria for establishing an indication for second look ultrasound. This study also showed that circumscribed contours and a progressive enhancement curve (type I) for masses on MRI had the strongest negative predictive value of greater than 0.85. In ultrasound, the round or oval shape, circumscribed contours and the parallel orientation to the skin favoured benignity with a NPV of greater than 0.85. For masses, the study showed that the agreement in interpretation of the benign versus suspicious morphological criteria between the MRI and the ultrasound was very weak for the shape (Kappa=0.09) and weak for the contours (Kappa=0.23). Finally, the MRI overestimated the size of the targets compared to ultrasound (Student t-test, p=0.0001). The performance of second look ultrasound has to be performed after the detection of an abdnormality on MRI even for lesion classified BIRADS 3. The biopsy indications must be wide with insertion of a clip and a control MRI. Only this control allows to stop the investigation if the biopsied lesion is benign.

Resume Introduction/objectif Le terme lesions de second look en IRM mammaire indique qu’il s’agit de lesions detectees en IRM non vues initialement en mammographie et en echographie. Les objectifs de notre etude etaient d’analyser le deplacement des cibles entre l’IRM et echographie de second look , de rechercher des criteres morphologiques BiRads discriminants pour predire le caractere benin ou malin pour mieux poser les indications d’echographie de second look et de biopsie, et d’analyser de la concordance des criteres morphologiques entre l’echographie et l’IRM. Patientes et methodes Il s’agit d’une etude retrospective, monocentrique, ayant inclus des patientes pour lesquelles une anomalie mammaire (masse ou rehaussement sans masse) a ete decouverte en IRM et non vue par un bilan initial incluant mammographie et echographie. Pour etre incluses, ces lesions devaient toutes etre retrouvees par une echographie de second look et biopsiees. Une description precise des caracteristiques de ces lesions en IRM et en echographie ainsi que de leur localisation a ete faite selon les criteres BiRads. Resultats Cent patientes consecutives (soit 108 lesions) ont ete incluses entre janvier 2008 et janvier 2010. Elles ont toutes ete suivies pendant au moins deux ans. Quatre-vingt-deux sur 108 lesions biopsiees (76 %) etaient benignes et 26/108 lesions (24 %) etaient malignes. L’etude confirme que le passage du procubitus en IRM au decubitus de l’echographie deplace la tumeur dans l’axe antero-posterieur principalement ; les deplacements dans les autres directions ne sont pas significatifs. L’etude montre que les facteurs de risque ne sont pas des criteres fiables pour poser une indication d’echographie de second look . Elle a montre egalement que des contours circonscrits et une courbe de rehaussement progressive (type I) pour les masses en IRM presentent la plus forte valeur predictive negative > 0,85. En echographie, la forme ronde ou ovale, les contours circonscrits et l’orientation parallele a la peau etaient en faveur de la benignite avec des VPN > 0,85. Pour les masses, l’etude montre que la concordance d’interpretation des criteres morphologiques benins versus suspectes entre l’IRM et l’echographie est tres faible pour la forme (Kappa = 0,09) et faible pour les contours (Kappa = 0,23). De plus, l’IRM surestime la taille des cibles par rapport a l’echographie ( t -test de Student, p = 0,0001). Conclusion L’examen de second look est indispensable apres une IRM meme en cas de lesion classee ACR 3 qui peut presenter un aspect suspect en echographie. Les indications de biopsies avec mise en place d’un clip doivent etre larges pour controler le site de biopsie en IRM. Seul ce controle permet de stopper sans risque les investigations en cas de resultats benin de la biopsie.

Resume L’imagerie de microcirculation des cancers du sein repose sur l’etude du rehaussement tissulaire apres injection de produit de contraste. Les vitesses de rehaussement servent a deduire la perfusion et la permeabilite. L’amplitude des rehaussements reflete les volumes sanguins et interstitiels. Cette technique a beneficie des progres de l’IRM qui permettent l’acquisition de grands volumes, avec un bon compromis entre resolutions temporelle et spatiale. Les logiciels ont egalement evolue, permettant de calculer des cartographies de la microcirculation et d’en analyser l’heterogeneite. L’imagerie de la microcirculation renforce le caractere suspect et agressif d’une lesion, devant une augmentation de la permeabilite et une chute du volume interstitiel ; elle permet l’evaluation precoce des traitements neoadjuvants, en montrant la normalisation des parametres fonctionnels qui precede les modifications morphologiques.

Resume Objectif Le depistage des surcharges cardiaques en fer se fait habituellement en IRM avec un raccourcissement du T2* myocardique en dessous 20 ms (1,5 T). Cette mesure a ete validee avec une sequence specifique et le logiciel de calcul CMRTools® (technique de reference). Le but de cette etude etait de valider l’emploi de sequences et de logiciels disponibles en routine clinique pour depister ces surcharges. Materiel et methodes Dans un premier temps, un fantome de 11 tubes de T2* compris entre 4 a 33 ms a ete teste sur trois sites ayant un appareil IRM de marque differente. Dans un second temps, les valeurs du T2* myocardique de 75 patients ont ete mesurees en routine clinique par deux methodes. La premiere methode employait la sequence de reference specialement implantee sur les machines associee au logiciel CMRTools®. La seconde methode employait les sequences d’acquisitions disponibles en standard sur les machines suivi du calcul sur tableur informatique. Resultats Sur fantome, la moyenne des differences de T2* entre chaque appareil est de 0,6 ms. Treize patients avaient une valeur abaissee du T2* avec la technique de reference. Trois cas etaient mal classes en technique de routine et correspondaient a des faux-positifs de faible surcharge (T2* compris entre 18–20 ms). Conclusion Le depistage des surcharges myocardiques en fer peut se faire en IRM en employant des sequences et des logiciels de calcul disponibles en routine clinique pendant le meme examen que celui de l’evaluation des surcharges hepatiques en fer.

Purpose Screening for cardiac iron overload is generally done by magnetic resonance imaging (MRI) and demonstrated by a shortening of the myocardial T2* below 20 ms at 1.5 Tesla. This measurement was validated with a specific sequence and the CMRTools ® calculation software (reference technique). The objective of this study was to validate the use of sequences and software programs that are available in routine clinical practice to screen for iron overload. Material and methods First, a phantom of 11 tubes with a T2* between 4 and 33 ms was tested at three sites that had MRI machines of different brands. Second, the myocardial T2* values of 75 patients were measured in routine clinical practice using two methods. The first method used the reference sequence specially installed in the machines associated with the CMRTool software. The second method used the standard acquisition sequences available in the machines followed by calculation on a computer spreadsheet. Results In the phantom, the mean of the differences in T2* between each machine was 0.6 ms. Thirteen patients had a lowered T2* value with the reference technique. Three cases were poorly classified using the routine technique and corresponded with false positives of low overload (T2* between 18 and 20 ms). Conclusion Screening for myocardial iron overload can be done by MRI by using sequences and calculation software available in routine clinical practice during the same examination as the one for the evaluation of hepatic iron overload.

Resume La biopsie pulmonaire transparietale guidee en imagerie permet de retrouver l’agent pathogene dans la moitie des infections fongiques et la plupart des infections bacteriennes (sensibilite = 55 %, specificite = 100 %). Les performances diminuent dans les condensations (50 % des infections) par rapport aux masses. Les complications, pneumothorax, hemorragies alveolaires et hemoptysies sont generalement benignes et necessitent rarement (

CT-guided transparietal lung biopsy in imaging makes it possible to find the pathogenic agent in half of all fungal infections and most bacterial infections (sensitivity=55%, specificity=100%). Performance is decreased in consolidations (50% of infections) compared to masses. Complications, pneumothorax, alveolar bleeding and hemoptysis are generally benign and rarely (

Resume Les biopsies abdominales ont connu ces dernieres annees un essor spectaculaire grâce aux progres des materiels de biopsie et des techniques de guidage (scanner et echographie), a une meilleure prise en charge des prelevements en anatomopathologie, et surtout a une meilleure maitrise des gestes interventionnels par les radiologues. Ainsi, de nombreuses lesions reputees difficiles d'acces ou dangereuses autrefois beneficient desormais de la technique de biopsie guidee. Lorsqu'une lesion semble difficile a aborder, plusieurs artifices techniques permettent de rendre la biopsie possible, et de la securiser. Le but de cette mise au point est de presenter l'etat de l'art des biopsies abdominales guidees, en insistant sur les methodes simples qui facilitent ces gestes. Les resultats attendus en fonction des organes cibles et des pathologies recherchees seront rappeles. Enfin, les contre-indications et les complications de ces ponctions guidees seront egalement presentees.

Core needle biopsy is increasingly replacing excisional lymph node biopsy in the diagnosis and subclassification of malignant lymphomas, with obvious advantages in terms of morbidity and costs. This technique has radically altered the diagnostic strategy of enlarged lymph nodes at our institution, avoiding unnecessary nodal excisions. It represents a viable alternative as long as the number and size of cores for morphologic and molecular studies are not compromised. This quick and safe technique can be applied to the initial diagnostic evaluation of malignant lymphomas as well as the reassessment of previously diagnosed malignant lymphomas at time of progression or recurrence.

Resume L’IRM mammaire ne doit pas etre utilisee pour le diagnostic differentiel entre un cancer du sein inflammatoire (CSI) et une mastite aigue (MA) avant traitement. Lorsque les symptomes de mastite persistent apres dix a 15 jours de traitement medical bien conduit, une IRM peut etre realisee en complement de l’echographie, de la mammographie et des prelevements histologiques pour eliminer un CSI. Concernant le bilan d’extension, l’IRM serait utile pour rechercher une lesion controlaterale, la TEP-TDM pour connaitre l’extension metastatique a distance et dans certains centres pour savoir l’extension ganglionnaire locoregionale initiale qui guide les champs d’irradiation (l’atteinte ganglionnaire pouvant etre negativee apres chimiotherapie neoadjuvante). L’IRM et la TEP-TDM seraient interessantes pour depister precocement les patientes repondant mal a la chimiotherapie neoadjuvante afin de la modifier rapidement.

Objectifs En cas de recidive locale post-radiotherapie (RLPR), la place des traitements ablatifs comme la cryotherapie reste peu evaluee. L’objectif de cette etude etait de decrire les resultats operatoires et oncologiques a court terme de la cryotherapie en cas de RLPR. Methodes Tous les patients traites par cryotherapie prostatique totale ou focale pour une recidive locale apres radiotherapie ou curietherapie pour cancer de la prostate entre 2011 et 2016 dans un centre ont ete inclus retrospectivement. Toutes les RLPR ont ete confirmees par mesure du PSA, biopsies prostatiques, IRM et PET a la choline. L’evaluation etait clinicobiologique a M1, M3, M6 et 1 an. Les criteres de jugement de l’efficacite du traitement etaient le PSA, l’introduction d’une hormonotherapie et la progression clinique. Resultats Dix-neuf hommes de 70 ans en moyenne ont ete inclus : 16 (84,2 %) traite par radiotherapie, 3 (15,8 %) par curietherapie. Le delai moyen de prise en charge apres traitement initial etait de 93,83 mois. Le PSA median avant cryotherapie etait de 5,27 ng/mL. Le PSA median a 1, 3, 6, 12 mois post-cryotherapie etait respectivement de 2, 0,63, 1,24 et 2,32 ng/mL. La duree moyenne d’hospitalisation etait de 1,58 jours. Quatre patients (21 %) ont presente une complication Clavien 2 (RAU) lors de l’hospitalisation. A un an, il existait 3 complications tardives (16 %) (2 incontinences urinaires severes, 1 stenose uretrale). Quatre patients (21 %) presentaient des signes irritatifs invalidants a 1 an. Le taux de recidive biologique et d’evolution clinique a 1 an etait de 15,8 % (3 patients) et 26,3 % (5 patients), respectivement. Au total, 8 patients (42 %) ont ete mis sous hormonotherapie depuis la cryotherapie. Conclusion La cryotherapie prostatique est faisable, avec des resultats operatoires satisfaisants mais au prix d’un taux significatif de complications tardives. Le taux de complications semble inferieur pour les cryotherapies focales par rapport aux totales. Plus d’un patient sur deux n’ont pas presente de reprise evolutive a 1 an.

Objectifs La cryotherapie per cutanee pourrait etre une alternative therapeutique a la nephrectomie partielle qui est le traitement de reference des tumeurs renales de moins de 4 cm. L’objectif de cette etude etait de comparer les resultats oncologiques de la cryotherapie par rapport a la tumorectomie robot assistee pour le traitement des tumeurs renales de stade T1. Methodes Les patients traites par tumorectomie robot vs cryotherapie pour tumeur renale maligne dans 4 centres entre 2009 et 2016 ont ete inclus retrospectivement. Les deux groupes furent appareilles un pour un sur le stade tumoral radiologique et le score RENAL (package Matchit, R software version 3.2.2). Tous les patients du groupe cryo ont ete biopsies. Les caracteristiques des patients avant et apres match ainsi que les resultats oncologiques ont ete compares entre les deux groupes. Une regression de Cox ajustee sur l’âge, le type de traitement, le type histologique et les marges a ete conduite pour identifier les facteurs associes a la recidive locale. Les marges positives etaient definies histologiquement dans le groupe robot et radiologiquement dans le groupe cryo. Resultats Au total, 647 patients ont ete identifies, 470 robots et 177 cryo. Apres appariement, on ne retrouvait pas de difference significative entre les deux groupes (177 robot et 177 cryo) pour le stade tumoral, le score RENAL, la taille tumorale (27,6 vs 25,9, p = 0,07), et le sexe. L’âge des patients du groupe cryo restait significativement superieur (69,9 vs 59,8 ans, p p = 0,03). La survie sans recidive a 5 ans etait de 85 % dans le groupe cryo vs 95 % dans le groupe robot ( log rank p = 0,02, Fig. 1 ). En analyse multivariee, seule la presence de marges positives etait significativement associee a la recidive locale ( p Conclusion Le taux de recidive locale apres cryotherapie etait significativement plus eleve qu’apres tumorectomie robot pour tumeur renale de stade T1. La realisation d’un traitement incomplet etait le principal critere associe a la recidive. Le taux de recidive pourrait etre surestime dans le groupe cryo en raison d’un suivi radiologique plus strict.

Les techniques de biopsies guidees par imagerie constituent une alternative raisonnable a l’exerese chirurgicale ganglionnaire dans le diagnostic d’une hemopathie lymphoide, a condition de realiser de multiples prelevements de grande taille, dont certains seront congeles pour des etudes moleculaires eventuelles.

The number of biopsy requests continuously increases over the years. Similarly, lesions that are not amenable to CT-guided biopsy are exceptional due to improved imaging guidance and technical advances. The needle tract should preferably go through fat, which is less painful and safer. The biopsy should be painless with the use of local anesthetics complemented by intravenous sedation. Blunt introducers and hydrodissection techniques create access to lesions without injury to vessels, bowel loops and fascias. The biopsy samples should be processed in accordance with the suspected diagnosis.

Background Diagnosis of melanoma metastasis is often based on a combination of clinical and radiological examinations in patients with a past history of melanoma. Chemotherapeutic treatment is often proposed without histological proof of the metastatic status. Objective The aim of this study was to investigate a cohort of melanoma patients with invasive diagnostic procedures (IDPs) for pathological confirmation of metastasis in case of suspicious visceral lesions. Methods A total of 109 melanoma patients with IDPs for suspicious visceral lesion(s) were included. Data about primary melanoma, IDPs characteristics, pathological result and therapeutic consequence were collected. Patients with AJCC Stage I–III melanoma at the time of the IDP were statistically analysed for various characteristics according to the final diagnosis yielded by the IDP. Results A total of 64 diagnostic surgical resections, 38 CT-guided core-needle biopsies, 15 ultrasound-guided core-needle biopsies, 6 surgical biopsies and 6 per-endoscopic biopsies were performed. Main target organs were the lungs (43.5%), breasts (8.5%) and liver (8%). IDPs were well tolerated and provided adequate samples for reliable diagnoses. Among the 105 IDPs in stage I–III patients, 56 melanoma metastases (53%), 25 benign lesions (24%) and 23 other cancers (22%) were found. One IDP was not informative. Multivariate analysis showed that nodular type of the primary melanoma, time-lag between primary melanoma and IDP over 12 months and the presence of suspicious lesions outside the organ biopsied were significantly associated with melanoma metastasis diagnosis. Conclusion Suspected melanoma metastasis was ruled out for benign lesion or second cancer in nearly half of the stage I–III patients having undergone an IDP, therefore modifying the medical treatment.

Les avancees technologiques en imagerie par resonance magnetique (IRM) permettent a present d’analyser certains biomarqueurs (densite cellulaire, microcirculation et metabolisme) caracterisant le developpement tumoral. L’imagerie dite ≪ fonctionnelle ≫ de ces differents biomarqueurs tumoraux tend a completer les donnees de l’imagerie morphologique classique et a ameliorer les performances diagnostiques, predictives de l’IRM en cancerologie. Enfin, les derniers developpements technologiques, permettant l’utilisation conjointe demultiples antennes, permettent d’examiner le corps entier. Ainsi, l’IRM corps entier prend une place croissante dans la prise en charge des patients en oncologie.

Angiogenesis is the process of activating dormant endothelial cells to form new vessels, after stimulation and it is essential in tumor growth. In many types of cancer, angiogenesis results from the activation of oncogenes that stimulate the production of Vascular Endothelial Growth Factor (VEGF). However, these newly formed vessels have a great number of abnormalities: increased density of fragile and hyper-permeable microvessels, arterial-venous shunts, caliber abnormalities and flow instabilities susceptible to flow direction inversion according to interstitial pressure. Anti-angiogenic treatments inhibit VEGF activity, perceived as structural and functional normalization of the microvascular pattern, such as reduced density of microvessels and restored morphology of the remaining ones. Conventional imaging techniques are not sensible to these changes, at best they show tumor size stabilization, hence the need of new techniques. Microvascularization imaging can be achieved by detecting functional disturbances to blood flow and not by showing the microvasculature per se. These techniques are based in quantifying the enhancement in tumor due to the passage of contrast agent after injection or protons labeled by a magnetic field. Through these measurements, one can derive interstitial and blood volumes as well as the tissue perfusion and capillary wall permeability. Microvascular imaging has greatly benefited from the improvements seen in CT and MRI equipment allowing large volume coverage with high spatial and temporal resolutions as from the evolutions in the methods to calculate, present and compare maps of the microcirculation and it's heterogeneity. However, software to analyze microvascularization are still rare, limiting the technique's application and validation in large scale. Nevertheless, imaging of the microcirculation is useful throughout the care of the oncological patient: it can reinforce the suspicious nature of a lesion, suggest anti-angiogenic treatment efficacy in hypervascular lesions, and show early treatment response before morphological changes as in RECIST criteria.

Background Data on factors influencing inclusion of Hodgkin's lymphoma (HL) patients in randomized clinical trials (RCT) are limited and, for the present study they were analyzed in a RCT for III/IV HL. Patients and methods All patients with stage III/IV HL referred to the Saint-Louis Hospital between January 2003 and May 2007 were studied. A Groupe d'Etudes des Lymphomes de l'Adulte/European Organisation for Research and Treatment of Cancer RCT, to compare ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) with increased-dose BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone), was open for recruitment. Noninclusion criteria and physician's reasons for non-recruitment were prospectively recorded. The reasons for patient's refusal were collected retrospectively. Logistic regression analyses were carried out in order to identify factors predicting inclusion. Results A total of 102 patients were diagnosed, among whom 51% were included. Seven patients were ineligible, 22 refused to participate, and 21 were not enrolled due to the physician's decision. Main reasons for patients’ refusal were standard treatment preference and concerns about experimental arm toxicity, mainly infertility risk. Conditions that could hamper accurate follow-up and toxicity concerns accounted for most of the physicians’ reasons. Adverse prognostic factors [B symptoms (odds ratio, OR = 5.35) and international prognostic score ≥3 (OR = 2.69)] were independently associated with inclusion. Conclusion Despite an attractive protocol, only 51% of patients were included. It highlights concerns about selection of patients and the difficulty to obtain informed consent with better prognostic profile patients.

Imaging and PET-CT of adultand childhood lymphoma Malignantlymphomas are lymphoproliferative disorders arising in both lymphoidtissue and non-lymphoid organ systems. Treatment rarely is surgical,and currently relies on a combination of chemotherapy and radiationtherapy. The role of imaging is to determine the spread of the disease,to identify targets and to assess therapeutic response. Imaging techniquesmainly use morphological criteria, and may underestimate infiltrativedisease, as observed in bones. The frequent presence of residualmasses after treatment usually prevents classification of patientsas complete response. Over time, positron emission tomography (PET) withF18-fluorodeoxyglucose (FDG) has become a prominent part of theworkup at diagnosis and during follow-up. Recently, PET has been integratedin the revised response criteria for malignant lymphoma.

Nocardiosis is an uncommon infection, which is exceptionally present as a postoperative event. A case of postoperative pulmonary and cerebro-meningeal infection caused by Nocardia otitidiscaviarum after a leg amputation in a diabetic patient is reported. Diagnosis has been delayed and the clinical, radiological and microbiological causes of this delay are assessed from a quality of care management point of view. Recommendations are proposed regarding physicians' role and optimized microbiological procedures for recognition of slowly growing nocardial strains.

Resume Les lymphomes de l'appareil urogenital sont des tumeurs rares dont le diagnostic est important car ils relevent d'un traitement medical specialise. Les localisations les plus frequentes sont le rein (nodule unique ou multiple) et le testicule, les autres etant exceptionnelles. L'important est d'avoir un diagnostic immunohistologique precis qui, associe a un bilan d'extension, permet de guider les options therapeutiques. Celles-ci reposent le plus souvent sur de la chimiotherapie (associee a une immunotherapie dans les lymphomes B) dont l'intensite et le nombre de cycles dependent des facteurs pronostiques initiaux.