[Vacuum-assisted stereotactic biopsy: experience of the regional cancer center of Caen]. / Macrobiopsies assistées par le vide: expérience du CRLCC François Baclesse de Caen.

PURPOSE: To report our experience with macrobiopsy under stereotaxy. MATERIALS AND METHODS: Retrospective study of 248 procedures in 236 patients for microcalcifications in 95% of cases. The macrobiopsies were performed under Mammotome for lesions graded ACR 3, ACR 4 and ACR 5 in 8.4%, 81.6% and 14.8% of cases respectively. RESULTS: From a technical point of view, 91% of procedures had no technical problem. The image guided excision was complete in 68% of cases with lesions less than 1 cm in size and in 6% of cases for lesions larger than 1 cm. The rate of a misdiagnosis of ductal carcinoma in situ for patients with invasive carcinoma was 27% whereas the rate of a misdiagnosis of atypical ductal hyperplasia in patients with ductal carcinoma in situ was 25% knowing that patients with atypical ductal hyperplasia for which all microcalcifications had been fully removed by macrobiopsy and without risk factors did not undergo surgery. CONCLUSION: Even if macrobiopsy of microcalcifications is a reliable method, its main limitation remains the risk of misdiagnosis of borderline lesions.

[Evaluation of predictive factors, particularly the Van Nuys index, of local recurrence in ductal carcinoma in situ of the breast: study of 166 cases with conservative treatment and review of the literature]. / In process citation.

Ductal carcinoma in situ (DCIS), a non metastazing lesion of the breast is more frequently observed due to the improvement of mammography and widespread use of screening. The most important risk of this disease is local recurrence. In about half of cases, it occurs as an infiltrating carcinoma. In a series of 166 DCIS treated by lumpectomy plus radiotherapy, we have studied clinico-pathological factors for the prognosis of local recurrences and particularly the Van Nuys Index criteria (nuclear grade, necrosis, size, margin width). After median follow up of 75 months, 21 recurrences were observed with 10 corresponding to an infiltrating carcinoma and one of them died. The size of DCIS evaluated on pathological documents (histological slides and shames), the Van Nuys Prognostic Index (VNPI) and the mitotic index were the main prognostic factors of local recurrence. We discuss these results and confront them to a review of the literature focalised on the delicate problem of the decision of conservative treatment. A multidisciplinary approach (Breast : Surgeon, Radiologist, Pathologist and Radiotherapist), a standardisation of pathological criteria (size, margin width) and the continuation of randomised trials are necessary to fine the best attitude of conservative therapy.

[Is mammography useful in Paget's disease of the breast?]. / La mammographie est-elle utile dans la maladie de Paget du sein?

PURPOSE: Interest of the mammogram in Paget's disease of the breast, especially for a therapeutic decision in otherwise asymptomatic women with Paget's disease, who would be candidates for conservative treatment. MATERIALS AND METHODS: 61 women with histological Paget's disease of the nipple, treated by mastectomy, were retrospectively analyzed with clinical, radiological and pathological correlations. RESULTS: An underlying carcinoma was found in 60 cases (98.4%), atypical epithelial hyperplasia in one. In the 24 women without breast palpable mass, 17 (71%) had a normal mammogram, 12 (50%) had carcinoma with an invasive component, 14 (58%) had a cancer at a distance from the nipple, 17 (71%) had a multifocal carcinoma. All 37 women with a palpable mass had a pathological mammogram, 36 of them had carcinoma with an invasive component, 35 (95%) a cancer at a distance from the nipple, 31 (84%) a multifocal carcinoma. CONCLUSION: Mammogram is of limited value in management of Paget's disease of the breast for women without breast palpable mass; it can not predict the site of malignancy, nor the invasive component.

Late cutaneous syphilis and neurosyphilis.

We report two syphilitic cases of indeterminable duration. The dramatic cutaneous lesions of the female patient, compatible with secondary-tertiary syphilis associated with a positive VDRL reaction in CSF together with the criteria of neurosyphilis in her male companion (despite normal TPHA and IgG indices), led us to treat both of them in an optimal way. The clinical and serological evolution was favourable.

[Pulmonary involvement of Bourneville's tuberous sclerosis. The value of early detection. A familial form]. / Les atteintes pulmonaires de la sclérose tubéreuse de Bourneville. Intérêts du dépistage précoce. A propos d'une forme familiale.

Pulmonary disease is very rare during the course of tuberous sclerosis of Bourneville (STB). The authors report two cases of STB with pulmonary involvement occurring in the same family, mother and daughter. Both presented with typical cutaneous manifestations of the disease and bilateral renal angiomyolipomas. In the daughter, the early pulmonary diagnosis was made by computed tomographic examination (TDM) which showed the images of the cyst very sharply, although the pulmonary radiograph was normal. Prolonged follow up with pulmonary function tests is important. Lung function tests were very abnormal in the mother with a frank diminution of the TLCO and hypoxia at rest. In the daughter, they revealed the development of obstructive airways disease. Bronchoalveolar lavage was carried out in both the mother and daughter and showed intra-alveolar haemorrhage (with a ground glass appearance on computed tomography in the mother). Pulmonary lymphangiomyomatosis (LPM) and STB with pulmonary involvement are clinical disorders which are anatomically closely related. If the value of hormonal treatment has been shown during the course of LMP, their efficacy in STB is variable.