BI-RADS: use in the French radiologic community. How to overcome with some difficulties.

In the United States, BI-RADS (Breast Imaging Reporting and Data System) has been set up as a quality assurance system for better communication between professionals and for the follow-up of breast screening programs. It has become a reference in the field of mammographic imaging and has been adopted by several countries throughout the world. It has been translated in French. The aim of this article is to discuss the difficulties in using it in the French radiologic communities. There are few problems with vocabulary excepted for microcalcifications. BI-RADS includes a guidance chapter giving some recommendations for using properly the lexicon. Classification of normal breast remains of concern, as it is difficult to evaluate precisely the content of fat and as the final image is also dependant of technical factors. The main difficulties are related to final classification in BI-RADS categories as the lexicon does not explicit which mammographic features should be included in the categories from three to five. In France, a table concerning the classification of mammographic abnormalities has been established by the HAS (former ANAES) which represents the highest scientific health authority in France. There are no major problems for using the BI-RADS for US and MRI. BI-RADS is suitable for different categories of women and for male and training has an important impact on acceptance and proper use of the lexicon.

Prevention of biliary lesions that may occur during radiofrequency ablation of the liver: study on the pig.

OBJECTIVE: To prevent bile duct injury by using a cold 5% glucose isotonic solution cooling in the bile ducts when radiofrequency (RF) is performed in a porcine model. SUMMARY BACKGROUND DATA: Complications that may arise during liver RF ablation include biliary stenosis and abscesses. METHODS: The RITA 1500 generator was used for the experiments. Two lesions were performed in the left liver. The pigs were killed 1 or 3 weeks after the procedure. An ex vivo cholangiogram was obtained by direct injection into the main bile duct. Samples of RF lesions, of liver parenchyma near and at a distance from the RF lesions, underwent pathologic studies. Two groups of 20 pigs each were treated: one without perfusion of the bile ducts and the other with perfusion of cold 5% glucose isotonic solution into the bile ducts. The Pringle maneuver was used in 50% of the RF procedures. Radiologic lesions were classified as biliary stenosis, complete interruption of the bile duct, or extravasation of the radiologic contrast liquid. RESULTS: Histologic lesions of the bile ducts were observed near the ablated RF lesion site and at a distance from the RF lesions when a Pringle maneuver was performed. Radiologic and histologic lesions of the bile ducts were significantly reduced (P < 0.0001) when the bile ducts were cooled. CONCLUSIONS: Cooling of the bile ducts with a cold 5% glucose isotonic solution significantly protects the intrahepatic bile ducts from damages caused by the heat generated by RF when performed close to the bile ducts.

[Provider delays among patients with breast cancer in a Regional Cancer Care Network: feasibility of personal care schedule]. / Délais de prise en charge des patientes atteintes d'un cancer du sein dans un réseau régional de soins en cancérologie: faisabilité d'un programme personnalisé de soins.

In order to determine the feasibility of a personal care schedule, we studied provider delays among women with breast cancer in hospitals of a French Regional Cancer Network. In 2001, 148 women have been treated by surgery in the Alexis Vautrin Comprehensive Cancer Centre (AVCCC), then by adjuvant chemotherapy and radiotherapy. Before surgery, individual variations in delays was observed: from 0 to 65 days between the appointment making and the first consultation, from 3 to 108 days to start the treatment. After surgery, no significant difference in delays was found between women treated at AVCCC and those managed in another network institution (average delays: 35 days between surgery and chemotherapy, 4 months for chemotherapy, 3 weeks between chemotherapy and radiotherapy, and 35 days for radiotherapy). These results suggest an efficient organisation that allow to establish a personal care schedule for each patient after providing anatomopathological data.

Dynamic maneuvers in local staging of head and neck malignancies with current imaging techniques: principles and clinical applications.

Imaging has been widely demonstrated to be important in local staging of head and neck malignancies as a complement to clinical examination, including endoscopy. Recent developments in multidetector row computed tomography (CT) provide better anatomic resolution within a shorter acquisition time and wider anatomic coverage. However, in many cases lesions still remain undefined. In such cases, performance of dynamic maneuvers could provide useful information about the local extent of a tumor. The usefulness of dynamic maneuvers has increased with the improvement in temporal and spatial resolution that resulted from the most recent techniques of multidetector row CT. The puffed cheek technique and the modified Valsalva maneuver allow evaluation of a lesion that was poorly demonstrated owing to apposition of mucosal surfaces. In some cases, phonation improves demonstration of small lesions of the vocal cords and allows more precise anatomic localization. The open mouth technique allows demonstration of a lesion that was previously overlooked due to dental amalgam artifacts.

[How to improve the initial management of adult patients with tumors of bone and soft tissues: the experience of a multidisciplinary committee from the Oncolor network before the distribution of regional guidelines]. / Comment améliorer la prise en charge initiale des patients adultes atteints de tumeurs des os et parties molles: expérience d'un comité de concertation pluridisciplinaire du réseau Oncolor, avant la diffusion des référentiels régionaux.

Tumors of bone and soft tissues in adults are rare accounting in France for 2000 to 2500 new cases per year. These tumors are heterogenous and their diagnosis is made after first surgery. Therefore, an early pluridisciplinary approach, by physicians who have acquired an expertise in this field, is advised before any biopsy or surgical resection and at all the further step in the subfrequent management. This paper describes the experience of a pluridisciplinary committee, specialized in malignant tumors of bone and soft tissues in adults, with a highly specialized team which is part of a network in the treatment of cancer in Lorraine, the Oncolor network, before the distribution of regional guidelines. After a description of the organisation of this committee, we made a retrospective analysis of all the cases submitted to these experts advice for the first time, between January and December 2000. This study reveals an insufficient pluridisciplinary coordination at the initial management, which has been done by making regional referentials available, and therefore some errors which lead in some cases to inadapted treatment. It underlines therefore the necessity to implement more actively the present data of science, and to develop the management in multidisciplinary committees. Oncolor aims to harmonize this pluridisciplinary approach as well as to diffuse standard recommendations.