Computed tomography in suspected local breast cancer recurrence.

PURPOSE: The purpose of this prospective study was to test computed tomography (CT) in the evaluation of local breast cancer recurrence. MATERIALS AND METHODS: Our study population included 103 women referred for mamma CT examination for reasons of suspicious findings in a conservatively treated breast. In these patients, both clinical and conventional imaging studies (mammography, ultrasonography) features of local recurrences were non specific or suspicious. The patients underwent breast CT before and 90 s after intra-venous contrast medium administration. Criterion for cancer recurrence was detection of a lesion with an enhancement of 20 UH or more. The final diagnosis was based on operative histopathological findings or follow-up for over two years. RESULTS: Local recurrence was confirmed on histology in 52 patients. CT identified 47 breast recurrent cancers. False-positive contrast enhancement was seen in five patients. CT showed 90% sensitivity, 90% specificity and 90% accuracy. CONCLUSION: Although mamma CT examination proved to have a high diagnostic efficacy in evaluating breast cancer recurrence, routine computed tomography is unnecessary for most patients.

[Interest of sentinel lymph node biopsy for the staging of ductal carcinoma in situ]. / Prélèvement de ganglions sentinelles dans les carcinomes intracanalaires du sein (+/- micro-invasion).

PURPOSE: The aim of this study was to define the interest of sentinel lymph node biopsy (SLNB) for the staging of ductal carcinoma in situ (DCIS) and DCIS with micro-invasion (DCISM) in patients with breast carcinoma. MATERIAL AND METHODS: From June 1999 to December 2002 we listed, in a retrospective study, 52 patients treated surgically for a DCIS or a DCISM. All except one had an histology before surgery, and all had SLNB. Intraoperative imprint cytology of the sentinel lymph node (SLN) was performed then there were analysed by staining with hematoxylin-eosin. Patients with positive SLN underwent complete axillary dissection. RESULTS: It was removed an average of three SLNs by patient (extreme 1 to 6). Metastases in the SLN were detected in four (7,7%) of the 52 patients, including three cases had only micrometastases in the SLN. In the four patients treated with complete axillary dissection, the SLN were the only positives nodes. CONCLUSION: The SLNB for DCIS and DCISM increases the involvement rate of lymph node. Because of the widespread for early detection of breast cancer, it is noted a regular increase in the rate of DCIS. Even if the attitude to be had towards the lymph node metastases in these cases is not yet well defined, and so only 2% of the patients approximately die of this pathology, it is interesting because of increase in absolute value of mortality, to try to improve the prognosis criteria to modify the treatment of this pathology.

[Osteosarcoma manifesting as Paget's bone disease]. / Ostéosarcome révélant une maladie de Paget.

Osteosarcoma is a malignant bone tumour of mesenchymal osteoid tissue origin. Osteosarcoma can be primitive, but it may also complicated a Paget's disease of bone. We described a 75yearold man with a right thigh mass discovered after a motoring accident. Histopathologic examination revealed the diagnosis of osteosarcoma. Plain film Xrays showed Paget's lesion of the right pelvis bone. CT and MRI allowed complete evaluation of this lesion. Final diagnosis was those of malignant transformation of Paget disease. The patient was refused for surgery in view of the size of the tumour and chimiotherapy followed.

rIL-2 in metastatic soft tissue sarcomas refractory to chemotherapy: response and enhancement of further chemosensitivity.

Chemotherapy (CT) in advanced and metastatic soft tissue sarcoma (STS) has a reported response rate of 17 to 30%, with a median survival of 30 months. Experimental and clinical studies have demonstrated some response with high-dose intravenous recombinant Interleukin-2 (r-IL2). We report a retrospective analysis of twelve patients with metastatic or locally evolutive STS who received high-dose rIL-2 immunotherapy: all patients were pre-treated with CT and were non responsive. All of these patients developed usual severe toxicity. One patient achieved a partial response with rIL-2 with more than 75% regression of lung metastases. All patients received CT post rIL-2 and 2 of them achieved a further response: 1 of them had a complete response (CR), and one had a partial response (PR). These results suggest that rIL-2 has a relatively low efficacy in patients with STS but that some of these patients can be, after rIL-2, responders to CT despite previous resistance.

[Value of surgery in the treatment of advanced cervical cancers]. / Place de la chirurgie dans le traitement des cancers avancés du col utérin.

Surgical resection of advanced nonmetastatic forms of cervical cancers is controversial, but improve local control. The local and regional staging assessment, comprising an examination under general anaesthesia, endocavitary ultrasonography, computed tomography (CT) and/or magnetic resonance imaging (MRI) allows staging, evaluation of the main prognostic factors and selection of the therapeutic strategy. Pelvic and lumboaortic lymph nodes can be investigated by CT, MRI or laparoscopic lymphadenectomy. Surgical resections consist of colpohysterectomy possibly combined with radical lymphadenectomy or pelvic exenteration, followed by pelvic reconstruction using various procedures: low colorectal anastomosis, continent urinary diversion, and vaginal reconstruction with pelvic filling. The mortality and morbidity of pelvic exenteration remain high. It is therefore important to prevent the most frequent complications as effectively as possible. The local control, overall survival and recurrence-free survival can be improved by combining concomitant radiotherapy-chemotherapy and large surgical resection. Some unfavourable local situations can justify palliative pelvic exenteration in highly selected indications designed to improve local control and comfort of survival.

[Deafness caused by malformation of the inner ear. Current contribution of x-ray computed tomography]. / Les surdités par malformation de l'oreille interne. Apport actuel de l'examen tomodensitométrique.

Hearing loss due to malformations of the auditory system may involve morphologic abnormalities of the external canal, the middle ear, or the inner ear. Various combined malformations are possible. Audiologic assessment and computed tomography make it possible to perform a precise diagnostic evaluation of inner ear malformations. In a series of 71 children with congenital sensorineural hearing loss, 31 had computed tomographic evidence of malformations. Since 19 children had bilateral lesions, a total of 50 ears were studied. The cochleovestibular abnormalities were typed and correlated to the severity and progression of hearing impairment. The 3 most frequently encountered malformations were: 1) isolated large cochlear aqueduct (n = 12), 2) large vestibular aqueduct (n = 8) and 3) the Mondini malformation (n = 7). The most severe hearing losses were associated with cochlear hypoplasia and incomplete cochlear segmentation. The severity of hearing impairment decreased with the following abnormalities in the order given: 1) large cochlear aqueduct, 2) Mondini malformation and 3) large vestibular aqueduct. Among the 15 patients with progressive hearing loss, 13 had large cochlear aqueducts either isolated or concomitant with other lesions. While certain evident abnormalities, such as cochlear aplasia or Mondini malformation, are relatively easy to diagnose, other more subtle morphologic changes, such as large cochlear aqueduct, still need to be better defined according to precise criteria for radiographic evaluation.

[Evaluation of diagnostic efficacy and clinical tolerability of ioversol in "whole body" computed tomography in children. A non comparative phase III trial]. / Evaluation de l'efficacité diagnostique et de la tolérance clinique du ioversol en tomodensitométrie "corps entier" chez l'enfant. Essai non comparatif de phase III.

An open-label noncomparative clinical study was conducted to evaluate the efficacy and tolerance of ioversol (Optiray 300), a new low-osmolality non ionic contrast medium, in body contrast-enhanced CT scanning in infants and children. Fourty pediatric patients who required contrast-enhanced CT scanning for evaluation of chest, abdominal or pelvic masses participated in the study. The vascular enhancement was judged to be excellent or good in 72.5% of the cases and the CT scans were judged to be diagnostic in 95% of the cases. Ioversol was well tolerated in the study with only two mild adverse reactions (nausea and vomiting, and metallic taste).

Splenic hemangioma--report of three pediatric cases with pathologic correlation.

Splenic hemangioma is a very rare neoplasm in children. We report three cases of splenic hemangioma, two of solitary hemangioma and one of hemangiomatosis. Two patients had hematologic disorders related to hemangioma. Imaging findings of this entity are presented and discussed with emphasis on pathologic correlation.

[Rhabdoid tumor of the neck]. / Tumeur rhabdoïde du cou.

Three pediatric cases of malignant rhabdoid tumor of the neck are described. Clinical data and imaging findings (US, CT and MRI) are stressed. The mass was well defined, containing punctate calcifications in two cases and encasing the vessels in two other cases. Two patients were treated with a chemotherapy regimen according to MMT 89 SIOP protocol, one had chemotherapy and radiotherapy. Two children died of progressive disease; the remaining child who had complete surgical removal of the tumor is on remission 17 months after diagnosis.

Topographical study of supratentorial brain tumors.

The topographic analysis of supratentorial brain tumors must answer the following questions: location of the tumor, its extension, its being infiltrative or well localized and especially the relationships with the main functional areas such as the speech areas, the sensori-motor area, and the visuel areas. Also the topographic analysis may help to approach the diagnosis of nature. The neuroradiological procedures include the CT, the angiography and especially the MRI in sagittal and coronal sections, with gadolinium enhancement. The anatomical accuracy is obtained using the bicommissural plane and superimposition techniques according to the Talairach's Atlas and anatomical sections and MRI superimposition with angiography. 3D volumic reconstruction is of considerable contribution for the topographic analysis of a cerebral tumor.

[Digitalized angiography in the study of critical ischemia of the lower limbs]. / Apport de l'angiographie numérisée dans l'exploration des ischémies critiques des membres inférieurs.

Twenty three patients suffering from severe chronic ischemia of the lower limbs were explored by conventional and digital angiography. A comparative study of these 2 angiographic techniques was carried out to appreciate the pre-operative distal vascular tree and the surgical indications. In all cases, digital angiography was never found to be less informative than conventional angiography. In 14 cases, the surgical approach was changed as a result of digital angiography in 4 cases the method of revascularization and in 10 cases the surgical indication itself (distal bypass instead of amputation). The authors consider digital angiography to be essential in this surgical indication.