Conversational hypnosis versus standard of care to reduce anxiety in patients undergoing marker placement under radiographic control prior to breast cancer surgery: A randomized, multicenter trial.

Background: Surgery is a cornerstone of breast cancer management. Prior to surgery, a wire marker is placed at the site of the tumor, to enable the surgeon to accurately localize the lesion during later surgery. This procedure can generate considerable anxiety for many patients. We investigated the value of conversational hypnosis (CH) in reducing anxiety in patients undergoing preoperative wire placement under radiographic control. Methods: Randomized, multicentre study in 7 centers in France. Inclusion criteria were patients aged >18 years with an Eastern Cooperative Oncology Group performance status ≤2, scheduled to undergo preoperative wire placement in one or several breast lesions. Patients were randomized in a 1:1 ratio, stratified by center to undergo preoperative wire placement with or without the use of CH by a radiological technician trained in the CH technique. The primary endpoint was the percentage of patients with an anxiety score ≥ 6 on a visual analog scale ranging from 0 (absence of anxiety) to 10 (maximal anxiety). Secondary endpoints were pain score, perceived duration reported by the patient, technician satisfaction with their relationship with the patient, and ease of marker insertion reported by the radiologist. Semi-structured interviews were performed with patients to assess their perception of the marker placement procedure. Results: The trial was prematurely interrupted for futility after a planned interim analysis after accrual of 167 patients, i.e., half the planned sample size. Prior to marker placement, 29.3% (n = 24) of patients in the control group had an anxiety score ≥ 6, versus 42.3% (n = 33) in the CH group (p = 0.08). After marker placement, the change of anxiety score was not significantly different between groups (11.0% (n = 9) versus 14.3% (n = 11), p = 0.615). There was no significant difference in any of the secondary endpoints. In the interviews, patients from both groups frequently spoke of a feeling of trust. Conclusion: This study failed to show a benefit of conversational hypnosis on anxiety in patients undergoing marker placement prior to surgery for breast cancer. The fact that some caregivers had learned this personalized therapeutic communication technique may have had a positive impact on the whole caregiving team. Trial registration: The study was registered with ClinicalTrials.gov (NCT02867644).

[Second reading in breast cancer screening program: State of knowledge and future]. / Seconde lecture en dépistage organisé du cancer du sein. États des lieux et perspectives d'évolution.

Second reading is an important part of breast cancer organized screening program. Image quality control and detection of non-diagnosed cancer by first reader are the two goals of this process. In France, 6 % of all screening cancer are diagnosed by second reading, actually done on screen film. With the technologic evolution (Digital breast tomosynthesis, Artificial intelligence) and societal digitalization, this process need to evolve. After some report about organization and results for second reading in France and outside, current and future shortcomings, proposition from professionals involved in breast cancer screening are made to improve this public health program.

Breast nodule classification with two-dimensional ultrasound using Mask-RCNN ensemble aggregation.

PURPOSE: The purpose of this study was to create a deep learning algorithm to infer the benign or malignant nature of breast nodules using two-dimensional B-mode ultrasound data initially marked as BI-RADS 3 and 4. MATERIALS AND METHODS: An ensemble of mask region-based convolutional neural networks (Mask-RCNN) combining nodule segmentation and classification were trained to explicitly localize the nodule and generate a probability of the nodule to be malignant on two-dimensional B-mode ultrasound. These probabilities were aggregated at test time to produce final results. Resulting inferences were assessed using area under the curve (AUC). RESULTS: A total of 460 ultrasound images of breast nodules classified as BI-RADS 3 or 4 were included. There were 295 benign and 165 malignant breast nodules used for training and validation, and another 137 breast nodules images used for testing. As a part of the challenge, the distribution of benign and malignant breast nodules in the test database remained unknown. The obtained AUC was 0.69 (95% CI: 0.57-0.82) on the training set and 0.67 on the test set. CONCLUSION: The proposed deep learning solution helps classify benign and malignant breast nodules based solely on two-dimensional ultrasound images initially marked as BIRADS 3 and 4.

Three artificial intelligence data challenges based on CT and ultrasound.

PURPOSE: The 2020 edition of these Data Challenges was organized by the French Society of Radiology (SFR), from September 28 to September 30, 2020. The goals were to propose innovative artificial intelligence solutions for the current relevant problems in radiology and to build a large database of multimodal medical images of ultrasound and computed tomography (CT) on these subjects from several French radiology centers. MATERIALS AND METHODS: This year the attempt was to create data challenge objectives in line with the clinical routine of radiologists, with less preprocessing of data and annotation, leaving a large part of the preprocessing task to the participating teams. The objectives were proposed by the different organizations depending on their core areas of expertise. A dedicated platform was used to upload the medical image data, to automatically anonymize the uploaded data. RESULTS: Three challenges were proposed including classification of benign or malignant breast nodules on ultrasound examinations, detection and contouring of pathological neck lymph nodes from cervical CT examinations and classification of calcium score on coronary calcifications from thoracic CT examinations. A total of 2076 medical examinations were included in the database for the three challenges, in three months, by 18 different centers, of which 12% were excluded. The 39 participants were divided into six multidisciplinary teams among which the coronary calcification score challenge was solved with a concordance index > 95%, and the other two with scores of 67% (breast nodule classification) and 63% (neck lymph node calcifications).

[Colorectal cancer screening in primary care pharmacy in Corsica: a support for the prevention in general medicine] / Dépistage du cancer colorectal en officine en Corse : un appui à la prévention en médecine générale.

Colorectal cancer (CRC) affects approximately 43,000 people each year in France and is responsible for nearly 18,000 deaths a year. The national organized screening program contributes to its early detection. The test is available to the preferred GP or, to the Regional Center in charge of the invited public. Often the process of going to his doctor to get the test is not well accepted and the participation in organized screening is low. Our project aims to evaluate the impact of the provision of this test in pharmacies on screening for colorectal cancer in Corsica. The article describes the method used to mobilize the primary care pharmacists of the territory, provide them the test kits and follow-up of the people who took part in the test. The results presented highlight a very positive impact of the experiment with a progression of the realized rate to 36% over the period of 9 months.