[Identification of sentinel lymph node: Comparison between SNOLL and routine isotopic procedure]. / Identification isotopique du ganglion sentinelle : comparaison du SNOLL avec la technique isotopique de référence.

INTRODUCTION: Axillary staging remains the most accurate predictive factor for recurrence risk and survival in patients with invasive breast carcinoma. Sentinel Node Occult Lesion Localization (SNOLL) allows with a single intra-lesion injection both localization of impalpable breast lesion and sentinel node biopsy. Our aim was to compare the efficacy of SNOLL and standard radio isotopic method for sentinel node localization by lymphoscintigraphy. METHODS: This retrospective study enrolled 100 patients treated for breast carcinoma with indication of sentinel node biopsy between may 2017 and January 2019 in breast surgery unit of Montpellier university hospital. RESULTS: SNOLL and standard radio isotopic method were realized in respectively 65 and 35 patients. Failure rates of sentinel node localization were respectively 34% and 11% by lymphoscintigraphy (P=0.02), 17% and 9% intraoperatively and 11% et 6% using radioisotope combined with colorimetric method. DISCUSSION: Failure rate of sentinel node localization is higher using SNOLL. This rate is reduced by additional radioisope migration in the time between isotope injection and surgery and by the use of combined method. SNOLL should therefore be combined with colorimetric method. These results must be confirmed in a larger study.

[Oncofertility program at the Montpellier university hospital 2 years after]. / Programme de préservation de la fertilité féminine au CHRU de Montpellier 2ans après.

OBJECTIVE: Female fertility preservation in the context of cancer management is crucial for patient's health care. The aim of this study was to evaluate the oncofertility practice at our university hospital of Montpellier since 2011. PATIENTS AND METHODS: The evaluation of management of young patients referred to Montpellier University Hospital from September 2011 to September 2013 for oncofertility counselling before cancer treatment. RESULTS: Seventy-one patients were referred to a specialized oncofertility center. Forty-two patients (59.1%) were included in the oncofertility program. Twenty-two patients (31%) were proposed for oocyte vitrification after COS protocol, eight patients (11.3%) for ovarian tissue cryoconservation, seven patients (9.9%) for GnRH injections, three patients (4.2%) ovarian transposition and two patients (2.8%) for embryo cryopreservation. Among the 42 indications of fertility preservation, only 18 will have finally taken place. CONCLUSION: Oncofertility counselling for young patients should now be part of the cancer management. It involves multidisciplinary teams. Further information of both oncologists and patients is needed to improve this new approach in the field of cancer treatments.

[Circulating tumor cells: cornerstone of personalized medicine]. / Cellules tumorales circulantes : pierre angulaire de la médecine personnalisée.

Cancer treatment has evolved toward personalized medicine. It is mandatory for clinicians to ascertain tumor biological features in order to optimize patients' treatment. Identification and characterization of circulating tumor cells demonstrated a prognostic value in many solid tumors. Here, we describe the main technologies for identification and characterization of circulating tumor cells and their clinical application in gynecologic and breast cancers.

Radioguided occult lesion localization plus sentinel node biopsy (SNOLL) versus wire-guided localization plus sentinel node detection: a case control study of 129 unifocal pure invasive non-palpable breast cancers.

AIMS: We compared histological patterns after lumpectomy for non-palpable breast cancers preoperatively localized by radioguided occult lesion localization plus sentinel node localization (SNOLL) versus wire-guided localization. METHODS: To ensure a homogeneously treated cohort and rigorous comparisons, only patients with invasive cancer and measurable opacity by imaging were included. Exclusion criteria were one or more parameters that could interfere with localization and/or the surgical procedure. Forty-three SNOLL were compared with 86 WGL plus sentinel node (SN) localization. Cancer localization effectiveness was based on careful assessment of histological data from only the first resected glandular specimen, as any additional resection specimens were guided by intraoperative histological examination. RESULTS: Reexcisions to ensure free tissue margins were performed during the same procedure in 13.9% of SNOLL versus 31.3% of WGL; p = 0.02. Significantly more women in SNOLL (53.4%) also had free nearest margins of >9 mm after the first procedure compared with WGL (33.7%); p = 0.03. The median centricity ratio after the first procedure was better in SNOLL (2.8, range 1.3-14) than WGL (5, range 1-50); p = 0.008. The median number of SN detected by lymphoscintigraphy was the same in SNOLL and WGL (1, range 0-9, vs. 1, range 0-8). Intraoperative SN detection by blue dye and/or gamma probe was successful for 97.6% of SNOLL versus 93% of WGL. CONCLUSION: In this study, SNOLL was effective and safe, and this procedure significantly improved the rate of negative margins in the first specimen and the rate of reexcision for positive margins compared with WGL.

[Anal sphincter injury during operative vaginal delivery using spatulas. What are the risk factors?]. / Lésions périnéales sévères liées à une extraction fœtale par spatules. Quels facteurs de risques ?

OBJECTIVE: To assess risk factors for anal sphincter injury during operative vaginal delivery using spatulas. PATIENTS AND METHODS: A monocentric retrospective study of all assisted vaginal deliveries using Thierry and Teissier's spatulas between January 1st, 2008 and December 31st, 2009 in a teaching level III maternity. We studied risk factors such as primiparity, gestational age, maternal age, previous perineal laceration, level and type of presentation, type of expulsion, unsuccessful extraction and successive use of tools, episiotomy, type of anaesthesia and birth weight. RESULTS: There were 346 perineal tears (60.5%); among them, 175 (31%) were type 1, 131 (23%) type 2, 35 (6.1%) type 3 and five (0.9%) type 4. There were 235 episiotomy (41.1%). There was no statistically significant difference between all the supposed risk factors and the severe perineal tears. CONCLUSION: There are no relationship between third and fourth degree perineal lesions during spatula's delivery and supposed risk factors of anal sphincter injury. Only statistical tendances between first vaginal delivery and anal sphincter injury and between occipitosacral delivery and anal sphincter injury were found. We need further randomized studies comparing assisted births using spatulas, forceps and vacuum extractors to better assess perineal tears risk factors.

[Imaging features of granulosa cell tumors of the ovary: about three cases]. / Aspect en imagerie des tumeurs de la granulosa de l'ovaire: à propos de trois cas.

Granulosa cell tumors of the ovary are rare, and included in the sex cord-stromal tumor category. They have a low malignancy potential and generally have a good prognosis. They are the most frequent hormone-secreting tumors of the ovary and may lead to suggestive clinical symptoms. Some biological markers (serum inhibin B and AMH) may be helpful for diagnosis, though their sensitivity is not perfect. Preoperative imaging diagnosis remains challenging due to the wide variability in morphology and lack of epidemiological data in the imaging literature (small patient populations). From a review of the clinical and MR imaging features of three cases of granulosa cell tumor of the adult and a review of the literature, we will describe a few imaging features that may suggest the correct diagnosis.

False positive lymph node activity on positron emission tomography (PET/CT) due to hemostatic compresses.

Combined positron emission tomography and computerized tomography (PET/CT) using 18-fluorodeoxyglucose (18-FDG) is the most effective study to identify invasion of pelvic and/or para-aortic lymph node chains in cancers of the uterine cervix. We report the case of a patient who underwent laparoscopic hysterectomy and cytoreductive surgery for endometrial cancer; postoperative PET/CT identified an intense localization of 18-FDG in the region of the right common iliac chain. This finding led to an open re-exploration at which the only finding was a granuloma arising in reaction to a hemostatic sponge.

Surgical treatment of recurring subareolar abscess using oncoplastic techniques.

PURPOSE: To evaluate the clinical and cosmetic results of our treatment of recurrent periareolar abscess. PATIENTS AND METHODS: Our technique was applied to 27 patients with recurrent periareolar abscess who had been previously surgically treated three or more times between January 2001 and December 2008. Our treatment combined resection of the fistula, the terminal milk ducts, and mammary gland involved in the inflammatory process. This was associated with glandular remodeling and a lift of the periareolar skin. Long-term clinical results and evaluation of cosmetic result are analyzed. RESULTS: The median age of patients was 36 years and the median course of disease was 5 years (2-11 years). The duration of follow-up was 37 months. Before being treated in our service, patients had a median of four prior surgeries for this condition (3-12). The average hospital stay was 3.2±0.6 days after surgery. One recurrence occurred among the 24 patients reviewed. She was treated by excision of the nipple and areola. Six patients (25%) rated their outcome excellent and 13 patients (54%) considered their results good. Five patients assessed their overall result as fair (21%), and no patients judged their results as poor. CONCLUSIONS: Our technique is simple and feasible and the results are encouraging. It can be used regardless of the location of the fistula around the periphery of the nipple-areola complex and it is perfectly suited to the management of chronic fistulous abscess.

[Recurrent adnexal torsion with normal ovarian, in the second and third trimesters of pregnancy]. / Torsion d'annexe récidivante, sur ovaire sain, aux deuxième et troisième trimestre de grossesse.

We report the only case of recurrent bilateral adnexal torsion during pregnancy with normal ovaries. This rare situation raises diagnostic as well as therapeutic management difficulties.

[Surgical training of trainees, specialists in obstetrics and gynecology: results from a national electronic survey]. / Formation chirurgicale des internes, spécialistes en gynécologie-obstétrique : résultats d'une enquête électronique nationale.

OBJECTIVES: The goal of this dissertation is to assess the current situation of surgical training provided to French trainees in obstetrics and gynecology. MATERIALS AND METHODS: An online survey was made available to all French gynecologists. Within six months, 657 answer forms had been submitted and respondents were sorted out into five subgroups: residents (group 1 [G1]), fellows (group 2 [G2]), public sector surgeons (group 3 [G3]), private sector surgeons (group 4 [G4]) and all surgeons and fellows (group A [GA]). RESULTS: Only 30% of interns (G1) and 78% of surgeons (GA) were satisfied with their training. Most respondents agreed that two general surgery courses as currently offered in the curriculum do not provide enough good basic surgical knowledge. Courses that allow residents to train in other hospitals are generally preferred to those that focus on a particular hospital. Ninety-two percent of respondents consider camaraderie and bonding within a medical unit to be key to a successful course. Theoretical training, including lectures and access to listed references, is thought to be weak. Resources and tools for practical training outside the operating room, including pelvic trainer and anatomical dissection, are scarce. Course evaluation is expected by 83% of all respondents, although it is now virtually nonexistent. CONCLUSION: Surgical training of residents in obstetrics and gynecology can be improved in many ways, such as using synthetic materials and operating on animals or cadavers. Rigorous course evaluation is key to improving surgical training of French residents in obstetrics and gynecology.

[Surgical treatment for genital prolapse in the very elderly: a continuous series of 43 patients]. / Traitement chirurgical du prolapsus du quatrième âge. A propos d'une série continue de 43 cas.

OBJECTIVES: To evaluate surgical treatment for genital prolapse in patients over the age of 75. PATIENTS AND METHODS: This is a continuous retrospective series of 43 patients operated for genital prolapse between March 2001 and October 2006. Surgical outcomes in terms of anatomical correction as well as urological and proctological results were analyzed. Morbidity and mortality studies were carried out. A satisfaction and quality of life assessment was carried out among 19 patients (44%) by an independent researcher at a distance from the intervention. RESULTS: Morbidity attributable to the surgery was minimal, with no cases of mortality. Mean hospital stay was five days. Anatomical correction was good without troubling urological or proctological consequences. Two surgical options were compared: surgery with vaginal occlusion in 23 patients (53.5%) and vaginal conserving surgery in 20 patients (46.5%). Surgical outcomes and morbidity were equivalent in the two groups. Seventy-nine percent of patients surveyed at a distance from the interventions estimated that the procedure had improved their quality of life. DISCUSSION AND CONCLUSION: Surgical treatment for genital prolapse in the very elderly population is a reasonable therapeutic option. Postoperative evaluation demonstrates good anatomical as well as functional results in the majority of cases.

[Surgery training of gynecologic residents: master and student in the operating room]. / Formation chirurgicale au bloc opératoire: enquête d'opinion auprès des praticiens et des internes en gynécologie-obstétrique.

OBJECTIVES: Describe the surgical training of gynecologic residents in the operating room, by collecting the opinion of French gynecologists. MATERIALS AND METHODS: A questionnaire investigating this subject was put on a web site. Every French gynecologist could answer the questionnaire from a duration of six months. The data of the inquiry were studied by comparing five groups: residents (group 1), fellows (group 2), seniors of public hospital (group 3), and seniors of private hospitals (group 4), or, groups 2, 3 and 4 together, as Group A. RESULTS: Six hundred and fifty-seven gynecologists answered the inquiry. For the residents, lack of time and senior's weak educational motivation are the explanations most frequently retained in order to explain that residents do not operate. For group A, it is rather the residents' skills which is the most important fact to have residents operate. Residents more often practice surgery in general public hospital that in faculty hospital. For 31% of all the referees, heads of departments do not incite their teams to have residents operate. Nearly 25% of all the investigated believe that a man operates more than a woman in resident curriculum. Besides, by analyzing the answers of groups 1 and 2, we were able to correlate resident seniority at their first practice of 13 surgical operations. For 26% of the group A, residents operate less than they do during their own studies. Finally, all the investigated confirm the lack of surgical assessment in the resident curriculum. DISCUSSION AND CONCLUSION: Decision to let the resident operate remains too dependent on senior personal appreciation and does not seem to join a strategy of training. Opinions of surgical training in the operating room is different between residents and seniors. Operating time increases when residents operate but there is no effect on quality of care. These results show again the necessity of a formal teaching and assessment, in a resident program with objectives, collecting every resident's surgery volume. These educational improvements will contribute certainly to the professionalization of residents.

[Ultrasonography of fetal esophagus: healthy appearance and prenatal diagnosis of a case of esophagus atresia with esotracheal fistula]. / Echographie de l'oesophage foetal: aspect physiologique et application au dépistage anténatal d'une atrésie oesophagienne.

The thoracic part of a fetal esophagus is generally overlooked by usual prenatal ultrasonography. However, screening it might improve the detection rate of esophageal malformations for which prenatal diagnosis remains far from accurate. In this article, we describe the technique which makes it possible to get a precise image of a fetal thoracic esophagus in its more sensitive part: between the trachea and the aorta. After describing the appearance of a healthy thoracic esophagus, we will show how this technique can be used for prenatal detection of esophagus malformations. For this purpose, we provide the case report of a prenatal diagnosis of esophagus atresia with esotracheal fistula.

[Intravascular leiomyomatosis: an original tumor]. / Léiomyomatose intravasculaire: une tumeur originale.

An unusual uterus benign tumor, intravascular leiomyomatosis is also a differential diagnosis of uterine fibromas. It is most likely to be diagnosed post operatively and must be treated in an adequate way to avoid a recidive.