[Evaluation of endometrectomy by radiofrequency for premenopausal women: a retrospective study]. / Évaluation de l'endométrectomie par radiofréquence chez les femmes préménopausiques : étude rétrospective sur 90 cas.

OBJECTIVE: In present study, we are assessing the efficiency of endometrial ablation by radiofrequency (Novasure(®)) for the treatment of abnormal uterine bleeding. MATERIAL AND METHODS: A total of 90 patients underwent an endometrial ablation by radiofrequency for uterine bleeding between 2009 and 2012. For the postoperative follow-up, symptoms amelioration and eventual adverse-events were evaluated by a self-administered questionnaire given to all patients after the surgery. RESULT: Sixty-five patients (74%) responded to the questionnaire with an average of 17.5 months. Among them, endometrial bleeding decreased in 92% of the cases (IC 95%; 86-99). The amenorrhea rate was 55% (IC 95%; 43-67) and 36% of the patients presented a diminution of menstrual bleeding after treatment. Thirty-two patients (36%) presented dysmenorrhea before the radiofrequency and 78% of them experienced an amelioration of the symptoms after treatment (IC 95%; 64-93). In 19 patients (21%), the cause of uterine bleeding was adenomyosis, among them, bleeding decreased in 84% of the cases (IC 95%; 71-98) and dysmenorrhea in 70%. (IC 95%; 41-97). Finally, 84% of the patients were satisfied with the result of the treatment. CONCLUSION: Our findings suggest that endometrial radiofrequency is effective for the treatment of menometrorrhagia, dysmenorrhea and also adenomyosis.

[Comparison of three models to predict non-sentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a retrospective study of 77 patients]. / Comparaison de trois modèles prédictifs d'envahissement des ganglions non sentinelles en cas de métastases des ganglions sentinelles dans le cancer du sein: une étude rétrospective sur 77 patientes.

UNLABELLED: Various statistic predictive models have been developed to predict the status of the non-sentinel lymph nodes (NSLN) when the sentinel one was invaded by tumor cells in the case of breast invasive carcinoma. The objective of this study was to compare the accuracy of three of these statistic models: the MSKCC nomogram, the Tenon score and the MDA score. The study was conducted at Croix Rousse Hospital, Lyon, France. OBJECTIVE: When sentinel lymph node is invaded by metastasis, complete lymph node dissection of the axilla can be avoided using statistic predictive models especially when talking about micrometastases and moreover about isolated tumor cells in the sentinel lymph node. Over the different existing models, we tested the three most used ones to determine the model that is most adapted to our everyday practice. METHOD: The study population consisted of 77 women with an invasive breast cancer treated by complete axillary lymph node dissection for metastatic sentinel lymph node. Over the nine models already published, we focused on three of them due to their ease to use as well as their good preliminary results: the Memorial Sloan-Kettering Cancer Center nomogram (MSKCC), the Tenon score and the M.D Anderson score (MDA). Different criteria are used by these models, but all of them take in consideration: tumor size, multifocality, tumor type, lymphovascular invasion, hormonal receptors, number of sentinel lymph node resected, degree of sentinel lymph node invasion (i.e. macrometastasis, micrometastasis or isolated tumor cells) and histologic method used to diagnose sentinel lymph node invasion. These scores are validated depending on their false negative ratio as well as the proportion of patient selected as having a low risk of non-sentinel lymph node invasion. The major criterion for the MSKCC score is the calibration that compares the predicted likelihood of invasion and the histologically proved one. RESULTS: The rate of non-sentinel lymph node invasion was 37.6%. The discrimination of the three models was good with an AUC of 0.74 for both MSKCC nomogram and Tenon score and of 0.72% for MDA score. MSKCC nomogram was well calibrated (P=0.23). The false negative ratio was 0 (CI 95%: 0-18.1%) for MSKCC nomogram, 16.7% (CI 95%: 8.6%-27.8%) for Tenon score and 16% (CI 95%: 6.8-31%) for MDA score. The percentage of patients considered as having a low risk of invasion of the non-sentinel lymph node was 20.5% for MSKCC nomogram, 34.7% for MDA score and 47.4% for Tenon score. CONCLUSION: MSKCC nomogram seems to be the statistic model that is most adapted to the population we studied. To validate the Tenon and MDA score, we should have a most important population.

Keeping data continuous when analyzing the prognostic impact of a tumor marker: an example with cathepsin D in breast cancer.

The prognostic value of cathepsin D has been recently recognized, but as many quantitative tumor markers, its clinical use remains unclear partly because of methodological issues in defining cut-off values. Guidelines have been proposed for analyzing quantitative prognostic factors, underlining the need for keeping data continuous, instead of categorizing them. Flexible approaches, parametric and non-parametric, have been proposed in order to improve the knowledge of the functional form relating a continuous factor to the risk. We studied the prognostic value of cathepsin D in a retrospective hospital cohort of 771 patients with breast cancer, and focused our overall survival analysis, based on the Cox regression, on two flexible approaches: smoothing splines and fractional polynomials. We also determined a cut-off value from the maximum likelihood estimate of a threshold model. These different approaches complemented each other for (1) identifying the functional form relating cathepsin D to the risk, and obtaining a cut-off value and (2) optimizing the adjustment for complex covariate like age at diagnosis in the final multivariate Cox model. We found a significant increase in the death rate, reaching 70% with a doubling of the level of cathepsin D, after the threshold of 37.5 pmol mg(-1). The proper prognostic impact of this marker could be confirmed and a methodology providing appropriate ways to use markers in clinical practice was proposed.

[Complete remission after abdominal wall metastasis from uterine cervical cancer on a laparoscopic trochar site: a case report]. / Rémission complète après métastase pariétale sur trajet de trocart de coelioscopie d'un cancer du col utérin. A propos d'un cas.

Abdominal wall metastasis to laparoscopic trochar sites after preoperative staging procedure is rare for uterine cervix cancer. Prognosis is unfavorable. We report a case of metastasis to a laparoscopic trochar site in a patient with a stage IIB cervical cancer with no nodal involvement who is alive four and a half years after radical surgery and radiotherapy.

Transvaginal sonohysterographic evaluation of intrauterine adhesions.

PURPOSE: We assessed the role of preoperative sonohysterography in the diagnosis of intrauterine synechiae. METHODS: Nineteen patients with a suspected diagnosis of intrauterine adhesion underwent hysterosalpingography, transvaginal sonography, and sonohysterography performed in the consultation room. The patients were then treated by hysteroscopy under laparoscopic or ultrasound guidance. RESULTS: Transvaginal sonography showed an abnormal uterine cavity in only 10 cases. The sensitivities of sonohysterography and hysterosalpingography in the diagnosis of intrauterine adhesions were both 100%. Sonohysterography showed complete correlation with hysterosalpingography. CONCLUSIONS: We recommend routine sonohysterography after transvaginal sonography in cases of suspected intrauterine synechiae.

Fine needle aspiration cytology of a solid papillary carcinoma of the breast. A case report with immunohistochemical studies.

BACKGROUND: Solid papillary carcinoma of the breast was recently described. This tumor display distinctive clinical and morphologic features. It is an intraductal papillary carcinoma frequently associated with mucinous carcinoma and infiltrating ductal carcinoma not otherwise specified. CASE: Fine needle aspiration cytology (FNAC) of a solid papillary carcinoma of the right breast in an 82-year-old female, demonstrated a cellular specimen of discohesive, small, uniform and ovoid tumor cells, with occasional loose cluster. The cytoplasm was abundant and finely granular. The nuclei were round, without marked atypia. The nucleoli were inconspicuous. SCant mucinous material was present. The diagnosis was confirmed histologically and immunohistochemically. CONCLUSION: The cytologic aspects of solid papillary carcinoma of the breast suggest a carcinoma with endocrine differentiation and a weak mucinous component.

Another two cases of ovarian tumours in women who had undergone multiple ovulation induction cycles.

Many questions have been raised recently about the possible association between ovulation induction and ovarian cancer. In order to contribute to the limited literature on this important issue, two cases of ovarian cancer in women who had multiple ovulation induction are presented here. In the first case the patient had ovarian induction by clomiphene citrate while she already had an ovarian cyst. The cyst enlarged under induction. During laparoscopy, the cyst was removed. Histological examination showed a borderline and invasive sero-papillary cystadenoma. In the second case, the patient underwent ovulation induction and intrauterine insemination. During the first ultrasound in the beginning of the cycle, an ovarian cyst was discovered. Laparoscopy was performed and the cyst removed. Histological examination showed a borderline and invasive mucinous cystadenoma.

Transvaginal hysterosonographic evaluation of septate uteri: a preliminary report.

The objective of this study was to evaluate the diagnostic value of hysterosonography in septate uterine congenital abnormalities and more particularly in septate uteri. A total of 14 patients with a history of repeated spontaneous abortion or infertility who had previously undergone hysterosalpingography were included in this study. Patients were first examined by standard transvaginal ultrasound. Hysterosonography was then carried out by the intrauterine injection of an isotonic saline solution. The septate uteri were diagnosed by hysterosonography in all 14 patients (100%). Hysterosonography permitted the measurement of the thickness and height of the septum. Hysterosonography and transvaginal ultrasound enabled the correct diagnosis of malformation type in eight cases (57%). The accuracy of hysterosonography in postoperative control was greater than that of hysteroscopy. Transvaginal hysterosonography with saline solution is a low-cost, easy and helpful examination method for septate uteri. We propose that hysterosonography should be performed for the primary investigation of infertility and repeated miscarriages.

[Hysterosonographic study of the uterine cavity]. / Etude de la cavité utérine par hystérosonographie.

OBJECTIVE: Evaluate the reliability, safety and performance of hysterosonographic assessment of the uterine cavity. MATERIALS AND METHODS: Hysterosonography was performed in 220 patients with injection of sterile saline into the uterine with a novel catheter. Among these patients, 132 patients then underwent a hysteroscopy or hysterectomy with a histology examination. RESULTS: There were 8 failures: 2 synechiae, 3 atresias of the cervix, and massive reflux in 3 cases. No other complication occurring. Hysterosonography appeared to give more information on the uterine cavity than standard vaginal sonography. In cases with metrorrhage before menopause, the diagnosis was correct in 75.4% of the cases. Errors were related to confusion between polyp and hyperplasia. In post-menopausal metrorrhagia, there was 92% agreement between sonography and histological results. Agreement was 86.3% in cases of infertility. CONCLUSION: Hysterosonography using saline solution injected with a novel catheter can be an excellent means of evaluating the uterine cavity and can completely replace classical hysterography, thus avoiding many exploratory hysterocopies.

[Prenatal diagnosis of trisomy 21: limits of chorionic villi sampling]. / Diagnostic anténatal de la trisomie 21: limites de la trophocentèse.

An analysis of the limits, risks and difficulties of interpreting trophocentesis leads to the conclusion that the method is effective and free from maternal risk. The unsuccessful cases and the "fetal losses" are however more numerous than for amniocentesis.