To determine the diagnostic performance of radiological evaluation of the margins of surgical spe... more To determine the diagnostic performance of radiological evaluation of the margins of surgical specimens from lumpectomies for subclinical malignant breast lesions. Retrospective study in two French hospitals including all patients who had a non-palpable in situ (ISDC) or invasive (IDC) ductal carcinoma treated by lumpectomy after radiological localisation. For the analysis, the lesions were divided into two groups depending on the majority component in the definitive histological examination: ISDC or IDC. The radiological margin considered was 10mm. For the 178 lumpectomies studied, the sensitivity of the radiographs of the surgical specimen was 33.3% for ISDC and 50% for IDC. The surgical revision rate was 27.41% for ISDC and 12.64% for IDC. The significant predictive factors for positive margins were the radiological size of the lesions (>10mm) for ISDC (P=0.02) and radiologically positive margins for IDC (P=0.01). Correlation was found between the histological and radiological...
Breast-conserving surgery with radiation therapy is the primary treatment for ductal carcinoma in... more Breast-conserving surgery with radiation therapy is the primary treatment for ductal carcinoma in situ (DCIS). Re-excision is indicated when clear resection margins have not been achieved, although in some cases the procedure may be unnecessary as there is no residual tumor. The purpose of our three-Center retrospective study was to identify predictors of positive re-excision findings following breast-conserving surgery for DCIS. A total of 285 patients underwent re-excision following conservative treatment for DCIS between 01/01/08 and 12/31/13 at three breast-cancer referral Centers. We conducted a retrospective, comparative review of the factors that differentiated patients with a residual tumor from those without. The study was based on clinical, radiological, surgical and pathological criteria. A total of 180 patients (63%) had residual tumor after conservative treatment. Six factors were predictive on univariate analysis: young age (p=0.025), non-menopausal status (p=0.016), a...
ABSTRACT Les techniques de réduction endométriale de deuxième génération sont à utiliser préféren... more ABSTRACT Les techniques de réduction endométriale de deuxième génération sont à utiliser préférentiellement car ils entraînent moins de complications que les techniques de première génération. Une contraception efficace est hautement recommandée après réduction endométriale. Les techniques de myolyse relèvent toujours du domaine de la recherche biomédicale, la myolyse par ultrasons focalisés monitoré par IRM ou par échographie est quant à elle accessible à environ 10 % des fibromes avec une efficacité sur les symptômes évaluée à 70 % à long terme. La ligature des artères utérines par cœlioscopie est aussi efficace que l’embolisation mais avec un effet moins durable dans le temps.
Second generation endometrial ablation techniques must be used preferably as they present less co... more Second generation endometrial ablation techniques must be used preferably as they present less complications than first generation techniques. An efficient contraception is highly recommended after thermal ablation. Myolysis techniques are still investigational, focused ultrasound myolysis MR or ultrasound-guided is accessible to approximately 10% of uterine myomas with 70% of long-term symptom relief. Outcomes of laparoscopic uterine artery occlusion are similar to those of uterine artery embolization but with less long-term durability.
Magnetic Resonance Materials in Physics, Biology and Medicine, 2016
To evaluate the feasibility of in vivo measurement of the fatty acid (FA) composition of breast a... more To evaluate the feasibility of in vivo measurement of the fatty acid (FA) composition of breast adipose tissue by MRS on a clinical platform. MRS experiments were performed at 3 T, using a STEAM sequence, on 25 patients diagnosed with breast cancer. MR spectra, acquired on healthy breast tissue, were analysed with the LCModel. The measured values of the saturated fatty acid (SFA), mono-unsaturated fatty acid (MUFA) and poly-unsaturated fatty acid (PUFA) fractions were 23.8 ± 7.1 %, 55.4 ± 6.8 % and 20.8 ± 4.4 %, respectively. The values of SFA, MUFA and PUFA observed in the current study are in the same range as those found in two previous studies performed at 7 T. The results of the current study show that it is possible to quantify the fatty acid composition of breast tissue in vivo in a clinical setting (3 T).
The microenvironment of breast epithelial tissue may contribute to the clinical expression of bre... more The microenvironment of breast epithelial tissue may contribute to the clinical expression of breast cancer. Breast epithelial tissue, whether healthy or tumoral, is directly in contact with fat cells, which in turn could influence tumor multifocality. In this pilot study we investigated whether the fatty acid composition of breast adipose tissue differed according to breast cancer focality. Twenty-three consecutive women presenting with non-metastatic breast cancer underwent breast-imaging procedures including Magnetic Resonance Imaging prior to treatment. Breast adipose tissue specimens were collected during breast surgery. We established a biochemical profile of adipose tissue fatty acids by gas chromatography. We assessed whether there were differences according to breast cancer focality. We found that decreased levels in breast adipose tissue of docosahexaenoic and eicosapentaenoic acids, the two main polyunsaturated n-3 fatty acids of marine origin, were associated with multif...
Fatty acids composition of adipose tissue may provide information on the nutritional part of the ... more Fatty acids composition of adipose tissue may provide information on the nutritional part of the risk or evolution of breast cancer. To determine whether 1H-NMR of adipose tissue provides information on the nature of the diet consumed, a dietary intervention with increasing percentage of polyunsaturated n-3 docosahexaenoic acid (DHA 22:6n-3, provided as DHASCO oil) was applied to a rat model of N-Nitroso N-Methyl Urea-induced mammary tumors. Spectra of the lipid extracts were obtained from adipose tissues in five groups of Sprague-Dawley rats fed with a diet containing 7% peanut/rapeseed enriched with 8%(w/w) of an oil without (palm oil) or with low (1%), moderate (3%) or high (8%) DHASCO content. A control group received a basal diet with 15% peanut/rapeseed representative of the "Western" diet. After 5 months of those 5 controlled diets, adipose tissue was collected for analysis of the lipid extract using both 1H-NMR analysis on an 11.7T spectrometer and gas chromatography considered as gold standard. 1H-NMR analysis showed a dose-dependent increase in DHA in the lipid extract of adipose tissues, a commensurate decrease in n-6 polyunsaturated fatty acids in the three DHA groups which allowed to follow n-6/n-3 ratio changes. The highest n-6/n-3 ratio was observed in the control "western diet" group compared to the other diet groups. The integrated spectral regions showed separation between groups thereby documenting a specific NMR lipid profile corresponding to each dietary intervention. Those diet-dependent NMR lipid profiles were consistent with that obtained with gas chromatography analyzes of the same samples. This study is a proof of concept highlighting the potential use of 1H-NMR approach to evaluate dietary intervention in biopsies of adipose tissues.
Pelvic actinomycosis is a rare disease that can be diagnosed before, during or after surgical tre... more Pelvic actinomycosis is a rare disease that can be diagnosed before, during or after surgical treatment of a suspected ovarian tumor, a suspected bowel obstruction, or acute peritonitis. The possibility of early detection of pelvic or abdominal abscess related to was evaluated through a personal series and literature review. Our series of 11 cases of severe abdominal or pelvic actinomycosis is related and compared to 58 cases reported in the literature. Seven patients in this series were diagnosed with pelvic inflammatory disease and acute peritonitis with or without bowel obstruction, and four women were diagnosed after surgical treatment for suspected ovarian cancer. Fifty-two of the 58 cases of reproductive tract actinomycosis reported in the literature review and all our cases were associated with prolonged use of an intrauterine contraceptive device with a mean of eight years. The contribution of pelvic ultrasound and angioscanner in evaluating these patients should not be underestimated and MRI may be useful in some cases as well. Early diagnosis based on Actinomyces-positive cervical smears or abscess aspiration was accomplished only once in our series and was rare in literature. A histopathologic diagnosis during laparoscopy or laparotomy could avoid more difficult and extensive surgery. In our series of 11 patients, five women required abdominal surgery, five required salpingo-oophorectomy and three required hysterectomy. All women required surgical intervention. Effective treatment combined long antibiotic therapy with surgery. Correct preoperative diagnosis is rare but if achieved, long-term treatment with penicillin for at least two months and sometimes up to a year may completely eradicate the infection. Surgery may still be necessary to improve medical treatment or to resolve pelvic abscesses. Any pelvic abscess occurring in a woman with a history of long-term use of an intrauterine device should be considered as possible pelvic actinomycosis. If there is no fever in association with an atypical adnexal tumor, frozen section should be obtained during surgery to rule out the diagnosis of actinomycosis.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction
To summarize the existing literature on therapeutic alternatives to hysterectomy and myomectomy f... more To summarize the existing literature on therapeutic alternatives to hysterectomy and myomectomy for management of symptomatic uterine fibroids other than medicinal treatment and embolization. Pubmed, Cochrane and Embase contents were searched up to December 2010. The Nd:YAG laser appeared to be effective but equipment's cost and postoperative adherence risk limited its development. Bipolar, microwave and cryomyolysis are still investigational. Radiofrequency thermal ablation is a less aggressive alternative when feasible under ultrasound guidance. Focused ultrasound surgery MR or ultrasound guided is accessible to approximately 10% of uterine fibroids with a rate of 60-70% of long-term symptom relief. Data following laparoscopic uterine artery occlusion suggest that outcomes are similar to those with uterine artery embolization (UAE) but with less long-term durability; by transvaginal way, there seem to be more complications. The efficiency of acupuncture remains uncertain. Numerous technical innovations have been developed. However, comparative studies with validated conservative options are still needed.
Background Churg-Strauss syndrome often involves the skin, and this may sometimes reveal the dise... more Background Churg-Strauss syndrome often involves the skin, and this may sometimes reveal the disease. Observation A 25-year-old woman was referred to a gynaecologist for inflammation of the right breast with breast discharge. Cytological analysis of the liquid showed numerous inflammatory cells, particularly polymorphonuclear eosinophils and neutrophils. Ultrasound examination of the breast was consistent with galactophoritis. CRP was normal, and hypereosinophilia was seen. The patient was subsequently referred to a dermatology unit. Skin examination revealed inflammation of the entire breast, which was painful, warm and erythematous; the border was oedematous with blisters. Necrotic lesions were also present on the thumbs and knees. Skin biopsy of the breast showed a dermal infiltrate with abundant infiltrate of polymorphonuclear eosinophils, including patchy necrosis and intraepidermal vesicles. Histological examination of a biopsy sample from a thumb revealed eosinophilic granulo...
To assess the impact of the surgical case volume on the accuracy of preoperative staging and comp... more To assess the impact of the surgical case volume on the accuracy of preoperative staging and compliance with the European Society of Medical Oncology (ESMO) guidelines for the management of endometrial cancer (EC). Centers were divided into those taking care of 20 or fewer EC cases, and those with more than 20 per year. Seventeen university teaching hospitals fully responded to the questionnaire. The differences between the preoperative assessment and postoperative risk groups were significant for all centers (p=0.001). However, this difference was not due to the volume of patients of centers (p=1.00). Lymphadenectomy was performed in 21% and 82% of patients in the ESMO low-risk and high-risk groups, respectively, without differences between centers overall and centers managing more or fewer than 20 ECs per year. For the ESMO intermediate-risk group, the difference was significant when taking all groups into account (p=0.02), but it was not significant between centers managing fewer...
To determine the diagnostic performance of radiological evaluation of the margins of surgical spe... more To determine the diagnostic performance of radiological evaluation of the margins of surgical specimens from lumpectomies for subclinical malignant breast lesions. Retrospective study in two French hospitals including all patients who had a non-palpable in situ (ISDC) or invasive (IDC) ductal carcinoma treated by lumpectomy after radiological localisation. For the analysis, the lesions were divided into two groups depending on the majority component in the definitive histological examination: ISDC or IDC. The radiological margin considered was 10mm. For the 178 lumpectomies studied, the sensitivity of the radiographs of the surgical specimen was 33.3% for ISDC and 50% for IDC. The surgical revision rate was 27.41% for ISDC and 12.64% for IDC. The significant predictive factors for positive margins were the radiological size of the lesions (>10mm) for ISDC (P=0.02) and radiologically positive margins for IDC (P=0.01). Correlation was found between the histological and radiological...
Breast-conserving surgery with radiation therapy is the primary treatment for ductal carcinoma in... more Breast-conserving surgery with radiation therapy is the primary treatment for ductal carcinoma in situ (DCIS). Re-excision is indicated when clear resection margins have not been achieved, although in some cases the procedure may be unnecessary as there is no residual tumor. The purpose of our three-Center retrospective study was to identify predictors of positive re-excision findings following breast-conserving surgery for DCIS. A total of 285 patients underwent re-excision following conservative treatment for DCIS between 01/01/08 and 12/31/13 at three breast-cancer referral Centers. We conducted a retrospective, comparative review of the factors that differentiated patients with a residual tumor from those without. The study was based on clinical, radiological, surgical and pathological criteria. A total of 180 patients (63%) had residual tumor after conservative treatment. Six factors were predictive on univariate analysis: young age (p=0.025), non-menopausal status (p=0.016), a...
ABSTRACT Les techniques de réduction endométriale de deuxième génération sont à utiliser préféren... more ABSTRACT Les techniques de réduction endométriale de deuxième génération sont à utiliser préférentiellement car ils entraînent moins de complications que les techniques de première génération. Une contraception efficace est hautement recommandée après réduction endométriale. Les techniques de myolyse relèvent toujours du domaine de la recherche biomédicale, la myolyse par ultrasons focalisés monitoré par IRM ou par échographie est quant à elle accessible à environ 10 % des fibromes avec une efficacité sur les symptômes évaluée à 70 % à long terme. La ligature des artères utérines par cœlioscopie est aussi efficace que l’embolisation mais avec un effet moins durable dans le temps.
Second generation endometrial ablation techniques must be used preferably as they present less co... more Second generation endometrial ablation techniques must be used preferably as they present less complications than first generation techniques. An efficient contraception is highly recommended after thermal ablation. Myolysis techniques are still investigational, focused ultrasound myolysis MR or ultrasound-guided is accessible to approximately 10% of uterine myomas with 70% of long-term symptom relief. Outcomes of laparoscopic uterine artery occlusion are similar to those of uterine artery embolization but with less long-term durability.
Magnetic Resonance Materials in Physics, Biology and Medicine, 2016
To evaluate the feasibility of in vivo measurement of the fatty acid (FA) composition of breast a... more To evaluate the feasibility of in vivo measurement of the fatty acid (FA) composition of breast adipose tissue by MRS on a clinical platform. MRS experiments were performed at 3 T, using a STEAM sequence, on 25 patients diagnosed with breast cancer. MR spectra, acquired on healthy breast tissue, were analysed with the LCModel. The measured values of the saturated fatty acid (SFA), mono-unsaturated fatty acid (MUFA) and poly-unsaturated fatty acid (PUFA) fractions were 23.8 ± 7.1 %, 55.4 ± 6.8 % and 20.8 ± 4.4 %, respectively. The values of SFA, MUFA and PUFA observed in the current study are in the same range as those found in two previous studies performed at 7 T. The results of the current study show that it is possible to quantify the fatty acid composition of breast tissue in vivo in a clinical setting (3 T).
The microenvironment of breast epithelial tissue may contribute to the clinical expression of bre... more The microenvironment of breast epithelial tissue may contribute to the clinical expression of breast cancer. Breast epithelial tissue, whether healthy or tumoral, is directly in contact with fat cells, which in turn could influence tumor multifocality. In this pilot study we investigated whether the fatty acid composition of breast adipose tissue differed according to breast cancer focality. Twenty-three consecutive women presenting with non-metastatic breast cancer underwent breast-imaging procedures including Magnetic Resonance Imaging prior to treatment. Breast adipose tissue specimens were collected during breast surgery. We established a biochemical profile of adipose tissue fatty acids by gas chromatography. We assessed whether there were differences according to breast cancer focality. We found that decreased levels in breast adipose tissue of docosahexaenoic and eicosapentaenoic acids, the two main polyunsaturated n-3 fatty acids of marine origin, were associated with multif...
Fatty acids composition of adipose tissue may provide information on the nutritional part of the ... more Fatty acids composition of adipose tissue may provide information on the nutritional part of the risk or evolution of breast cancer. To determine whether 1H-NMR of adipose tissue provides information on the nature of the diet consumed, a dietary intervention with increasing percentage of polyunsaturated n-3 docosahexaenoic acid (DHA 22:6n-3, provided as DHASCO oil) was applied to a rat model of N-Nitroso N-Methyl Urea-induced mammary tumors. Spectra of the lipid extracts were obtained from adipose tissues in five groups of Sprague-Dawley rats fed with a diet containing 7% peanut/rapeseed enriched with 8%(w/w) of an oil without (palm oil) or with low (1%), moderate (3%) or high (8%) DHASCO content. A control group received a basal diet with 15% peanut/rapeseed representative of the "Western" diet. After 5 months of those 5 controlled diets, adipose tissue was collected for analysis of the lipid extract using both 1H-NMR analysis on an 11.7T spectrometer and gas chromatography considered as gold standard. 1H-NMR analysis showed a dose-dependent increase in DHA in the lipid extract of adipose tissues, a commensurate decrease in n-6 polyunsaturated fatty acids in the three DHA groups which allowed to follow n-6/n-3 ratio changes. The highest n-6/n-3 ratio was observed in the control "western diet" group compared to the other diet groups. The integrated spectral regions showed separation between groups thereby documenting a specific NMR lipid profile corresponding to each dietary intervention. Those diet-dependent NMR lipid profiles were consistent with that obtained with gas chromatography analyzes of the same samples. This study is a proof of concept highlighting the potential use of 1H-NMR approach to evaluate dietary intervention in biopsies of adipose tissues.
Pelvic actinomycosis is a rare disease that can be diagnosed before, during or after surgical tre... more Pelvic actinomycosis is a rare disease that can be diagnosed before, during or after surgical treatment of a suspected ovarian tumor, a suspected bowel obstruction, or acute peritonitis. The possibility of early detection of pelvic or abdominal abscess related to was evaluated through a personal series and literature review. Our series of 11 cases of severe abdominal or pelvic actinomycosis is related and compared to 58 cases reported in the literature. Seven patients in this series were diagnosed with pelvic inflammatory disease and acute peritonitis with or without bowel obstruction, and four women were diagnosed after surgical treatment for suspected ovarian cancer. Fifty-two of the 58 cases of reproductive tract actinomycosis reported in the literature review and all our cases were associated with prolonged use of an intrauterine contraceptive device with a mean of eight years. The contribution of pelvic ultrasound and angioscanner in evaluating these patients should not be underestimated and MRI may be useful in some cases as well. Early diagnosis based on Actinomyces-positive cervical smears or abscess aspiration was accomplished only once in our series and was rare in literature. A histopathologic diagnosis during laparoscopy or laparotomy could avoid more difficult and extensive surgery. In our series of 11 patients, five women required abdominal surgery, five required salpingo-oophorectomy and three required hysterectomy. All women required surgical intervention. Effective treatment combined long antibiotic therapy with surgery. Correct preoperative diagnosis is rare but if achieved, long-term treatment with penicillin for at least two months and sometimes up to a year may completely eradicate the infection. Surgery may still be necessary to improve medical treatment or to resolve pelvic abscesses. Any pelvic abscess occurring in a woman with a history of long-term use of an intrauterine device should be considered as possible pelvic actinomycosis. If there is no fever in association with an atypical adnexal tumor, frozen section should be obtained during surgery to rule out the diagnosis of actinomycosis.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction
To summarize the existing literature on therapeutic alternatives to hysterectomy and myomectomy f... more To summarize the existing literature on therapeutic alternatives to hysterectomy and myomectomy for management of symptomatic uterine fibroids other than medicinal treatment and embolization. Pubmed, Cochrane and Embase contents were searched up to December 2010. The Nd:YAG laser appeared to be effective but equipment's cost and postoperative adherence risk limited its development. Bipolar, microwave and cryomyolysis are still investigational. Radiofrequency thermal ablation is a less aggressive alternative when feasible under ultrasound guidance. Focused ultrasound surgery MR or ultrasound guided is accessible to approximately 10% of uterine fibroids with a rate of 60-70% of long-term symptom relief. Data following laparoscopic uterine artery occlusion suggest that outcomes are similar to those with uterine artery embolization (UAE) but with less long-term durability; by transvaginal way, there seem to be more complications. The efficiency of acupuncture remains uncertain. Numerous technical innovations have been developed. However, comparative studies with validated conservative options are still needed.
Background Churg-Strauss syndrome often involves the skin, and this may sometimes reveal the dise... more Background Churg-Strauss syndrome often involves the skin, and this may sometimes reveal the disease. Observation A 25-year-old woman was referred to a gynaecologist for inflammation of the right breast with breast discharge. Cytological analysis of the liquid showed numerous inflammatory cells, particularly polymorphonuclear eosinophils and neutrophils. Ultrasound examination of the breast was consistent with galactophoritis. CRP was normal, and hypereosinophilia was seen. The patient was subsequently referred to a dermatology unit. Skin examination revealed inflammation of the entire breast, which was painful, warm and erythematous; the border was oedematous with blisters. Necrotic lesions were also present on the thumbs and knees. Skin biopsy of the breast showed a dermal infiltrate with abundant infiltrate of polymorphonuclear eosinophils, including patchy necrosis and intraepidermal vesicles. Histological examination of a biopsy sample from a thumb revealed eosinophilic granulo...
To assess the impact of the surgical case volume on the accuracy of preoperative staging and comp... more To assess the impact of the surgical case volume on the accuracy of preoperative staging and compliance with the European Society of Medical Oncology (ESMO) guidelines for the management of endometrial cancer (EC). Centers were divided into those taking care of 20 or fewer EC cases, and those with more than 20 per year. Seventeen university teaching hospitals fully responded to the questionnaire. The differences between the preoperative assessment and postoperative risk groups were significant for all centers (p=0.001). However, this difference was not due to the volume of patients of centers (p=1.00). Lymphadenectomy was performed in 21% and 82% of patients in the ESMO low-risk and high-risk groups, respectively, without differences between centers overall and centers managing more or fewer than 20 ECs per year. For the ESMO intermediate-risk group, the difference was significant when taking all groups into account (p=0.02), but it was not significant between centers managing fewer...
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