Breast cancer management and outcome according to surgeon's affiliation: a population-based comparison adjusted for patient's selection bias.

BACKGROUND: Studies have reported that breast cancer (BC) units could increase the quality of care but none has evaluated the efficacy of alternative options such as private BC networks, which is our study objective. PATIENTS AND METHODS: We included all 1404 BC patients operated in the public unit or the private network and recorded at the Geneva Cancer Registry between 2000 and 2005. We compared quality indicators of care between the public BC unit and the private BC network by logistic regression and evaluated the effect of surgeon's affiliation on BC-specific mortality by the Cox model adjusting for the propensity score. RESULTS: Both the groups had high care quality scores. For invasive cancer, histological assessment before surgery and axillary lymph node dissection when indicated were less frequent in the public sector (adjusted odds ratio (OR): 0.4, 95% confidence interval (CI) 0.3-0.7, and OR: 0.4, 95% CI 0.2-0.8, respectively), while radiation therapy after breast-conserving surgery was more frequent (OR: 2.5, 95% CI 1.4-4.8). Surgeon affiliation had no substantial effect on BC-specific mortality (adjusted hazard ratio (HR): 0.8, 95% CI 0.5-1.4). CONCLUSIONS: This study suggests that private BC networks could be an alternative to public BC units with both structures presenting high quality indicators of BC care and similar BC-specific mortality.

[Risks of diagnostic errors in pathology research of post-abortion herpetic endometritis: limitations of immunohistochemistry in situ hybridization]. / Risques d'erreurs diagnostiques dans la recherche anatomo-pathologique de l'endométrite herpétique post-abortum : limites de l'immunohistochimie et de l'hybridation in situ.

Endometrial Herpes-simplex infection is rare. Less than 10 cases have been reported. The impact of herpetic endometritis and abortion is not known, because of the scarcity of clinical and histological data. We present and discuss two cases of abortion with microscopic intranuclear inclusion of biotin, suggestive of herpetic endometritis. These inclusions were positively marked on immunohistochemistry, using anti-herpes antibodies. Similar results were obtained with in situ hybridization using biotin labeled probes (commonly used in some laboratories). But the normal accumulation of biotin in the endometrial cells of pregnant women diminishes the value of such results in gestational material. In fact the interaction between intranuclear endogenous biotin and the avidin-biotin-peroxidase complex may explain the positive controls, performed without anti-herpes antibodies. The biotin labeled probes may also explain the positive results of in situ hybridization. We strongly support the opinion that in pregnant women, the diagnosis of herpetic endometritis needs methodological precautions to avoid pitfall caused by endogenous biotin.