Interest of systematic tomosynthesis (3D mammography) with synthetic 2D mammography in breast cancer screening.

Full field digital mammography (FFDM) is the current pillar of breast cancer screening program. However, the emerging technique digital breast tomosynthesis (DBT) has demonstrated a significant increase in the sensibility of cancer detection in several large cohort trials. DBT is particularly helpful for young patients, dense breasts and soft masses due to its ability to reduce overlapping of tissue. In such a population of women, radiologists are more confident and the recall rates are reduced together with a higher positive predictive value. To reduce the breast absorbed doses of screened women and facilitate the workflow, a synthetized two-dimensional (2D) digital mammography (sDM) is obtained from DBT to replace the FFDM. No significant differences regarding detection of anomalies have been reported with respect to FFDM. These results validate a modern strategy for breast cancer screening supported by two views of DBT with sDM. In terms of mean absorbed doses, this strategy is around 1.5 mGy/view and almost equivalent to FFDM. In Europe, major limitations to such evolution are public health policies especially agreements and reimbursement for the technique being used in organized screening.

[Oncologic outcome of 11.6 lipofilling procedures for reconstructive breast surgery]. / Injection de graisse autologue purifiée en chirurgie reconstructrice mammaire. Suivi carcinologique à 3 ans à propos de 116 cas.

AIMS OF THE STUDY: Autologous fat graft injection has been systematically used by our team since 2001 in order to enhance the esthetic outcome of breast reconstruction. However, this technique remains controversial, notably in France. This study evaluated oncologic outcomes at 3 years among 110 patients operated on and monitored by two surgeons. PATIENTS AND METHODS: 116fat graft injections in 110 patients who required reconstructive breast surgery between January 2001 and December 2011 were included in the analysis of oncologic outcomes. The AJCC (American Joint Committee on Staging) stages were: stage 0 (18 %), stage I (44 %), stage II (26.7 %), and stage III (11.3 %). Mean follow-up was 6.3 years (9 months to 17 years) after initial breast cancer surgery, and 3 years (6 months to 9.5 years) after the last lipofilling procedure. RESULTS: The majority of patients (91.8 %) are alive and recurrence-free. Remote metastases occurred in 8.2 % of patients: one patient had a local and systemic recurrence, one patient had a local, regional and systemic recurrence. CONCLUSION: Although confirmation is needed from multicenter randomized trials with longer follow-up, a larger group of patients and a control group matched for the cancer status of the lipofilling group, our results support the view that lipofilling has little or no effect on the risk of locoregional recurrence of breast cancer.

Immediate reconstruction after neoadjuvant chemotherapy: effect on adjuvant treatment starting and survival.

BACKGROUND: For patients treated with initial surgery, the safety of immediate breast reconstruction after mastectomy has been demonstrated. Some concerns exist after neoadjuvant chemotherapy because this sequence is proposed for patients with large tumors and for whom adjuvant therapies are considered cornerstones of treatment. In this study, we sought to determine whether reconstruction after neoadjuvant chemotherapy and mastectomy for large operable breast cancer affects the interval between surgery and adjuvant treatment and affects survival. METHODS: A single-institution retrospective analysis was performed by using the database of the Institut Gustave-Roussy. RESULTS: Forty-eight patients who had undergone mastectomy and immediate reconstruction (implant, 60%) followed by adjuvant chemotherapy were identified. They were compared with 181 patients who underwent mastectomy without reconstruction and with 32 patients who underwent mastectomy followed by delayed reconstruction (implant, 19%). No difference was found concerning the interval between surgery and adjuvant chemotherapy: 26 vs. 23 days for patients with immediate breast reconstruction and for patients treated with modified radical mastectomy followed or not by delayed reconstruction, respectively (P = .11). No difference was found concerning the onset of radiotherapy: 87 vs. 81 days (P = .22). Survival was not different in patients treated with immediate reconstruction compared with those with mastectomy alone. CONCLUSIONS: Immediate breast reconstruction does not delay the starting of adjuvant therapy and has no significant effect on local relapse-free or distant disease-free survival. Additional data are needed concerning the use of flap for this indication.

Sternal resection and reconstruction for primary malignant tumors.

BACKGROUND: Primary malignant sternal tumors (PMST) are locally aggressive and their optimal surgical management still continues to evolve. METHODS: From 1986 to 2002, 38 patients (25 females/13 males) underwent radical resection of PMST. This series included 33 sarcomas, 17 of which had been radiation-induced, 3 hematologic tumors, and 2 carcinomas. Seventeen were high-grade tumors. Nine patients had received preoperative chemotherapy. Twelve patients required extensive skin excision. Eight total, seven subtotal, and 23 partial sternectomies were performed. Resection was extended to the anterior chest-wall in 4 patients, lung in 4, brachiocephalic vein in 3, superior vena cava in 2, and pericardium in 1. In 36 patients, chest wall stability was obtained by Marlex (n = 21) or Vicryl (n = 2) mesh and polytetrafluoroethylene patch (n = 13), with methylmethacrylate reinforcement in 12 patients. Soft tissue coverage was done by the pectoralis major muscles with skin advancement in 25 patients, a myocutaneous flap in 11, a breast transposition in 1, and a skin flap in 1. Omentoplasty was performed in 3 patients. RESULTS: One patient died from pneumonia. Two patients needed a tracheostomy after total sternectomy. No flap-related complication was observed. Four local septic complications required removal of the composite prosthesis with reoperations. Local recurrence occurred in 9 patients, 7 patients having a repeat resection. Metastases developed in eight. The 5-year overall and disease-free survival was 66% and 53%, respectively. The histologic grade of sarcomas was a survival predictor (high grade versus others p = 0.035). CONCLUSIONS: Wide resection of PMST is necessary to minimize local recurrence. Large sternal defects are safely reconstructed with a musculocutaneous flap. We suggest that the use of methylmethacrylate should be limited to reconstruction after total sternectomy.