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Background The American Thyroid Association (ATA) recommends using ultrasound-guided fine-needle aspiration (FNA) in order to evaluate supracentimetric and suspect thyroid nodules. The purpose of this study was to evaluate the effective use of FNA before surgery for nodules over 3 cm in diameter. Methods In this retrospective study, we analyzed the results of ultrasound-guided FNA and postoperative histological analysis in 843 nodules >3 cm. Results The FNA was informative in 42.6%. The correlation with the final histological analysis was 94.8% for benign nodules and 71.0% for malignant nodules. The FNA had a positive predictive value of 71%, a specificity of 97%, a sensitivity of 56%, and a 4.7% rate of false-negative results. Conclusion Because there is a nonnegligible FNA risk of error, notably allowing the evolution of a cancer in 1 of 20 cases, the FNA data should not delay surgical intervention for potentially suspect nodules >3 cm in diameter. © 2016 Wiley Periodicals, Inc. Head Neck 39: 32–36, 2017

To study the impact of thyroid surgery on obstructive sleep apnea syndrome (OSAS) evaluated by the apnea/hypopnea index (AHI) was studied. Secondary objectives were to evaluate the impact on the positional component of OSAS and to highlight possible predictors of improvement of OSAS after thyroidectomy. Twenty-eight patients with OSAS are included in this monocentric study: they underwent total thyroidectomy (n = 26) or left loboisthmectomy. Postoperative assessment involves a nocturnal control polysomnography as of 60 days after surgery. The mean age at the time of surgery is 61.3 years (standard deviation ±7.3) and average body mass index is 29.6 kg/m2 (±7.3). Continuous positive airway pressure (CPAP) treatment is introduced preoperatively in 82 % of patients. The statistical analysis shows a significant decrease of 33 % in postoperative AHI for the total population (p = 0.001), 77 % in patients under CPAP (p = 0.05), and 27 % in patients without CPAP (p = 0.02). CPAP therapy could be released in four patients. Given the limited number of subjects studied, the surgery did not impact on the positional component of the OSAS. Statistical analysis failed to link a predictive factor to AHI reduction. We propose thyroid surgery as an alternative or as a complement to CPAP treatment for the patients with goitre: it allows a significant decrease in postoperative AHI, allowing adaptation of the CPAP treatment downward, or even a release in some cases. These results need to be confirmed on a larger series of patients in a prospective study with standardized criteria for polysomnography and multivariate analysis.

La présente étude propose d’analyser les caractéristiques spatio-temporelles de la voix de patients francophones présentant une immobilité laryngée suite à une opération de la glande thyroïde. Il s’agit ici d’évaluer les conséquences de l’immobilité laryngée sur le timing des articulateurs, à l’aide d’un corpus de logatomes (ou de séquences VCV). Notre investigation, bien qu’acoustique, entend analyser, le Voice Onset Time les différents indices articulatori-acoustiques qui peuvent être observés à partir d’un signal acoustique continu, et ainsi remonter aux configurations articulatoires (Abry et al., 1985). Une attention particulière sera donc accordée aux différentes perturbations temporelles qu’une immobilité laryngée peut provoquer sur la voix des patients, grâce à l’étude de la réorganisation temporelles des paramètres retenus. Notre étude se veut longitudinale puisque la voix des patients est enregistrée lors de différentes phases post-opératoires (post-opératoire 2, 3 et 4), ce qui devrait nous permettre de mettre au jour, non seulement les perturbations provoquées par l’immobilité laryngée, mais également les réajustements que les patients pourraient mettre en place au cours du temps et de leur rééducation orthophonique. Seul l’intervalle du VOT pour les occlusives sonores a été modifié. Pour les occlusives voisées, la transition CV implique uniquement un changement d’un état obstrué de conduit vocal à un état suffisamment dégagé de celui-ci pour permettre l’apparition d’une structure formantique claire et stable. En revanche, pour les occlusives non voisées, cette transition CV exige, outre le changement d’état du conduit vocal, une modification de la configuration de la glotte d’une position ouverte pour la consonne non voisée à une position fermée pour la voyelle subséquente. En conséquence, en raison de difficultés de maintien de vibrations laryngées, le VOT, qui est un indice de voisement, est alors généralement plus long pour les occlusives voisées que celles produites par les locuteurs contrôles. La durée du VOT de Klatt (1975) des occlusives voisées des patients reste toutefois quantitativement distincte des occlusives non voisées. En conséquence, la durée de la tenue consonantique des patients se voit également allongée dans les phases d’enregistrement précoces.

International audience; BACKGROUND: Pure Tubular Carcinoma (PTC) of the breast is a rare histological subtype of invasive breast cancer characterized by a low rate of lymph node involvement. Currently there is no consensus on less surgical axillary node staging according to this histological subtype. METHODS: We performed a retrospective multi-institutional study. Inclusion criteria were PTC, sentinel lymph node detection (SLND) and conservative breast surgery. RESULTS: From January 1999 to December 2006, 234 patients were included in the study from 9 institutions. The median pathological tumor size was 9.59 (1-22) mm. SLN were successfully detected in 98% (229/234) of patients. Among the 234 patients, a macrometastasis was found in 6 cases (2.5%), micrometastasis in 15 cases (6.4%), and isolated cells in 2 cases (0.8%). In the case of patients with SLND macrometastasis, half of them had macrometastasis in the complementary axillary lymphadenectomy, and none in the case of SLN only micrometastasis or isolated cells. Of the 122 patients with a pathological tumor size 10 mm) was the only parameter significatively linked to the risk of lymph node involvement (p = 0.007). CONCLUSION: In a large multi-institutional series with SLND, we have shown that the risk of axillary lymph node involvement in PTC is very low. In the case of PTC

The American Thyroid Association (ATA) recommends using ultrasound-guided fine-needle aspiration (FNA) in order to evaluate supracentimetric and suspect thyroid nodules. The purpose of this study was to evaluate the effective use of FNA before surgery for nodules over 3 cm in diameter.In this retrospective study, we analyzed the results of ultrasound-guided FNA and postoperative histological analysis in 843 nodules3 cm.The FNA was informative in 42.6%. The correlation with the final histological analysis was 94.8% for benign nodules and 71.0% for malignant nodules. The FNA had a positive predictive value of 71%, a specificity of 97%, a sensitivity of 56%, and a 4.7% rate of false-negative results.Because there is a nonnegligible FNA risk of error, notably allowing the evolution of a cancer in 1 of 20 cases, the FNA data should not delay surgical intervention for potentially suspect nodules3 cm in diameter. © 2016 Wiley Periodicals, Inc. Head Neck 39: 32-36, 2017.

The standard management for advanced-stage epithelial ovarian cancer is optimum cytoreductive surgery followed by platinum based chemotherapy. However, retroperitoneal lymph node resection remains controversial. The multiple directions of the lymph drainage pathway in ovarian cancer have been recognized. The incidence and pattern of lymph node involvement depends on the extent of the disease and the histological type. Several published cohorts suggest the survival benefit of pelvic and para-aortic lymphadenectomy. A recent large randomized trial have demonstrated the potential benefit for surgical removal of bulky lymph nodes in term of progression-free survival but failed to show any overall survival benefit because of a critical methodology. Further randomised trials are needed to balance risks and benefits of systematic lymphadenectomy in advanced-stage disease. CARACO is a French ongoing trial, built to bring a reply to this important question. A huge effort for inclusion of the patients, and involving new teams, are mandatory.

The use of somatostatin analogs is a new conservative therapeutic approach for the treatment of chyle fistulas developing after thyroid cancer surgery. The combination therapy with a total parenteral nutrition should avoid the high morbidity of a re-intervention with an uncertain outcome. This promising trend is supported by the present case report of a chyle leak occurring after total thyroidectomy with central and lateral neck dissection for a papillary carcinoma, which was treated successfully without immediate or distant sequelae.

The development of acute myeloid leukaemia after low-dose radioiodine therapy and its presentation as a myeloid sarcoma of the uterine cervix are both rare events. We report a case of acute myeloid leukaemia revealed by a myeloid sarcoma of the uterine cervix in a 48-year-old woman, 17 months after receiving a total dose of 100 mCi 131I for papillary thyroid cancer. A strict hematological follow-up of patients treated with any dose of 131I is recommended to accurately detect any hematological complications which might have been underestimated. Unusual presentations, such as chloroma of the uterine cervix, may reveal myeloid malignancy and should be kept in mind.

Resume Objectif Preciser les caracteristiques, le diagnostic et les modalites therapeutiques des metastases intrathyroidiennes. Methode Les auteurs rapportent un cas de metastase intrathyroidienne localement avancee d’un cancer bronchique. Resultat Une patiente de 60 ans, aux antecedents d’adenocarcinome bronchique bien differencie, developpe sept ans plus tard une augmentation de volume de la thyroide dont la biopsie etablit la nature metastatique. Suite a une radiochimiotherapie incomplete, une chirurgie d’exerese palliative et de proprete est realisee associant loboisthmectomie et exerese cutanee large avec fermeture par lambeau myocutane de grand pectoral. Conclusion Les metastases intrathyroidiennes sont rares et leur traitement est chirurgical. Le type de chirurgie devra tenir compte de la nature et de la cinetique du cancer primitif, de la localisation metastatique intrathyroidienne et des modalites de dissemination metastatique. A l’exception des metastases isolees des cancers du rein, le pronostic reste pejoratif.

The presence of a metastatic papillary carcinoma in the neck is presumptive evidence of a primary thyroid neoplasm since neck metastases of other primary tumors are uncommon. Immunohistochemical studies may be required to diagnose these metastases. We report 2 cases in which an unrelated tumor mimicked a thyroid malignancy. Both patients had been referred for evaluation of enlarged lymph neck nodes without any other symptoms. In both cases, a lymph node biopsy identified a metastatic papillary adenocarcinoma that was believed to be consistent with a thyroid primary. Thyroidectomy was not performed in either case. Further investigations led to the diagnosis of other primary tumors that were unrelated to the thyroid; the unrelated primaries were an ovarian serous tumor in one patient and a papillary renal cell carcinoma in the other.

The aim of this study was to evaluate the predictive value of five different biological factors in breast cancer patients treated with neoadjuvant anthracycline-based chemotherapy: (1) tumour grade scored according to the Elston-Ellis classification, (2) hormonal receptor (HR) status; (3) tumour cell proliferation evaluated by Ki-67 staining, (4) HER-2 and topoisomerase II alpha (TopoIIalpha) expression evaluated by immunohistochemistry (IHC), (5) HER-2 and TopoIIalpha amplification evaluated by real-time polymerase chain reaction (PCR). 119 patients with operable breast cancer were treated with six cycles of FEC (100 5-fluorouracil (5-FU) 500 mg/m2, Epirubicin 100 mg/m2, Cyclophosphamide 500 mg/m2). Tumour response was assessed clinically and by computed tomography (CT) scan, then by pathological assessment. The clinical overall response (OR) was 80%, with 19% of complete responders (CR). The radiological OR was 71%, with 16% of CR. A pathological CR was demonstrated in 13% of the patients according to the Sataloff classification. In the multivariate analysis, the absence of HR expression and Ki-67 > or = 20% were predictive for a clinical CR. A high tumour grade was predictive for a pathological CR. Overexpression or amplification of HER2 or Topollcalpha were not predictive of response.

Three surgical approaches have been described for the treatment of women presenting an endometrial cancer. The aim of this study was to appreciate the current criteria that would offer guidelines for this choice. We reviewed the data available in the literature (search Medline). Only laparotomy and laparoscopy permit the carrying out of all the routine surgical staging according to the FIGO's criteria (classification 1988). Only one randomised study compares the results obtained by laparotomy and laparoscopy. Laparoscopy patients had significantly less morbidity. Overall survival did not differ in both groups with a limited follow-up. The other not randomised studies show that laparoscopy is usually proposed to patients having a lower IMC and presenting limited stages. No randomized study had compared laparotomy with the only vaginal surgery. The latter is generally proposed for patients having an associated comorbidity and presenting limited stages. In such cases, no difference in survival is highlighted. Obesity does not represent an absolute contra indication for any way. It makes the surgery generally more complex. A suspicious ovarian lesion, a large uterus are, currently, an indication for laparotomy. Laparoscopy can be accepted only if the uterine volume is lower than 500 g and without deep myometrial infiltration. Laparotomy surgery is the standard. The main indication of vaginal surgery is to permit treatment to high operatory risk patients. Laparoscopy is an option for the early stages. It is not recommended if an ovarian lesion or a deep uterine parietal infiltration are suspected. Whatever the route used, the surgeon must be trained.

Surgery, which remains a conventional treatment of breast tumors, may induce the secretion of growth factors that support angiogenesis and wound healing. These factors are suspected to trigger carcinoma cell division and promote tumor relapse. We addressed this question by culturing breast cancer cell lines in the presence of wound fluid harvested after surgery.Wound fluids were collected from patients who underwent either breast reconstruction, tumor resection, or tumor resection after neoadjuvant chemotherapy. MCF-7 (estrogen receptor (ER)+/progesterone receptor (PgR)+, HCC1937 (ER/PgR-, human epidermal growth factor receptor/neuralized (HER2/neu)-) and MCF-10A (used as a negative control) cell lines were grown in culture media supplemented with wound fluids.Wound fluids drained during the three categories of procedures significantly stimulated the proliferation of MCF-7 and HCC1937 cells in a similar manner.This stimulatory effect on tumor cell proliferation could be attenuated by therapeutic targeting against growth factors and inflammation processes in order to avoid tumor relapse.

As a prerequisite to nonviral gene therapy approaches of ovarian carcinoma, we evaluated the possibility of transfecting established tumor cell lines (SKOV3, IGROV1) as well as primary mesothelial and tumor cells by various polyethylenimine (PEI) derivatives. Several PEI-based vectors were able to effectively transfect these cells, as shown by high luciferase expression levels (10(8) to 10(9) relative light units per milligram of cell protein) that corresponded with 25-50% of green fluorescent protein-positive cells after 24 hours. However, unpredictable differences were observed among the vectors and cell types that a posteriori justified the screening procedure. We also showed that cells that were not transfected after the first experiment remained transfectable in a subsequent transfection experiment to a level similar to that of the initial population. This experiment does not support the emergence of a transfection-resistant cell population and opens the door to multiple therapeutic gene deliveries. Although efficacy and cell targeting still remain to be improved, PEI derivatives appear to be promising molecules for the development of nonviral gene therapy of ovarian carcinoma.

Resume But de l'etude Ce travail portant sur le ganglion axillaire sentinelle dans le cancer du sein a pour objet d'etudier la faisabilite technique de son individualisation et la predictivite sur le statut lymphatique de l'aisselle. Patients et methodes Entre janvier 1996 et juin 1997, 128 malades atteints de cancers invasifs du sein ont beneficie, aux centres regionaux de lutte contre le cancer de Strasbourg et de Lyon, d'une individualisation du ganglion axillaire sentinelle par injection de colorant lymphotrope (bleu Patent) suivie d'une lymphadenectomie axillaire (etages I a II de Berg). Resultats Le taux d'opacification du ganglion axillaire sentinelle a ete de 76,5 % et sa predictivite du statut axillaire de 94,9 %. Le taux de faux negatifs de la procedure a ete de 5,1 %. L'envahissement histologique du ganglion axillaire sentinelle a ete de 43,9 % et son envahissement etait isole dans 30,2 %. La sensibilite de la technique a ete de 94 % (IC95 % = [88 %–98 %]) et sa specificite de 100 %. Conclusion Bien que devant etre encore consideree comme une voie de recherche en cours d'evaluation dans le cadre d'essais prospectifs controles, cette etude atteste de la faisabilite et de la reproductibilite d'une technique qui devrait, dans un proche avenir, ouvrir la voie d'une chirurgie axillaire mini-invasive de stadification dans les cancers du sein.

Since tamoxifen is widely used in breast cancer treatment and has been proposed for the prevention of breast cancer, its endometrial iatrogenic effects must be carefully examined. We have investigated the association between endometrial cancer and tamoxifen use or other treatments in women treated for breast cancer in a case-control study. Cases of endometrial cancer diagnosed after breast cancer (n = 135) and 467 controls matched for age, year of diagnosis of breast cancer and hospital and survival time with an intact uterus were included. Women who had received tamoxifen were significantly more likely to have endometrial cancer diagnosed than those who had not (crude relative risk = 4.9, p = 0.0001). Univariate and adjusted analyses showed that the risk increased with the length of treatment (p = 0.0001) or the cumulative dose of tamoxifen received (p = 0.0001), irrespective of the daily dose. Women who had undergone pelvic radiotherapy also had a higher risk (crude relative risk = 7.8, p = 0.0001). After adjusting for confounding factors, the risk was higher for tamoxifen users (p = 0.0012), treatment for more than 3 years (all p < 0.03) and pelvic radiotherapy (p = 0.012). Women who had endometrial cancer and had received tamoxifen had more advanced disease and poorer prognosis than those with endometrial cancer who had not received this treatment. Our results suggest a causal role of tamoxifen in endometrial cancer, particularly when used as currently proposed for breast cancer prevention. Pelvic radiotherapy may be an additional iatrogenic factor for women with breast cancer. Endometrial cancers diagnosed in women treated with tamoxifen have poorer prognosis. Women who receive tamoxifen for breast cancer should be offered gynaecological surveillance during and after treatment. A long-term evaluation of the risk-benefit ratio of tamoxifen as a preventive treatment for breast cancer is clearly warranted.

Resume But de l'etude II s'agit d'une analyse combinee de facteurs cliniques et histologiques (determines a partir d'une microbiopsie prealable) ayant pour objet d'evaluer le risque d'envahissement ganglionnaire axillaire (pN + ) dans les cancers du sein inferieurs a 3 cm. Materiel et methodes Chez 893 patientes atteintes d'un cancer invasif du sein ToT 1 T 2 ≤ 3 cm cinq parametres ont ete analyses: la taille clinique ( T ), la taille histologique (pT), le sous-type histologique (carcinome canalaire infiltrant, divise selon les trois grades histopronostiques SBR, carcinome lobulaire infiltrant et autres), l'âge ( 60 ans) et la taille du sein, determinee objectivement sur un critere dosimetrique recemment publie ( Eur J Cancer 1997; 33: 2432–4). Resultats Le taux global de pN + etait de 25,3 %, avec respectivement: pN1: 10 %, pN2-3: 8,4 % et pN > 3: 6,9 %. Pour les t 0 , T 1 et T 2 ≤ 3 les taux de pN + etaient respectivement de 13,8 %, 19,8 % et 36,2 %. Selon le pT on notait respectivement 11,1 %, 17,7 %, 23,5 %, 30,1 % et 36 % de pN + pour les lesions correspondantes: 09,9 mm, 10–14,9 mm, 15–19,9 mm, 20–24,9 mm et 259,9 mm. Pour les carcinomes canalaires infiltrants SBR 1, 2 et 3 les taux de pN + etaient de 18,3 %, 27,2 % et 37,8 %; pour les carcinomes lobulaires infiltrants et les autres soustypes, de 22,7 % et 10 %. Pour les trois categories d'âge sus-citees, les taux de pN + etaient respectivement 30,3 %, 25,8 % et 22,4 %. Selon la taille du sein, il y avait 30,1 % et 24,4 % de pN + pour les seins de petit volume par rapport a ceux de moyen ou gros volume. Apres analyse multivariee, trois facteurs restaient significativement predictifs pour le risque de pN + : la taille clinique de la tumeur ( p p = 0,0005), la taille du sein ( p = 0,004). En combinant simultanement ces trois facteurs, le risque de pN + variait de 5 a 50 %. De plus, il etait egalement possible de predire le nombre de ganglions envahis. Conclusions Ce modele simple peut permettre au clinicien d'identifier un groupe de patientes dont le risque d'envahissement ganglionnaire axillaire est ≤ 30 % et qui pourrait donc beneficier d'une chirurgie axillaire limitee avec analyse du ganglion sentinelle.

The outcome of patients presenting with vaginal melanoma has been assessed in a large multicentric retrospective study. The databases of 12 French institutions were searched for primary vaginal melanomas managed between 1990 and 2007. Among the 54 patients recorded, 46 were managed with a curative intent and included in the study. The clinical characteristics, treatments, and detection of c-KIT protein expression have been studied. The median age of the patients was 63.5 years (42-88). Twenty-eight patients were classified as International Federation of Gynecology and Obstetrics (FIGO) stage I, five as stage II, six as stage III, and one as stage IVA. c-KIT protein was overexpressed in 80% of the patients. Forty-two patients underwent surgical resection of the tumor, nine patients received local adjuvant treatment, and 10 received systemic adjuvant therapy. The median relapse-free survival was 10.9 months. c-KIT-negative status (P=0.01) and stage I (P=0.02) were associated with locoregional recurrence. The rate of metastasis was increased for advanced FIGO stages (P

Le présent travail est une étude acoustique de quelques caractéristiques spectrales de voyelles soutenues de patients souffrant de paralysies récurrentielles mais également de patients pour lesquels le diagnostic ORL n'a pas révélé de paralysie mais dont la voix est altérée après une opération de la glande thyroïde. Les conséquences de l'opération chirurgicale sont évaluées dans le but d'identifier les différentes perturbations que cette opération peut provoquer mais également afin de mettre au jour les possibles stratégies de compensations et/ ou réajustements que le patient peut mettre en place seul ou à l'aide d'une rééducation orthophonique. Notre étude se veut longitudinale puisque les patients sont enregistrés lors de différentes phases post-opératoires.

Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients.We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery.Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€ 2947 (σ = 580) versus € 3331 (σ = 902); P = 0.0001].ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.

Absence of hormonal receptors (HR) expression is a predictive factor of high pathologic complete response (pCR) rate after neo-adjuvant chemotherapy. However, HR-positive tumors are less chemosensitive. In the present study, we evaluated the predictive value of estrogen (ER) and progesterone (PgR) semi-quantitative expression in patients with HR-positive tumors treated uniformly with antracycline-based neoadjuvant chemotherapy without hormonal treatment. Value of HR expression as a predictive factor was then evaluated in a multivariate analysis with tumor grade, Ki67 index and HER2 expression. From January 2000 and December 2006, 177 patients with HR-positive breast ductal invasive carcinoma ≥2 cm in its largest diameter were treated with six cycles of an anthracycline-based neo-adjuvant chemotherapy. Tumor grade, ER, PgR, HER2 status and Ki67 index were determined on microbiopsy performed before chemotherapy. A semi-quantitative evaluation of ER and PgR expression by IHC was performed using the Barnes’score. pCR rate was significantly different (P < 0.001) according to the ER expression score. pCR rate was 28% for low score, 9% for medium score and 3% for high score. On the contrary, pCR rate was not significantly different (P = 0.49) according to the PgR expression score. In the multivariate analysis, ER expression score (P = 0.0002) and Ki67 index (P = 0.02) were the only predictive factors of response for HR-positive tumors. pCR after anthracycline-based chemotherapy is significantly correlated with the ER expression score.

70 cases of strictly intraductal breast carcinoma were treated from January 1975 to December 1987. 34 patients underwent radical modified mastectomy, and 36 patients had local excision (2), lumpectomy (26) or quadrantectomy (8), with a complementary irradiation in 34/36 cases (with boost in 32). The main histological subtype is comedocarcinoma (25/70). One local relapse (3%) is noted in radical surgery group at 55 months. 3 local relapses (9%) are noted in conservative treatment group, respectively at 27, 48 and 52 months. The obvious factor influencing the local recurrence is the inefficient surgical excision. Since breast screening programs may lead to early duct carcinoma in situ identification, our results suggest that appropriate conservative surgery associated to radiation therapy could be an adequate alternative to mastectomy in the treatment of this in situ lesion.

Thyroid surgeries associated with an elevated incidence of recurrent laryngeal nerve (RLN) injury are considered high-risk thyroidectomies. These high-risk operations include surgery for thyroid cancer, Graves disease, and recurrent goitre. In addition, the size of the goitre is an important risk factor for RLN injury.In our retrospective study, we tried to evaluate the role of intraoperative neuromonitoring of RLN specifically in high-risk thyroid surgery with 421 nerves at risk.Thyroid surgeries in our study were done by experienced surgeons in a high-volume provider centre.The overall percentage of RLN injury was 8.8% in the monitored group in comparison with 9.1% in the unmonitored group. The percentage of permanent nerve palsy in the monitored group was 3.9% of nerves at risk in comparison with 3.8% in the unmonitored group. No statistically significant difference was found between groups.Routine visual identification of the nerve by meticulous dissection is the best method to avoid RLN injury. The benefit of RLN neuromonitoring could be further assessed by performing a multicentre prospective study to compare the role of RLN neuromonitoring in high-risk thyroid surgeries.

Purpose Predictive factors of non-sentinel lymph node (NSN) involvement at axillary lymph node dissection (ALND) have been studied in the case of sentinel node (SN) involvement, with validation of a nomogram. This nomogram is not accurate for SN micrometastasis. The purpose of our study was to determine a nomogram for predicting the likelihood of NSN involvement in breast cancer patients with a SN micrometastasis. Methods We collated 909 observations of SN micrometastases with additional ALND. Characteristics of the patients, tumours and SN were analysed. Results Involvement of SN was diagnosed 490 times (53.9%) with standard staining (HES) and 419 times solely on immunohistochemical analysis (IHC) (46.1%). NSN invasion was observed in 114 patients (12.5%), whereas 62.3% (71) had only one NSN involved and 37.7% (43) two or more NSN involved. In multivariate analysis, significant predictive factors were: tumour size (pT stage ≤10 mm or >11 and ≤20 or >20 mm [odds ratio (OR) 2.1 and 3.43], micrometastases detected by HES or IHC [OR 1.64], presence or absence of lymphovascular invasion (LVI) [OR 1.76], tumour histological type mixed or not [OR 2.64]. The rate and probability of NSN involvement with the model are given for 24 groups, with a representation by a nomogram. Conclusion One group, corresponding to 10.1% of the patients, was associated with a risk of NSN involvement of less than 5%, and five groups, corresponding to 29.8% of the patients, were associated with a risk ≤10%. Omission of ALND could be proposed with minimal risk for a low probability of NSN involvement.

Radiation-induced small bowel injury is a limiting factor to postoperative tumoricidal pelvic doses exceeding 4500 to 5000 cGy. Data from a review of the literature showed the inadequacy of medical measures and the bad reproducibility of radiation therapeutic attempts to decrease small intestine damage. Recent studies cited the benefit of a polyglycolic acid mesh to create an absorbable intestinal sling and suspend the loops above the pelvic radiation field. In 60 cases of gynecologic and rectal malignancies with a surgical intestinal morbidity of 8.3% (5 cases), the rate of radiation enteritis was 7% (4 cases) with an average follow-up of 17.8 months (range, 1 to 57 months). The quality of small intestinal elevation and the absence of loop herniation were demonstrated by the barium index. Magnetic resonance imaging was used for checking the polymer polyglycolic acid mesh position and its complete resorption at the third to fifth postoperative month. The authors conclude that this new procedure is safe in selected patients with high pelvic recurrence risk after optimal surgery, in residual disease after debulking surgery, or at the time of exploration for unresectable pelvic tumors. Clinical studies are ongoing to evaluate the long-term efficacy of this surgical technique to prevent chronic radiation enteropathy and improve locoregional control in advanced pelvic carcinomas.

Purpose To determine the optimal injection path for blue dye and radiocolloid for sentinel lymph node (SLN) biopsy in early breast cancer. Patients and Methods A prospective randomized multicentric study was initiated to compare the peritumoral (PT) injection site to the periareolar (PA) site in 449 patients. Results The detection rate of axillary SLN by lymphoscintigraphy was significantly higher (P = .03) in the PA group (85.2%) than in the PT group (73.2%). Intraoperative detection rate by blue dye and/or gamma probe was similar (99.11%) in both groups. The rate of SLN detection was somewhat higher in the PA group than in the PT group: 95.6% versus 93.8% with blue dye (P = .24) and 98.2% versus 96.0% by probe (P = .16), respectively. The number of SLNs detected by lymphoscintigraphy and by probe was significantly higher in the PA group than in the PT group, 1.5 versus 1.2 (P = .001) and 1.9 versus 1.7 (P = .02). The blue and hot concordance was 95.6% in the PA group and 91.5% in the PT group (P = .08). The mean ex vivo count of the SLN was significantly higher in the PA group than in the PT group (P < .0001). Conclusion This study strongly validates the PA injection technique given the high detection rate (99.1%) of SLN and the high concordance (95.6%) between blue dye and the radiotracer, as well as higher significant ex and in vivo counts, improving SLN probe detection.

Tamoxifen has been used for two decades as adjuvant therapy for breast cancer. It is also now being used to try and prevent this disease in women at high risk. A series of 89 patients who developed endometrial cancer on adjuvant has been identified from nine French cancer institutes. Although there was a high frequency of superficial, generally well-differentiated forms, some patients did have aggressive disease with a relatively poor outcome and there were 10 deaths from endometrial carcinoma. These data support gynaecological surveillance of women receiving tamoxifen therapy.

To confirm the hypothesis that reducing the interval between surgery and adjuvant chemotherapy could improve prognosis, a randomized multicentric study of adjuvant perioperative chemotherapy (POC) in breast cancer was initiated.A total of 552 patients were randomized to evaluate whether the addition of POC to standard adjuvant treatment significantly improved outcome. Patients were stratified according to menopausal status, with 362 patients in the postmenopausal group and 192 patients in the premenopausal group. Premenopausal women with positive axillary nodes, negative hormonal receptors, or grade 3 tumors received adjuvant mitoxantrone-based chemotherapy. Node-negative premenopausal patients with grade 1 or 2 tumors expressing hormonal receptors received no standard adjuvant treatment. All postmenopausal women received hormonal therapy (tamoxifen 20 mg/day for 3 years). The perioperative regimen was a 14 mg/m(2) mitoxantrone infusion at the end of tumor excision.With a median follow-up of 6.1 years, this study showed no significant advantage of POC on overall survival, disease-free survival, or metastasis-free survival for the total cohort or for the premenopausal and postmenopausal groups.POC was a safe procedure in this study. However, the addition of POC to standard adjuvant treatment offered no benefit in breast cancer adjuvant treatment.

The sentinel node is detected by blue dye, radiocolloïd injection or by combined techniques. Before performing selective lymphadenectomy, a complementary axillary clearance is mandatory during the learning phase. This axillary mini-invasive surgery requires a close collaboration with the nuclear physicians, the pathologists and a training under expert teams leadership.

The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Cancer Centers, and specialists from French Public Universities, General Hospitals and Private Clinics, and some specialists learned societies. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The SORs are developed using a methodology based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.To develop clinical practice guidelines for the management of patients with carcinoma of the endometrium according to the definitions of the Standards, Options and Recommendations project.Data were identified by searching Medline , web sites, and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 63 independent reviewers.The main recommendations for the management of carcinoma of the endometrium are: 1) The diagnosis of carcinoma of the endometrium is based on biopsy and histological examination. However, as first intention, the first elements for diagnosis can be obtain from a hysterography, or particularly, a endovaginal ultrasound examination. Ultrasound allows locoregional metastases to be detected, the CT scan allows the lymph node involvement to be assessed and magnetic resonance imaging allows the myometrium invasion to be evaluated. 2) For the majority of patients, surgery is the initial treatment, both for localised and advanced-stage carcinomas. The excised sample can be used for pathological analysis and tumour staging, using the FIGO (Fédération internationale de gynécologie obstétrique) classification. Surgery for patients with stage I and II carcinomas involves total extrafascial hysterectomy with bilateral salpingo-oophorectomy., In patients with stage III and IV carcinomas radical surgery should be performed, when possible. If this is not possible, then surgery should be as complete as possible and be associated with a complementary treatment. In patients with the most advanced carcinomas, tumour reduction by surgery should be performed. 3) Complementary treatment includes external-beam radiotherapy and brachytherapy. The decision concerning the extent and type of irradiation should be taken taking into consideration the stage and the prognostic factors present. For patients with stage I and II carcinoma, complementary treatment with brachytherapy can be performed, if the myometrium invasion is not deep, or if the carcinoma is grade 2 or 3. Patients with stage III carcinomas can be treated with pelvic or abdominal-pelvic complementary irradiation. In patients that cannot undergo surgery, exclusive radiotherapy can be performed. 4) In the absence of any symptoms, surveillance should include a general clinical and gynaecological examination. All patients with symptoms should undergo an additional work-up.

Breast helical computed tomography (CT) was evaluated for use in assessing response to neoadjuvant chemotherapy and residual tumor volume. Forty-three patients with large, inflammatory breast cancers (stage IIA, 12; IIB, 13; IIIA, 9; IIIB, 9), all histologically confirmed by core biopsy, were evaluated prior to and following neoadjuvant chemotherapy. The breast helical CT procedure involved patients in the prone position using single acquisition during quiet respiration following intravenous injection of nonionic contrast material. Helical CT results (3.2-mm slices and maximum intensity projections) were compared to clinical and mammographic evaluations, as well as to pathologic findings. All tumors were clearly visible by breast helical CT, showing important tumor enhancement. Helical CT evaluation of response to chemotherapy (using World Health Organization criteria) corresponded better with mammography (78%, Cohen's kappa statistic (κ) = 0.65) than with clinical examination (53%, κ = 0.30). Helical CT measurement of residual tumor volume after neoadjuvant chemotherapy and correlation with pathologic findings were globally satisfactory. The intraclass correlation coefficient was 0.69 (excellent for rounded opacities [0.97], but not as good for diffuse, scattered or multinodular opacities [0.60]). By contrast, clinical and mammographic correlations were globally unsatisfactory (0.49 and 0.28, respectively). Breast helical CT can be very useful in the quantitative assessment of response to neoadjuvant chemotherapy and preoperative determination of residual tumor volume. For this reason, it can be considered an alternative to breast magnetic resonance imaging because of its simplicity, rapidity, and accessibility.

1Centre Leon Berard, Lyon; 2FNCLCC, Paris; 3Institut Bergonie, Bordeaux; 4Centre Jean Perrin, Clermont-Ferrand; 5Centre Paul Papin, Angers; 6CHU Bretonneau, Tours; 7Centre Alexis Vautrin, Nancy; 8Centre Henri Becquerel, Rouen; 9CHU, Angers; 10CHU, Hopital Arnaud de Villeneuve, Montpellier; 11Centre Paul Strauss, Strasbourg; 12Clinique Sainte-Catherine, Avignon, France British Journal of Cancer (2001) 84(Supplement 2), 31–36 © 2001 FNCLCC doi: 10.1054/ bjoc.2001.1760, available online at http://www.idealibrary.com on

The aim of this study was to evaluate the reliability and accuracy of sentinel node biopsy for invasive breast cancer and the predictability of axillary node status. Between January 1996 and June 1997 a total of 73 patients underwent patent blue dye lymphatic mapping and sentinel node biopsy followed by standard (level I and II) axillary node dissection (one bilateral procedure). The sentinel node was identified in 82.4% (61/74) of the cases and was predictive of axillary status in 96.7% (59/61). The false-negative rate of the procedure was 8.0% (2/25). The sentinel node was involved in 37.7% (23/61) and was the only one invaded in 30.4% (7/23). The sensitivity of the procedure was 92% (CI95% 74–99%) and its specificity 100%. It is currently considered to be an attractive new procedure undergoing evaluation in prospective controlled trials. This study confirmed the reliability and reproducibility of intraoperative lymphatic mapping and sentinel node biopsy. This is the first step toward a new era of minimally invasive axillary surgery for breast cancer.

Sentinel lymph node biopsies (SLNB) were investigated in 8 cases (6 squamous cell carcinomas, 2 melanomas) of vulvar malignancy. The sentinel node was detected by patent blue dye injection (1 case), pre operative lymphoscintigraphy with intra-operative gamma hand-held probe (2 cases), and combined techniques (5 cases). The procedure was successful in all cases but one (1 invasive squamous cell carcinoma) in which there was medial groin recurrence at 6 months. Nodal invasion was observed in only one case and was confined to the sentinel node. No specific morbidity related to the SLNB procedure occurred. SLNB appears to be a feasible and promising technique, however, requiring further evaluation before being considered as a reliable method to spare inguinofemoral lymphadenectomy in early-stage patients free of sentinel node metastasis, or to be substituted in screening elderly clinically node-negative females.

From 1980 to 1992, 17 women underwent lumpectomy (13) or quadrantectomy (4) and whole breast irradiation (median dose: 52 Gy) for pure lobular carcinoma in situ (LCIS). Three cases correspond to palpable lesions and 14 were discovered only by mammography. Twelve women also received tamoxifen at 20 mg/day for two years. With a median follow-up of 88 months, no local or regional recurrences have been recorded. The global rate of bilateral carcinoma was 17.6% (2 synchronous and one metachronous). In the literature, only eight other cases of LCIS were treated by lumpectomy and radiation therapy, but without details and data on long-term results. After biopsy alone for LCIS subsequent infiltrating carcinoma occurred in about 15% of the cases. Thus, the classical radiosurgical association should represent an interesting alternative both for biopsy alone and radical surgery until now only proposed to treat LCIS.

Patent Blue V (PBV), a dye used clinically for sentinel lymph node detection, was mixed with human serum albumin (HSA). After binding to HSA, the fluorescence quantum yield increased from 5 × 10(-4) to 1.7 × 10(-2), which was enough to allow fluorescence detection and imaging of its distribution. A detection threshold, evaluated in scattering test objects, lower than 2.5 nmol × L(-1) was obtained, using a single-probe setup with a 5-mW incident light power. The detection sensitivity using a fluorescence imaging device was in the µmol × L(-1) range, with a noncooled CCD camera. Preclinical evaluation was performed on a rat model and permitted to observe inflamed nodes on all animals.