Search

Background: Given the increased use and diversity of diagnostic procedures, it is important to understand genetic susceptibility to radiation-induced thyroid cancer. Methods: On the basis of self-declared diagnostic radiology examination records in addition to existing literature, we estimated the radiation dose delivered to the thyroid gland from diagnostic procedures during childhood and adulthood in two case–control studies conducted in France. A total of 1,071 differentiated thyroid cancer (DTC) cases and 1,188 controls from the combined studies were genotyped using a custom-made Illumina OncoArray DNA chip. We focused our analysis on variants in genes involved in DNA damage response and repair pathways, representing a total of 5,817 SNPs in 571 genes. We estimated the OR per milli-Gray (OR/mGy) of the radiation dose delivered to the thyroid gland using conditional logistic regression. We then used an unconditional logistic regression model to assess the association between DNA repair gene variants and DTC risk. We performed a meta-analysis of the two studies. Results: The OR/mGy was 1.02 (95% confidence interval, 1.00–1.03). We found significant associations between DTC and rs7164173 in CHD2 (P = 5.79 × 10−5), rs6067822 in NFATc2 (P = 9.26 × 10−5), rs1059394 and rs699517 both in ENOSF1/THYS, rs12702628 in RPA3, and an interaction between rs7068306 in MGMT and thyroid radiation doses (P = 3.40 × 10−4). Conclusions: Our results suggest a role for variants in CDH2, NFATc2, ENOSF1/THYS, RPA3, and MGMT in DTC risk. Impact: CDH2, NFATc2, ENOSF1/THYS, and RPA3 have not previously been shown to be associated with DTC risk.

Background New rescue regimens are needed for pediatric refractory/recurrent low-grade glioma. Nilotinib is a tyrosine kinase inhibitor that has potential synergistic effects with vinblastine on angiogenesis, tumor cell growth, and immunomodulation. Methods This phase I trial aimed to determine the recommended doses of this combination for phase II trials (RP2D) using the dual-agent Bayesian continual reassessment method. Nilotinib was given orally twice daily (BID) in combination with once-weekly vinblastine injections for a maximum of 12 cycles of 28 days (clinicaltrials.gov, NCT01884922). Results Thirty-five pediatric patients were enrolled across 4 dose levels. The median age was 7 years and 10 had neurofibromatosis type 1. Patients had received a median of 3 prior treatment lines and 25% had received more than 4 previous treatment lines. Dose-limiting toxicity (DLT) during cycle 1 was hematologic, dermatologic, and cardiovascular. The RP2D was identified at 3 mg/m2 weekly for vinblastine with 230 mg/m2 BID for nilotinib (estimated probability of DLT = 18%; 95% credibility interval, 7–29%). Fifteen patients completed the 12 cycles; 2 stopped therapy prematurely due to toxicity and 18 due to disease progression. Three patients achieved a partial response leading to an objective response rate of 8.8% (95% confidence interval [CI], 1.9–23.7), and the disease control rate was 85.3% (95% CI, 68.9–95.1). The 12-month progression-free survival was 37.1% (95% CI, 23.2–53.67). Conclusions Vinblastine and nilotinib combination was mostly limited by myelosuppression and dermatologic toxicity. The efficacy of the combination at the RP2D is currently evaluated in a randomized phase II trial comparing this regimen to vinblastine alone.

Purpose Rapid diagnosis is a key issue in modern oncology, for which one-stop breast clinics are a model. We aimed to assess the diagnosis accuracy and procedure costs of a large-scale one-stop breast clinic. Patients and methods A total of 10,602 individuals with suspect breast lesions attended the Gustave Roussy's regional one-stop breast clinic between 2004 and 2012. The multidisciplinary clinic uses multimodal imaging together with ultrasonography-guided fine needle aspiration for masses and ultrasonography-guided and stereotactic biopsies as needed. Diagnostic accuracy was assessed by comparing one-stop diagnosis to the consolidated diagnosis obtained after surgery or biopsy or long-term monitoring. The medical cost per patient of the care pathway was assessed from patient-level data collected prospectively. Results Sixty-nine percent of the patients had masses, while 31% had micro-calcifications or other non-mass lesions. In 75% of the cases (87% of masses), an exact diagnosis could be given on the same day. In the base-case analysis (i.e. considering only benign and malignant lesions at one-stop and at consolidated diagnoses), the sensitivity of the one-stop clinic was 98.4%, specificity 99.8%, positive and negative predictive values 99.7% and 99.0%. In the sensitivity analysis (reclassification of suspect, atypical and undetermined lesions), diagnostic sensitivity varied from 90.3% to 98.5% and specificity varied from 94.3% to 99.8%. The mean medical cost per patient of one-stop diagnostic procedure was €420. Conclusions One-stop breast clinic can provide timely and cost-efficient delivery of highly accurate diagnoses and serve as models of care for multiple settings, including rapid screening-linked diagnosis.

Resume La douleur mammaire est un motif frequent de consultation, anxiogene pour les patientes. On distingue les douleurs mammaires cycliques, non cycliques et les douleurs mammaires associees a d’autres symptomes. Les causes sont multiples, habituellement benignes. L’interrogatoire et l’examen clinique sont essentiels pour determiner des facteurs favorisants. Meme si l’imagerie n’est pas toujours necessaire en cas de douleur mammaire isolee, elle reste utile pour le diagnostic de causes specifiques comme des kystes sous tension, des adenofibromes geants ou une thrombophlebite de Mondor. L’echographie est l’examen de premiere intention, avant la mammographie, l’IRM ou la biopsie qui peuvent etre indiquees en cas d’anomalies suspectes. Certains cancers peuvent etre reveles par une douleur, ce qui implique que la douleur mammaire doit toujours etre prise en consideration par les radiologues et les cliniciens.

Resume Objectif Revue iconographique avec analyse semiologique fine des tumeurs ovariennes de l’enfant et l’adolescente afin de proposer une orientation diagnostique pertinente. Patients et methode Etude retrospective (2001–2011) de 41 patientes âgees de moins de 15 ans et operees d’une masse ovarienne avec etude anatomo-pathologique. Resultats Soixante-deux pour cent des lesions etaient benignes, 33 % etaient malignes et 5 % etaient borderline. Les tumeurs germinales etaient les plus frequentes (77,5 %) suivies des tumeurs des cordons sexuels et du stroma (12,5 %) et des tumeurs epitheliales (7,5 %). Les tumeurs malignes etaient plus frequemment observees entre 0 et 2 ans. En imagerie, les calcifications et la graisse etaient specifiques des tumeurs germinales ; le nodule mural etait evocateur de teratome mature ( p p p = 0,05), biologiques : augmentation du taux d’hCG et/ou d’AFP ( p p p p Conclusion Cette analyse semiologique permet de mieux apprehender le diagnostic etiologique des tumeurs ovariennes en pediatrie et souligne, en particulier, a cote des criteres classiques, l’importance de la mise en evidence d’une vascularisation tumorale hautement predictive de malignite.

Background Patients with neuroblastoma are now stratified at diagnosis according to the presence and number of image-defined risk factors (IDRFs). We examined the added value of IDRF assessment after neoadjuvant chemotherapy for predicting surgical resection. Material and Methods From 2009–2012, 39 out of 91 patients operated on in our institution for neuroblastic tumors received neoadjuvant chemotherapy based on ongoing SIOPEN protocols or treatment guidelines. IDRFs were assessed both at diagnosis and preoperatively on CT and/or MRI. Results Median age at diagnosis was 30 months [range 2–191]. The tumor locations were adrenal (n = 20), paravertebral (n = 13) and perivascular (n = 6). INRGSS stages were L2 (n = 13), M (n = 25) and Ms (n = 1). Eleven tumors (28%) were MYCN-amplified. Chemotherapy reduced the number of IDRFs in 54% of patients overall (21/39): 61.5% (16/26) of M and Ms patients, and 38.5% (5/13) of non metastatic patients (P

Background Minimally invasive surgery (MIS) is still not a well-accepted surgical approach to remove neuroblastic tumors. We aimed to assess the indications and limits of MIS in this childhood tumor according to tumor location and image-defined risk factors (IDRFs). Procedure Between 2006 and 2012, 39 patients underwent MIS for neuroblastic tumors, using thoracoscopic (n = 20), retroperitoneoscopic (n = 1) or laparoscopic approaches (n = 18). The tumor locations were paravertebral (n = 18; thoracic n = 15, lumbar n = 3), perivascular (n = 5; abdominal n = 2; thoracic n = 3), adrenal (n = 13), pleural (n = 2) and pelvic (n = 1). Two patients were treated for relapses. According to the INRG staging system, IDRFs were absent in 20 patients and present in 19 patients. Ten patients received chemotherapy preoperatively. Mean largest diameter was 35 mm for thoracic tumors (range: 7–85 mm) and 34 mm for abdominal tumors (range: 10–75 mm). Mean follow-up was 25 months (range: 5–116 months). Results Resection was macroscopically incomplete (R2) for six thoracic tumors and one adrenal tumor. Conversion was necessary for three thoracic L2 tumors. Postoperative complications consisted of chylothorax in three patients with L2 paravertebral thoracic tumors, Horner's syndrome in a patient with a cervicothoracic tumor, and renal atrophy in a patient with a L2 abdominal tumor. No perioperative or postoperative complications occurred in patients with adrenal and abdominal paravertebral tumors. The overall survival rate was 98%. Conclusion In carefully selected cases, MIS permits safe and efficient resection of neuroblastic tumors in children. Open surgical approach should be considered if organ or vascular control or quality of resection is jeopardized. Pediatr Blood Cancer 2015;62:257–261. © 2014 Wiley Periodicals, Inc.

Resume L’IRM corps entier, en raison de son excellente resolution en contraste et de son caractere non irradiant, est une alternative aux examens de medecine nucleaire particulierement interessante en oncopediatrie. Cette technique, aujourd’hui realisable en routine clinique, permet d’evaluer la dissemination metastatique et la reponse au traitement, facteurs pronostiques determinants dans la prise en charge therapeutique. De nombreuses etudes ont demontre la non-inferiorite de cette technique comparativement aux examens de medecine nucleaire, il reste toutefois necessaire de standardiser ses parametres techniques et ses indications pour chaque type de cancer a chaque etape de leur prise en charge. Nous aborderons en premier lieu les bases techniques de l’IRM corps entier, puis, a la lumiere d’une revue exhaustive de la litterature, nous dresserons le bilan actuel et a venir de la place de cette technique dans l’evaluation des cancers de l’enfant.

Whole body MRI provides excellent contrast resolution imaging and is an interesting alternative to nuclear medicine examinations in paediatric oncology because it does not involve exposure to radiation. This technique, now feasible in clinical practice, helps to evaluate metastatic spread and response to treatment, which are of great prognostic interest. Numerous studies have demonstrated the non-inferiority of this technique when compared to nuclear medicine examinations. However, there is still a need to standardize indications in each type of cancer and at every stage of it. This article first discusses the technical principles of whole body MRI, then reviews current clinical applications for the modality in children, and finally, discusses future useful developments for paediatric oncology.

Breast elastography is being increasingly used to better characterize breast lesions. Published studies have shown that it improved specificity of B mode ultrasound. Two elastography modes are available: free-hand elastography and shear wave elastography. Free-hand elastography is obtained by a mechanic wave induced by the ultrasound probe, deforming the target, either by small movements induced by breathe. An elastogram is obtained and displayed either as a colour map or a size ratio or elasticity ratio measurement. The second mode is shear wave elastography; two methods are available: Shear Wave Elastography (SWE) and ARFI mode (Acoustic Radiation Force Impulse). Shear wave elastography is less operator-dependent than free-hand elastography mode and provides a quantitative approach. A value of over 80kPa (SWE) or velocity results of over 2m/s (ARFI) are considered as suspicious. False negatives may occur in soft breast cancers (mucinous carcinoma, carcinoma with an inflammatory stroma, etc.) and false positives may be seen with poorly deformable benign lesions such as old fibrous adenomas. In practical use, elastography is a useful complementary tool for undetermined breast lesions categorized as BI-RADS 4a or BI-RADS 3, or for cystic lesions but cannot avoid fine needle aspiration or core biopsy if ultrasound features are clearly suspicious.

Computer-aided detection (CAD) systems have been developed for interpretation to improve mammographic detection of breast cancer at screening by reducing the number of false-negative interpretation that can be caused by subtle findings, radiologist distraction and complex architecture. They use a digitized mammographic image that can be obtained from both screen-film mammography and full field digital mammography. Its performance in breast cancer detection is dependent on the performance of the CAD itself, the population to which it is applied and the radiologists who use it. There is a clear benefit to the use of CAD in less experienced radiologist and in detecting breast carcinomas presenting as microcalcifications. This review gives a detailed description CAD systems used in mammography and their performance in assistance of reading in screening mammography and as an alternative to double reading. Other CAD systems developed for MRI and ultrasound are also presented and discussed.

Background To evaluate a strategy whereby extensive surgery ± external radiotherapy (RT) could improve local control in pterygopalatine/infratemporal fossa (PIF) sarcoma. Procedure Forty-one patients with a diagnosis of sarcoma involving the PIF and referred to our Institute from 1984 to 2009 were included in the analysis. Patients received multidrug chemotherapy and radiotherapy ± surgery, depending on the period of treatment. Results The median age at diagnosis was 7.6 years (range: 0.1–22 years). There were 36 RMS, 3 undifferentiated sarcoma and 2 other soft-tissue sarcomas. Sixty-eight percent of patients had meningeal risk factors at diagnosis. Local treatment consisted of RT alone in 19 patients, surgery in combination to RT in 19 patients and surgery alone in 3 patients. The local progression rate (LPR) at 5 years was 45% for the entire population, 59% for the 19 patients treated with RT alone and 34% for the 22 patients who had surgery as part of their treatment. All locoregional failures after extensive surgery occurred at the skull base and/or in leptomeningeal spaces. Conclusions Multidisciplinary approach including extensive surgery for PIF sarcoma is feasible and yields good local control with 15/22 patients in local complete remission. Future studies are warranted to confirm these promising results, to evaluate the possibility of avoiding RT or limiting the RT field, and to extend the indication for extensive surgery to other “worse” sites of PM sarcoma such as the paranasal sinuses. Pediatr Blood Cancer 2013; 60: 928–934. © 2013 Wiley Periodicals, Inc.

espanolEl sistema de salud argentino se caracteriza por su heterogeneidad y fragmentacion, lo que genera inconvenientes en la eficiencia asignativa. Segun datos del ultimo censo, la sumatoria de la poblacion cubierta por las jurisdicciones provinciales a traves de la salud publica y de la que posee cobertura de la seguridad social provincial, representa —en promedio— el 52% de la poblacion del pais, cifra que evidencia el rol fundamental que ocupan los estados provinciales en la construccion de politicas publicas sanitarias y la necesaria interaccion que requiere el sector, para poder generar una sinergia positiva de las partes. En este articulo, se expone informacion relevada a traves del Observatorio de la Seguridad Social Provincial que permite identificar el grado de cobertura del Sistema de Salud Argentino para los distintos segmentos y analizar la estructura demografica cubierta por las Obras Sociales Provinciales, en pos de aportar datos para caracterizar demograficamente la poblacion bajo cobertura y exponer indicadores de consumo y costo. EnglishThe Argentine health system is characterized by its heterogeneity and fragmentation, which creates problems in allocative efficiency. According to the last census, the sum of the population covered by the provincial jurisdictions through the public health and which have coverage of the provincial social security, represents, on average, 52% of the country’s population, a figure that demonstrates the key role that occupy the provinces in building public health policies and the necessary interaction required in the sector in order to generate a positive partner’s synergy. In this article, information gathered through the Observatory of the Provincial Social Security that identifies the coverage of the Argentine Health System for the various segments and analyze the demographic structure covered by the Provincial Social Securities, in order to provide information for sanitary planning.

Background Standard treatment for recurrent ependymomas is not defined. Re- irradiation has been proposed but its modalities and results are still to be explored. Patients and methods From June 1994 to December 2013, 32 pediatric patients with ependymoma were re-irradiated for local (n = 15) or metastatic (n = 17) relapses. Files were reviewed retrospectively. Results Local relapses were treated with hypofractionated focal radiotherapy (hypoFFRT) (n = 8) or focal fractionated radiotherapy (FFRT) (n = 7). Metastatic relapses were treated with hypoFFRT (n = 3), FFRT (n = 3), spinal radiotherapy (n = 4) and craniospinal irradiation (CSI) (n = 7). Median PFS and OS after re-irradiation were 1.2 and 3.5 years respectively with a median follow-up of 2.1 years (0.2–11.4). For local relapses, median PFS was 2.5 years for patients treated with hypoFFRT versus 1.2 years for patients treated with FFRT (p = 0.2). For metastatic relapses, median PFS was 0.7 years for patients treated with focal radiotherapy (hypoFFRT, FFRT, spinal radiotherapy) versus 6.8 years for patients treated with CSI (p = 0.073). 15 patients achieved greater PFS after second radiotherapy (RT2) than after first radiotherapy (RT1). 27 patients (84 %) had surgery before re-irradiation. PFS was better for patients with GTR before RT2 (14.7 vs 6.7 months) (p = 0.05). 5 patients developed radionecrosis; only one required corticosteroids. Conclusion Re-irradiation at relapse is a safe, feasible and potentially curative treatment. Metastatic relapse may require CSI even when isolated and re-operated. For local relapses, considering conflicting results in the literature, a randomized trial is warranted to explore fractionated focal radiotherapy versus hypofractionated focal irradiation.

Resume Les tumeurs apocrines du sein sont des tumeurs malignes rares et peu etudiees en imagerie. Nous rapportons le cas d’une femme de 45 ans a risque familial de cancer du sein, qui a presente un carcinome apocrine in situ du sein, avec une masse palpable et des lesions uniquement visibles en IRM.

El presente trabajo se enmarca en el proyecto de investigación que se viene desarrollando en la Facultad de Ciencias Económicas de la Universidad Nacional del Litoral, denominado “Educación y trabajo. El caso de los alumnos que abandonan los estudios superiores”. Se parte de reconocer que el estudio de las trayectorias académicas de los estudiantes constituye una línea de investigación capaz de aportar información relevante al renovado debate sobre los fenómenos de rezago y abandono y sustentar el diseño de estrategias orientadas al logro de una educación superior más inclusiva. Atendiendo a la complejidad de este objeto de estudio, se analizan distintas perspectivas conceptuales y metodológicas en torno al concepto de trayectorias académicas y a su abordaje empírico.

Breast magnetic resonance imaging (MRI) has demonstrated increased sensitivity over conventional imaging in identifying and characterizing in situ and invasive, multifocal, and multicentric disease. A histologic diagnosis is required for any enhancing lesion displaying suspicious features, especially in the presence of lower and often variable reported specificity values. Breast MRI findings occult on mammography and ultrasound should undergo an MR-guided biopsy. We retrospectively evaluate our 8 years' experience with this procedure. Our study included 259 lesions in 255 consecutive patients referred for MR-guided breast biopsy. MRI screening of women at a high risk for developing breast cancer accounted for 84 lesions, 54 lesions were detected on MRI staging for multifocal and multicentric disease, and 115 were incidental findings or lesions that presented diagnosis related issues on conventional imaging. Six procedures were cancelled due to lack of visualization. MR-guided breast biopsy was performed for 100 mass and 153 nonmass enhancements. Pathology results were classified into benign (113 lesions), high risk (47 lesions), and malignant (40 ductal carcinoma in situ, 38 invasive ductal carcinoma, 15 invasive lobular carcinoma). Subsequent surgery for high risk and malignant findings revealed an underestimation rate of 34% (16/47) for high risk lesions and of 7.5% for ductal carcinoma in situ (3/40). The overall positive predictive value (PPV) was calculated at 43.1% (33.3% for high-risk women, 70.3% for cancer staging, and 37.4% for incidental/undetermined lesions). The PPV was higher for mass (57%) versus nonmass enhancements (34%). MR-guided breast biopsy proved to be a reliable procedure for the diagnosis and management of occult breast MRI findings, or lesions that preclude biopsy under conventional guidance. The PPV displayed significant variation between patient subgroups, correlating higher values with a higher associated breast cancer prevalence.

Patients with neuroblastoma are now stratified at diagnosis according to the presence and number of image-defined risk factors (IDRFs). We examined the added value of IDRF assessment after neoadjuvant chemotherapy for predicting surgical resection.From 2009-2012, 39 out of 91 patients operated on in our institution for neuroblastic tumors received neoadjuvant chemotherapy based on ongoing SIOPEN protocols or treatment guidelines. IDRFs were assessed both at diagnosis and preoperatively on CT and/or MRI.Median age at diagnosis was 30 months [range 2-191]. The tumor locations were adrenal (n = 20), paravertebral (n = 13) and perivascular (n = 6). INRGSS stages were L2 (n = 13), M (n = 25) and Ms (n = 1). Eleven tumors (28%) were MYCN-amplified. Chemotherapy reduced the number of IDRFs in 54% of patients overall (21/39): 61.5% (16/26) of M and Ms patients, and 38.5% (5/13) of non metastatic patients (P 0.001). The number of IDRFs lost after chemotherapy was proportional to the degree of tumor shrinkage (P = 0.002), independent of the primary tumor location (P = 0.73), although the number was higher in patients with left versus right adrenal locations (P = 0.004). Patients with neuroblastoma on post-surgical histology lost more IDRFs (median: 1[0-9]) than patients with ganglioneuroblastoma (median: 0[0-4]) (P 0.001). The completeness of resection was related only to the number of preoperative IDRFs (P = 0.028).IDRF assessment after neoadjuvant chemotherapy is useful for predicting completeness of resection of neurogenic tumors. A larger international study is needed to confirm these results and to explore a possible correlation between preoperative IDRF status and survival.

Minimally invasive surgery (MIS) is still not a well-accepted surgical approach to remove neuroblastic tumors. We aimed to assess the indications and limits of MIS in this childhood tumor according to tumor location and image-defined risk factors (IDRFs).Between 2006 and 2012, 39 patients underwent MIS for neuroblastic tumors, using thoracoscopic (n = 20), retroperitoneoscopic (n = 1) or laparoscopic approaches (n = 18). The tumor locations were paravertebral (n = 18; thoracic n = 15, lumbar n = 3), perivascular (n = 5; abdominal n = 2; thoracic n = 3), adrenal (n = 13), pleural (n = 2) and pelvic (n = 1). Two patients were treated for relapses. According to the INRG staging system, IDRFs were absent in 20 patients and present in 19 patients. Ten patients received chemotherapy preoperatively. Mean largest diameter was 35 mm for thoracic tumors (range: 7-85 mm) and 34 mm for abdominal tumors (range: 10-75 mm). Mean follow-up was 25 months (range: 5-116 months).Resection was macroscopically incomplete (R2) for six thoracic tumors and one adrenal tumor. Conversion was necessary for three thoracic L2 tumors. Postoperative complications consisted of chylothorax in three patients with L2 paravertebral thoracic tumors, Horner's syndrome in a patient with a cervicothoracic tumor, and renal atrophy in a patient with a L2 abdominal tumor. No perioperative or postoperative complications occurred in patients with adrenal and abdominal paravertebral tumors. The overall survival rate was 98%.In carefully selected cases, MIS permits safe and efficient resection of neuroblastic tumors in children. Open surgical approach should be considered if organ or vascular control or quality of resection is jeopardized. Pediatr Blood Cancer 2015;62:257-261. © 2014 Wiley Periodicals, Inc.

Imaging of breast cancer is multimodal. Mammography uses X-rays, the development of digital mammography has improved its quality and enabled implementations of new technologies such astomosynthesis (3D mammography) or contrast-enhanced digital mammography. Ultrasound is added to mammography when there is need to improve detection in high-density breast, to characterize an image, or guide apuncture or biopsy. Breast MRI is the most sensitive imaging modality. It detects a possible tumor angiogenesis by highlighting an early and intense contrast uptake. This method has an excellent negative predictive value, but its lack of specificity (false positives) can be problematic, thus it has to be prescribed according to published standards. An imaging breast screening report must be concluded by the BI-RADS lexicon classification of the ACR and recommendations about monitoring or histological verification.

L’incidence du cancer de l’endometre a atteint 6 800 cas en 2011 en France pour une mortalite de 2 080 cas, alors que le taux d’incidence standardise a la population europeenne etait de 13,6 pour 100 000 femmes en 2005 [1]. Sur le plan epidemiologique, on considere qu’il existe deux types de cancers de l’endometre: un type œstrogeno-dependant peu agressif et bien differencie (carcinome endometrioide de grade 1, 2) et un type œstrogeno-independant, plus agressif (carcinome endometrioide de grade 3, carcinome sereux ou a cellules claires) [6]. Par ailleurs, le tamoxifene, largement utilise pour son effet protecteur vis-a-vis du cancer du sein, a un effet œstrogene-like sur l’endometre. Son utilisation augmente le risque de developper un cancer de l’endometre [7, 8].

Le cancer du col est le troisieme cancer gynecologique et atteint preferentiellement les femmes jeunes de moins de 45 ans. Aujourd’hui, la strategie therapeutique est plus efficace qu’auparavant grâce a l’introduction de la chimiotherapie et de la radiotherapie concomitantes, dans les stades evolues, superieur au stade FIGO IB2. L’IRM permet d’optimiser cette planification therapeutique en proposant un bilan d’extension initial complet. L’IRM permet ainsi de completer l’examen clinique et de reduire le recours aux multiples examens qui etaient realises auparavant (urographie intraveineuse, lymphographie, lavement baryte, etc.).

The aim of this study was to evaluate the accuracy and safety of breast lesion excision system (BLES) procedure with an Intact system device, under stereotactic and ultrasound guidance. Retrospective data review of 32 breast lesions BI-RADS 4 or 5 underwent Intact procedures, from March 2010 to January 2012. Underestimation rates of atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) were evaluated; percentage of complete radiologic and histologic removal of the breast lesion were analyzed, as were the complications due to procedure. Complete radiologic excision of the target lesion was achieved in all masses and 58.6% of calcifications. Lesion size was less than 11 mm (mean size 5.6 mm). Underestimation of ADH and DCIS was 0% and 10%, respectively. Low complication rate was noted: only one hematoma. BLES appears an accurate and safe biopsy system for sampling nonpalpable breast lesions, especially in case of microcalcifications clusters categorized as BI-RADS 4 and 5.

Malignant germ cell tumours are less common than epithelial ovarian tumours, accounting for less than 2–3 % of all ovarian cancers in Western countries. They usually occur in younger women with a peak incidence before 20 years.

L’imagerie connait depuis quelques annees des progres fulgurants, que se soit dans le domaine des rayons X, de l’IRM, des ultrasons et de l’imagerie metabolique. L’imagerie senologique a beneficie de chacune de ces avancees technologiques. Dans le domaine de la mammographie du deploiement, la mammographie numerique a permis de dissocier le processus d’acquisition de l’image de celui du traitement et de l’affichage des images ainsi que de leur archivage facilitant l’optimisation de chacune de ces etapes. L’acquisition de l’image mammographique par rayons X a beneficie de l’optimisation de detecteurs suffisamment sensibles et epais pour absorber une grande fraction des rayons X transmis au sein, l’elimination du bruit de granularite et la reduction de la dose d’irradiation a la glande. L’etude DMIST sur 49 528 femmes qui se sont presentees consecutivement pour un depistage du cancer du sein dans 33 sites nord-americains entre 2001 et 2003 a permis de valider la mammographie numerique montrant pour les femmes de 50 ans et plus une performance interne equivalente a la mammographie analogique, tous cancers confondus, mais une meilleure sensibilite de la mammographie numerique en comparaison a la mammographie analogique dans le groupe des moins de 50 ans, dans le groupe des femmes pre- ou perimenopausees et dans le groupe des seins a densite heterogene ou extreme (difference peu significative).

1535Background: Li Fraumeni syndrome (LFS) is a rare cancer predisposition caused by TP53germline mutation. Its broad cancer spectrum includes breast, sarcoma, brain tumor and leukemia, typically occurring in childhood or young adulthood. The challenge of the LFS clinical management is made even more complex by the suspicion of a much broader spectrum. Methods: The LIFSCREEN French study is an open, randomized, multicentric prospective trial, designed to assess whole body MRI performance. It will evaluate the efficacy and tolerability of 2 screening schemes, performed yearly at least 3 times. At each round, quality of life (QOL) and psychological impact (PI) is assessed. To better define the tumor spectrum, we report here data of the LIFSCREEN participants (pts) and their families, collected at inclusion. Moreover, we describe the cancers identified to date. Results: Any TP53 germline mutation carrier, with or without personal cancer history, aged > 5 and < 71, were included from Oct-2011 to Jan-2015 in 1...

To evaluate a strategy whereby extensive surgery ± external radiotherapy (RT) could improve local control in pterygopalatine/infratemporal fossa (PIF) sarcoma.Forty-one patients with a diagnosis of sarcoma involving the PIF and referred to our Institute from 1984 to 2009 were included in the analysis. Patients received multidrug chemotherapy and radiotherapy ± surgery, depending on the period of treatment.The median age at diagnosis was 7.6 years (range: 0.1-22 years). There were 36 RMS, 3 undifferentiated sarcoma and 2 other soft-tissue sarcomas. Sixty-eight percent of patients had meningeal risk factors at diagnosis. Local treatment consisted of RT alone in 19 patients, surgery in combination to RT in 19 patients and surgery alone in 3 patients. The local progression rate (LPR) at 5 years was 45% for the entire population, 59% for the 19 patients treated with RT alone and 34% for the 22 patients who had surgery as part of their treatment. All locoregional failures after extensive surgery occurred at the skull base and/or in leptomeningeal spaces.Multidisciplinary approach including extensive surgery for PIF sarcoma is feasible and yields good local control with 15/22 patients in local complete remission. Future studies are warranted to confirm these promising results, to evaluate the possibility of avoiding RT or limiting the RT field, and to extend the indication for extensive surgery to other "worse" sites of PM sarcoma such as the paranasal sinuses.