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Lavoué V, Fritel X, Chopier J, Roedlich MN, Chamming's F, Mathelin C, Bendifallah S, Boisserie-Lacroix M, Canlorbe G, Chabbert-Buffet N, Coutant C, Guilhen N, Fauvet R, Laas E, Legendre G, Thomassin Naggara I, Ngô C, Ouldamer L, Seror J, Touboul C, Daraï E. [Clinical practice guidelines: Benign breast tumor--Aims, methods and organization]. J Gynecol Obstet Hum Reprod 2015; 44:898-903. [PMID: 26527015 DOI: 10.1016/j.jgyn.2015.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 09/18/2015] [Indexed: 06/05/2023]
Abstract
Conversely to breast cancer, few data and guidelines are available to explore and manage benign breast disorders. Therefore, the Collège national des gynécologues et obstétriciens français (CNGOF - French College of Gynaecologists and Obstetricians) decided to establish clinical practice guidelines for benign breast tumour (BBT). CNGOF appointed a committee with responsibility for selecting experts, compiling questions and summarizing the recommendations. The summary of valid scientific data for each question analyzed by the experts included a level of evidence, based on the quality of the data available and defined accordingly rating scheme developed by the Haute Autorité de santé (French National Authority for Health).
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Affiliation(s)
- V Lavoué
- Service de gynécologie, CHU de Rennes, ER440, Oncogenesis, Stress and Signaling, labelisé Inserm, CRLCC Eugène-Marquis, université de Rennes 1, 35000 Rennes, France; Collège national des gynécologues et obstétriciens français, 91, boulevard Sébastopol, 75002 Paris, France.
| | - X Fritel
- Université de Poitiers, CIC 1402, CHU de Poitiers, 86021 Poitiers, France; CESP Inserm U1018, 94270 Le Kremlin-Bicêtre, France
| | - J Chopier
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - M-N Roedlich
- Service de radiologie, hôpital Hautepierre, 1, avenue Molière, 67100 Strasbourg, France
| | - F Chamming's
- Service de radiologie, hôpital européen Georges-Pompidou, AP-HP, 15, rue Leblanc, 75015 Paris, France
| | - C Mathelin
- Unité de sénologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg, France
| | - S Bendifallah
- Inserm UMRS707, service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - M Boisserie-Lacroix
- Service de radiologie, centre régional de lutte contre le cancer Bergognié, 33000 Bordeaux, France
| | - G Canlorbe
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, Inserm UMRS938, 4, rue de la Chine, 75020 Paris, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Coutant
- Service de chirurgie, centre régional de lutte contre le cancer Georges-François-Leclerc, 21000 Dijon, France
| | - N Guilhen
- Service de gynécologie-obstétrique, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
| | - R Fauvet
- Service de gynécologie-obstétrique, CHU de Caen, université de Basse-Normandie, Inserm U1199, BIOTICLA, avenue de la Côte-de-Nacre, 14033 Caen cedex 09, France
| | - E Laas
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU d'Angers, CESP Inserm U1018, 49100 Angers, France
| | - I Thomassin Naggara
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Ngô
- Service de chirurgie cancérologique, gynécologique et du sein, hôpital européen Georges-Pompidou, AP-HP, université Paris Descartes, 15, rue Leblanc, 75015 Paris, France
| | - L Ouldamer
- Unité Inserm 1069, département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, faculté de médecine François-Rabelais, 2, boulevard Tonnellé, 37044 Tours, France
| | - J Seror
- Cabinet médical, 146, avenue Ledru-Rollin, 75011 Paris, France; Service d'échographie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Touboul
- Service de gynécologie-obstétrique, CHI, 40, avenue de Verdun, 94000 Créteil, France
| | - E Daraï
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, Inserm UMRS938, 4, rue de la Chine, 75020 Paris, France
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Daney de Marcillac F, Molière S, Pinton A, Weingertner AS, Fritz G, Viville B, Roedlich MN, Gaudineau A, Sananes N, Favre R, Nisand I, Langer B. [Accuracy of placenta accreta prenatal diagnosis by ultrasound and MRI in a high-risk population]. J Gynecol Obstet Biol Reprod (Paris) 2015; 45:198-206. [PMID: 26321608 DOI: 10.1016/j.jgyn.2015.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/21/2015] [Accepted: 07/13/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Main objective was to compare accuracy of ultrasonography and MRI for antenatal diagnosis of placenta accreta. Secondary objectives were to specify the most common sonographic and RMI signs associated with diagnosis of placenta accreta. MATERIAL AND METHODS This retrospective study used data collected from all potential cases of placenta accreta (patients with an anterior placenta praevia with history of scarred uterus) admitted from 01/2010 to 12/2014 in a level III maternity unit in Strasbourg, France. High-risk patients beneficiated antenatally from ultrasonography and MRI. Sonographic signs registered were: abnormal placental lacunae, increased vascularity on color Doppler, absence of the retroplacental clear space, interrupted bladder line. MRI signs registered were: abnormal uterine bulging, intraplacental bands of low signal intensity on T2-weighted images, increased vascularity, heterogeneous signal of the placenta on T2-weighed, interrupted bladder line, protrusion of the placenta into the cervix. Diagnosis of placenta accreta was confirmed histologically after hysterectomy or clinically in case of successful conservative treatment. RESULTS Twenty-two potential cases of placenta accreta were referred to our center and underwent both ultrasonography and MRI. All cases of placenta accreta had a placenta praevia associated with history of scarred uterus. Sensibility and specificity for ultrasonography were, respectively, 0.92 and 0.67, for MRI 0.84 and 0.78 without significant difference (p>0.05). The most relevant signs associated with diagnosis of placenta accreta in ultrasonography were increased vascularity on color Doppler (sensibility 0.85/specificity 0.78), abnormal placental lacunae (sensibility 0.92/specificity 0.55) and loss of retroplacental clear space (sensibility 0.76/specificity 1.0). The most relevant signs in MRI were: abnormal uterine bulging (sensitivity 0.92/specificity 0.89), dark intraplacental bands on T2-weighted images (sensitivity 0.83/specificity 0.80) or placental heterogeneity (sensitivity 0.92/specificity 0.89). Association of two sonographic or MRI signs had the best sensitivity/specificity ratio. DISCUSSION AND CONCLUSION Ultrasonography and RMI represent two interesting and complementary diagnostic tools for antenatal diagnosis of placenta accreta. Because of its cost and accessibility, ultrasonography remains the first in line to be used for diagnosis. Use of an analytical grid for diagnosis of placenta accreta could be helpful.
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Affiliation(s)
- F Daney de Marcillac
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - S Molière
- Département de radiologie, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - A Pinton
- Département de santé publique, hôpital Civil, hôpitaux universitaire de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - A-S Weingertner
- Département de gynécologie-obstétrique, CMCO, hôpitaux universitaire de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - G Fritz
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - B Viville
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - M-N Roedlich
- Département de radiologie, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - A Gaudineau
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - N Sananes
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - R Favre
- Département de gynécologie-obstétrique, CMCO, hôpitaux universitaire de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - I Nisand
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - B Langer
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
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Koutsomanis A, Bruant-Rodier C, Roedlich MN, Bretz-Grenier MF, Perrot P, Bodin F. [Radiological trap and oncological precautions in a patient who has undergone a permanent withdrawal of PIP breast implants]. ANN CHIR PLAST ESTH 2015; 60:533-6. [PMID: 26232069 DOI: 10.1016/j.anplas.2015.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/30/2015] [Indexed: 11/28/2022]
Abstract
We report the case of a 57-year-old patient who presented radiological images similar to ruptured breast implants one year after the supposed withdrawal of the latter. This woman had benefited for the first time from cosmetic PIP breast implants in 2000. Early in 2014, she requested the removal of the implants without renewal because she was feeling pain and functional discomfort. A few months after the operation, she consulted for breast swelling in the upper pole of the breast. Radiological assessment showed liquid formations compatible with the presence of implants. At our request, the rereading of the MRI by the radiologist definitively concluded on a bilateral seroma within the persistent fibrous capsule. In the absence of symptoms, clinical monitoring had been decided. But at the recrudescence of anaplastic large cell lymphoma cases associated with breast implants, a cytological sampling was intended. In case of cytological abnormality or recurrence of the seroma, a surgical procedure should be performed. In conclusion, the removal of a breast implant without capsulectomy may result in the formation of a seroma whose images resemble those of an implant. It is always worthwhile to provide precise clinical data to the radiologist in order to help him to make informed interpretations. Every serous effusion in a breast lodge having contained a silicone implant must evoke the diagnosis of anaplastic large cell lymphoma.
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Affiliation(s)
- A Koutsomanis
- Service de chirurgie plastique et reconstructrice, hôpital civil, CHU de Strasbourg, 1, place de l'Hôpital, B.P. n(o) 426, 67091 Strasbourg cedex, France
| | - C Bruant-Rodier
- Service de chirurgie plastique et reconstructrice, hôpital civil, CHU de Strasbourg, 1, place de l'Hôpital, B.P. n(o) 426, 67091 Strasbourg cedex, France
| | - M-N Roedlich
- Service de radiologie, unité d'imagerie de la femme, CHU de Strasbourg, 67098 Strasbourg cedex, France
| | - M-F Bretz-Grenier
- Service de radiologie, unité d'imagerie de la femme, CHU de Strasbourg, 67098 Strasbourg cedex, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, CHU de Nantes, 44093 Nantes cedex 1, France
| | - F Bodin
- Service de chirurgie plastique et reconstructrice, hôpital civil, CHU de Strasbourg, 1, place de l'Hôpital, B.P. n(o) 426, 67091 Strasbourg cedex, France.
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Abstract
BACKGROUND The initial manifestation of a lymphoma as an ovarian mass is unusual, with a reportedly poor prognosis. An exploratory laparotomy is often performed as the ovarian tumor can mimic an advanced epithelial carcinoma. The criteria of lymphoma used in the selection of a nonsurgical approach, that is, chemotherapy possibly associated with radiation, are rarely defined. CASE We report the case of a 36-year-old woman who presented with an ovarian tumor suggestive of advanced carcinoma. After an initial approach including optimal surgery, the diagnosis of large B-cell CD30+ non-Hodgkin malignant lymphoma was established. Complete remission was obtained after a chemotherapy regimen, appropriate to the specific histologic type of the lymphoma. CONCLUSION The choice treatment of ovarian non-Hodgkin lymphoma (NHL) is chemotherapy. In the presence of an ovarian tumor, the possibility of ovarian NHL must be considered, and its clinical, biological, and/or radiological signs must be actively sought. Controlled biopsies must also be included to avoid mutilating surgery.
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Affiliation(s)
- A S Weingertner
- Department of Obstetrics and Gynaecology, University Hospital of Strasbourg, 1 Avenue Moliere, 67098 Strasbourg Cedex, France
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Abstract
Imaging of the window of the temporal bone has became an important tool in the analysis of hearing loss, vertigo, tinnitus in a context of trauma, malformation, otosclerosis, and chronic otitis media. A good knowledge of the anatomy and a good technical procedure are necessary for making an efficient diagnosis. The increased thickness of the footplate may be delineated in otosclerosis, chronic otitis media, malformation, when it is measured at 0.7 mm or more in horizontal computed tomography (CT) sections. The traumatic displacement of the stapes, particularly within the labyrinths, is easily diagnosed in horizontal CT section. Imaging of the round window is now very important for the detection of otosclerotic foci, congenital stenosis, and perilymphatic fistula with or without fracture. Magnetic resonance imaging (MRI) with the high-resolution T2 plays an important role in the detection of a small amount of fluid in the round window recess, confirming the traumatic perilymphatic fistula without fracture.
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Affiliation(s)
- F Veillon
- Department of Radiology 1, University Hospital of Strasbourg, France.
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Affiliation(s)
- F Veillon
- Department of Radiology, Hopital de Hautepierre, Strasbourg, France
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Veillon F, Riehm S, Moulin G, Roedlich MN, Blonde E, Tongio J. [Imaging of tumors and pseudotumors of the ear]. J Radiol 1999; 80:1795-806. [PMID: 11013704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
CT and MRI are in most of the cases associated in imaging of tumours and pseudo-tumours of the temporal bone. The tumours of the external auditory meatus particularly the malignant ones are rare. It is of a great interest to delineate a possible extension to the chorda tympani. Secondary cholesteatoma are the most frequent pseudo-tumours of the middle ear: CT and MRI evaluate very well their extension particularly in the giant forms. Others tumours like tuberculosis, histiocytosis, primitive cholesteatoma, tympanic body++ tumours may be diagnosed by imaging as well as the neuroma of the facial nerve, the meningioma or some rarer lesions as the adenoma, or the carcinoid tumour of the middle ear. The adenoma of the endolymphatic sac is the only true tumour of the membranous labyrinth whose diagnosis is nicely made by MRI. The primitive cholesteatoma, the neuroma of the facial nerve may reach the labyrinthine bone and are easily diagnosed by imaging which generally speaking is very good in evaluating the kind of pathology of each cavities, delineating the extension of the lesions and orientating the surgical procedures.
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Affiliation(s)
- F Veillon
- Hôpital de Hautepierre, Service de Radiologie I, Strasbourg.
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