Diagnostic strategy for the assessment of axillary lymph node status in breast cancer.

The nodal status in breast cancer is a major prognostic factor in terms of survival. It also plays a role in the therapeutic decision-making process. Therefore, the evaluation of lymph node involvement in breast cancer is imperative in establishing a personalized treatment scheme. The sentinel lymph node procedure has proved successful for small breast tumors (T1-T2), limiting axillary lymphadenectomy and its side effects without changing overall survival. Even so, a substantial number of women must undergo axillary lymphadenectomy during a second surgery when the analysis of the sentinel node discloses major nodal involvement. Imaging can improve patient selection, especially those who appear eligible for immediate axillary lymphadenectomy. Ultrasound is able to depict morphological abnormalities in the lymph nodes such as cortical thickening, peripheral vascularization, hilar infiltration and loss of the kidney-shaped appearance of a normal node. When ultrasound is negative, the risk of massive nodal involvement is limited, thus allowing the oncologist to take an approach with the sentinel lymph node procedure. Magnetic resonance imaging (MRI) can also be useful in detecting pathological lymph nodes, particularly with diffusion-weighted MRI sequence.

Long-term survival of advanced triple-negative breast cancers with a dose-intense cyclophosphamide/anthracycline neoadjuvant regimen.

BACKGROUND: Triple-negative (TN) breast cancers exhibit major initial responses to neoadjuvant chemotherapy, but generally have a poor outcome. Because of the lack of validated drug targets, chemotherapy remains an important therapeutic tool in these cancers. METHODS: We report the survival of two consecutive series of 267 locally advanced breast cancers (LABC) treated with two different neoadjuvant regimens, either a dose-dense and dose-intense cyclophosphamide-anthracycline (AC) association (historically called SIM) or a conventional sequential association of cyclophosphamide and anthracycline, followed by taxanes (EC-T). We compared pathological responses and survival rates of these two groups and studied their association with tumours features. RESULTS: Although the two regimens showed equivalent pathological complete response (pCR) in the whole population (16 and 12%), the SIM regimen yielded a non-statistically higher pCR rate than EC-T (48% vs 24%, P=0.087) in TN tumours. In the SIM protocol, DFS was statistically higher for TN than for non-TN patients (P=0.019), although we showed that the TN status was associated with an increased initial risk of recurrence in both regimens. This effect gradually decreased and after 2 years, TN was associated with a significantly decreased likelihood of relapse in SIM-treated LABC (hazard ratio (HR)=0.25 (95% CI: 0.07-0.86), P=0.028). CONCLUSIONS: AC dose intensification treatment is associated with a very favourable long-term survival rate in TN breast cancers. These observations call for a prospective assessment of such dose-intense AC-based regimens in locally advanced TN tumours.

Correlation between MRI and biopsies under second look ultrasound.

The term "second look" lesions in MRI refers to lesions detected by MRI that were not initially seen on mammography or ultrasound. The objectives of our study were to analyse the displacement of targets between MRI and ultrasound; to define discriminating BIRADS morphological criteria to predict benign or malignant character and better establish the indications of second look ultrasound and biopsy; and to analyse the agreement between ultrasound and MRI in terms of morphological criteria. A retrospective and monocentric review was performed of the records of consecutive patients with breast abnormalities (mass or non-mass) initially detected by MRI that were not initially seen on mammography or ultrasound. All patients with abnormalities found during the performance of second look ultrasound and biopsied were included in the study. All lesions were documented using the BIRADS lexicon for MRI and ultrasound. Of 100 included patients, 108 lesions were detected by MRI, found via second look ultrasound and biopsied between January 2008 and 2010. All of the included patients were followed-up for a variable period, from 2 to 5 years. Eighty-two upon 108 biopsied lesions (76%) were benign and 26/108 lesions (24%) were malignant. This study confirmed the switch from procubitus to decubitus essentially displaces the tumour in the antero-posterior direction. It showed that the risk factors were not reliable criteria for establishing an indication for second look ultrasound. This study also showed that circumscribed contours and a progressive enhancement curve (type I) for masses on MRI had the strongest negative predictive value of greater than 0.85. In ultrasound, the round or oval shape, circumscribed contours and the parallel orientation to the skin favoured benignity with a NPV of greater than 0.85. For masses, the study showed that the agreement in interpretation of the benign versus suspicious morphological criteria between the MRI and the ultrasound was very weak for the shape (Kappa=0.09) and weak for the contours (Kappa=0.23). Finally, the MRI overestimated the size of the targets compared to ultrasound (Student t-test, p=0.0001). The performance of second look ultrasound has to be performed after the detection of an abdnormality on MRI even for lesion classified BIRADS 3. The biopsy indications must be wide with insertion of a clip and a control MRI. Only this control allows to stop the investigation if the biopsied lesion is benign.

Perfusion studies in senology.

Microcirculation imaging in breast cancer involves studying tissue enhancement after contrast injection, which is used to calculate perfusion and permeability. The magnitude of enhancement reflects blood and interstitial volumes. This technique has benefitted from advances in MRI, which allow large volumes to be acquired with a good compromise between temporal and spatial resolution. Software has also advanced enabling microcirculation maps to be calculated and heterogeneity to be analyzed. If permeability is increased and interstitial volume is reduced, the microcirculation imaging suggests a suspicious aggressive lesion and can be used for early assessment of neoadjuvant therapies by demonstrating restoration of normal functional indices, which precede morphological changes.

Breast inflammation: indications for MRI and PET-CT.

Breast MRI should not be used for differential diagnosis between inflammatory breast cancer and acute mastitis (AM) prior to treatment. When mastitis symptoms persist after 10 to 15 days of well-managed medical treatment, MRI may be performed in addition to an ultrasound examination, a mammogram and to taking histological samples, in order to eliminate inflammatory breast cancer (IBC). For staging, MRI would seem to be useful in looking for a contralateral lesion, PET-CT for finding information about remote metastases and in certain centres, for information about the initial extension to local/regional lymph nodes, which would guide the fields of irradiation (since patients can become lymph node negative after neoadjuvant chemotherapy). MRI and PET-CT seems to be useful for early detection of patients responding poorly to neoadjuvant chemotherapy so that the latter may be rapidly modified.

BI-RADS categorisation of 2,708 consecutive nonpalpable breast lesions in patients referred to a dedicated breast care unit.

OBJECTIVES: To determine the malignancy rate of nonpalpable breast lesions, categorised according to the Breast Imaging Reporting and Data System (BI-RADS) classification in the setting of a Breast Care Unit. METHODS: All nonpalpable breast lesions from consecutive patients referred to a dedicated Breast Care Unit were prospectively reviewed and classified into 5 BI-RADS assessment categories (0, 2, 3, 4, and 5). RESULTS: A total of 2708 lesions were diagnosed by mammography (71.6%), ultrasound (8.7%), mammography and ultrasound (19.5%), or MRI (0.2%). The distribution of the lesions by BI-RADS category was: 152 in category 0 (5.6%), 56 in category 2 (2.1%), 742 in category 3 (27.4%), 1523 in category 4 (56.2%) and 235 in category 5 (8.7%). Histology revealed 570 malignant lesions (32.9%), 152 high-risk lesions (8.8%), and 1010 benign lesions (58.3%). Malignancy was detected in 17 (2.3%) category 3 lesions, 364 (23.9%) category 4 lesions and 185 (78.7%) category 5 lesions. Median follow-up was 36.9 months. CONCLUSION: This pragmatic study reflects the assessment and management of breast impalpable abnormalities referred for care to a specialized Breast Unit. Multidisciplinary evaluation with BI-RADS classification accurately predicts malignancy, and reflects the quality of management. This assessment should be encouraged in community practice appraisal.

[Diffusion-weighted MR imaging of the breast]. / Diffusion en IRM mammaire.

Diffusion-weighted imaging is helpful to further characterize lesions that remain indeterminate after morphological and dynamic MR evaluation. Suspicious lesions are hyperintense on diffusion-weighted images with corresponding low ADC values, indicating restricted diffusion and hypercellularity. Benign lesions and tumors responding to treatment usually have no diffusion restriction. ADC maps are useful for T2W hyperintense lesions that could mask the presence of restricted diffusion. Image fusion is sometimes needed to accurately localize enhancing lesions on ADC maps. For indeterminate lesions, a hypocellular appearance suggests a lower ACR category whereas the presence of restricted diffusion suggests a higher category.

[Value of whole body CTA in the management of brain-dead patients]. / Intérêt de l'angioscanner corps entier dans la prise en charge du patient en état de mort encéphalique.

PURPOSE: To assess the value of whole body CTA, as a complement to head CTA, in the management of brain-dead patients as potential organ donors. Materials and Methods. A total of 27 consecutive brain-dead patients admitted in a center authorized in the harvesting of organs between October 2006 and January 2008 were included. The imaging protocol used was the protocol recommended by the French Society of Neuroradiology, with additional arterial phase helical acquisition of the chest, abdomen and pelvis, and parenchymal phase helical acquisition of the abdomen and pelvis. The imaging findings were then correlated to the surgical reports after organ harvesting. RESULTS: CTA readily demonstrates tissue lesions, a contraindication to harvesting (14 cases, including one false positive), and anatomical variants of the vascular system (7 arterial variants and 3 venous variants) and liver (8 patients). CONCLUSION: CTA, the gold standard paraclinical examination for brain death assessment, allows, in a single examination, the identification of contraindications to organ harvesting that may modify the surgical approach and even avoid unnecessary mobilisation of the transplant team. It may also provide valuable preoperative evaluation by detecting anatomical variants of the liver and kidneys.

Co(Ni)/MoS2 nanostructured catalysts for the hydrodesulphurization of dibenzothiophene.

In this study Co(Ni)/MoS2 unsupported nanocatalysts (nanorods and nanoribbons) were synthesized with Co(Ni)/(Co(Ni) + Mo) = 0.3, 0.5 molar ratios for Co and Ni respectively. First the alpha-MoO3 nanostructures were impregnated with an aqueous solution of Co(Ni)Cl2 x 6H2O or Co(Ni)(NO3)2 x 6H2O, then were treated for 2 h at 473 K, and finally the precursors were activated under a H2S/H2 mixture (15% v/v H2S) by ramping the temperature from room temperature to 773 K and keeping it at that value for 2 h. The resulting materials were characterized by scanning electron microscopy, energy dispersive X-ray spectroscopy, transmission electron microscopy, X-ray diffraction, specific surface area and X-ray photoelectron spectroscopy, and tested as catalysts for the hydrodesulfurization (HDS) of dibenzothiophene (DBT). It was found that these materials presented specific surface areas below 25 m2/g. The catalytic test showed that only when Co is added a promoter effect is observed compared with MoS2 unpromoted catalysts. Among the materials prepared, the Co/MoS2 catalyst made from cobalt chloride presented the highest catalytic activity (6.95 mol s(-1) g(-1)catalyst) for the HDS of DBT. The selectivity for the latter indicated a clear preference for the direct desulphurization over the hydrogenating pathway.

Optimization of the synthesis of alpha-MoO3 nanoribbons and hydrodesulfurization (HDS) catalyst test.

An optimized process for synthesis of alpha-MoO3 nanoribbons characterized by uniform morphology and composition was carried out. The optimized process turned out to be the aging of a precursor of an aqueous solution of ammonium heptamolybdate for a week under constant stirring at 333 K; followed by hydrothermal treatment for 36 h up to 48 h at 473 K. The dimensions of the nanoribbons were between 5 and 10 microm in length and a width between 100 and 600 nm. The thickness was between 60 and 200 nm. This material was tested for hydrodesulfurization (HDS) of dibenzothiophene (DBT) by in situ activation and showed its catalytic activities to be similar to those of unsupported MoS2 catalysts. The structure and morphology of these materials was characterized by analytical transmission electron microscopy, scanning electron microscopy, and X-ray diffraction using the Rietveld method to determine the quantitative crystallographic phases. A chemical semiquantitative analysis was carried out by energy dispersive spectroscopy and a qualitative analysis was carried out by electron energy loss spectroscopy.

Synthesis of MoS(2) nanorods and their catalytic test in the HDS of dibenzothiophene.

Partially sulfided nanostructures were synthesized by direct sulfurization of alpha-MoO(3) nanorods using a mixture of H(2)S/H(2), 15 vol%, at several temperatures (400, 500, 600, 700, and 800 degrees C). These materials were tested as catalysts in the hydrodesulfurization (HDS) of dibenzothiophene (DBT) and characterized by specific surface areas using the expression developed by Brunauer, Emmett, and Teller (BET equation), x-ray diffraction (XRD), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The TEM images show a gradual evolution from a smooth surface to a rough material, presenting some type of holes all over the particles, but keeping their rod-like structure throughout sulfidation. The results of evaluating the catalysts in the HDS of DBT showed that the best temperature for sulfidation is 500 degrees C. In all samples, a higher selectivity for hydrogenation over sulfur removal was observed.

[Risks associated with MRI: safety rules, incidents, and accidents]. / Risque IRM: règles de sécurité, incidents et accidents.

It is now accepted that MR imaging does not present any biological risk for humans, even in cases of repeated exposure. However, several of the MR components (magnetic field, gradients, RF pulses, electrodes...) may cause some inconveniences to patients, most of them being reversible. However, severe accidents have been reported. Even though screening of patients for MR imaging eligibility is performed to identify patients with contra-indications to MRI, the lack of vigilance or the ignorance of certain basic safety requirements could lead to serious adverse effects, including death. The goal of this article is to review the various accidents reported with MRI, to explain their mechanism, and to describe means of prevention.

[Swallowing study with kinetic MRI using a single shot fast spin echo sequence in healthy volunteers and patients treated for head and neck cancer]. / Etude de la déglutition par ciné-IRM utilisant la séquence single shot fast spin écho (SSFSE) chez des volontaires sains et des patients traités pour un cancer ORL.

PURPOSE: To evaluate the single shot fast spin echo sequence (SSFSE) rapid MRI sequence for swallowing study, to describe the swallowing phases analyzable by kinetic MR Imaging and to show the advantages and the limits of the method in patients treated for head and neck cancer. METHODS AND MATERIALS: A preliminary study was conducted in 8 healthy volunteers and 11 patients treated for a head and neck cancer between June 1999 and April 2001. Examinations were obtained on a 1.5 T machine using a multi-slice SSFSE sequence with an acquisition time of 1 second/slice. The different phases of swallowing were analyzed. Examinations were done with and without water ingestion. RESULTS: Kinetic MRI allows to clearly analyze the anatomy and the dynamic of the tongue, the soft palate, the hyoid bone, the larynx and the posterior pharyngeal wall. The hypopharyngeal and esophageal phases were suboptimally assessed. CONCLUSION: Kinetic MRI allows to clearly analyze the oral and early pharyngeal phases of swallowing, which can be correlated with normal and surgically reconstructed areas in spite of the low temporal resolution and the non-physiologic position. It is simple and rapid to perform and may be useful in treated patients with head and neck cancer.