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Lavoue V, Favier A, Franck S, Boutet G, Azuar AS, Brousse S, Golfier F, Uzan C, Vaysse C, Molière S, Boisserie-Lacroix M, Kermarrec E, Seror JY, Delpech Y, Luporsi É, Maugard CM, Taris N, Chabbert-Buffet N, Sabah J, Alghamdi K, Fritel X, Mathelin C. French college of gynecologists and obstetricians (CNGOF) recommendations for clinical practice: Place of breast self-examination in screening strategies. Breast 2024; 75:103619. [PMID: 38547580 PMCID: PMC10990735 DOI: 10.1016/j.breast.2023.103619] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 04/07/2024] Open
Abstract
Breast cancer is the most common female cancer in the world. Numerous studies have shown that the risk of metastatic disease increases with tumor volume. In this context, it is useful to assess whether the regular practice of formal breast self-examination (BSE) as opposed to breast awareness has an impact on the number of cancers diagnosed, their stage, the treatments used and mortality. DESIGN The Commission of Senology (CS) of the Collège National de Gynécologie et Obstétrique Français (CNGOF) respected and followed the Grading of Recommendations Assessment, Development and Evaluation method to assess the quality of the evidence on which the recommendations were based. METHODS The CS studied 16 questions individualizing four groups of women (general population, women aged over 75, high-risk women, and women previously treated for breast cancer). For each situation, it was determined whether the practice of BSE versus abstention from this examination led to detection of more breast cancers and/or recurrences and/or reduced treatment and/or increased survival. RESULTS BSE should not be recommended for women in the general population, who otherwise benefit from clinical breast examination by practitioners from the age of 25, and from organized screening from 50 to 74 (strong recommendation). In the absence of data on the benefits of BSE in patients aged over 75, for those at high risk and those previously treated for breast cancer, the CS was unable to issue recommendations. Thus, if women in these categories wish to undergo BSE, information on the benefits and risks observed in the general population must be given, notably that BSE is associated with a higher number of referrals, biopsies, and a reduced quality of life.
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Affiliation(s)
- Vincent Lavoue
- CHU Service de Gynécologie, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Amélia Favier
- Gynécologie-obstétrique et Médecine de La Reproduction, Maternité Hôpital Tenon, 4 Rue de La Chine, 75020, Paris, France
| | - Sophie Franck
- Institut Curie, 26 Rue D'Ulm, 75248, Paris Cedex 05, France
| | - Gérard Boutet
- AGREGA, Service de Chirurgie Gynécologique et Médecine de La Reproduction, Centre Aliénor D'Aquitaine, Centre Hospitalier Universitaire de Bordeaux, Groupe Hospitalier Pellegrin, Place Amélie-Raba-Léon, 33000, Bordeaux, France
| | - Anne-Sophie Azuar
- Centre Hospitalier Clavary, Chemin de Clavary, 06130, Grasse, France
| | - Susie Brousse
- Service D'oncologie Chirurgicale, Centre Eugène Marquis, Unicancer, Rennes, France
| | - François Golfier
- Service de Chirurgie Gynécologique et Cancérologique - Obstétrique, Hospices Civils de Lyon, CHU Lyon Sud, Lyon, France
| | - Catherine Uzan
- Hôpital Pitié Salpetrière, 47 Bld de L'Hôpital, 75013, Paris, France
| | - Charlotte Vaysse
- Service de Chirurgie Oncologique, CHU Toulouse, Institut Universitaire Du Cancer de Toulouse-Oncopole, 1 Avenue Irène Joliot Curie, 31059, Toulouse, France
| | | | | | - Edith Kermarrec
- Hôpital Tenon Service de Radiologie, 4 Rue de La Chine, 75020, Paris, France
| | - Jean-Yves Seror
- Imagerie Duroc, 9 Ter Boulevard Montparnasse 75006 Paris, France
| | - Yann Delpech
- Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189, Nice, France
| | - Élisabeth Luporsi
- Oncologie Médicale et Oncogénétique, CHR Metz-Thionville, Hôpital de Mercy, 1 Allée Du Château, 57085, Metz, France
| | - Christine M Maugard
- Service de Génétique Oncologique Clinique et Unité de Génétique Oncologique Moléculaire, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
| | - Nicolas Taris
- Service de Génétique Oncologique, ICANS, 17 Rue Calmette, 67200, Strasbourg, France, France
| | | | - Jonathan Sabah
- CHRU Avenue Molière, 67200, Strasbourg et ICANS, 17 Rue Albert Calmette, 67033, Strasbourg,Cedex, France
| | - Khalid Alghamdi
- CHRU Avenue Molière, 67200, Strasbourg et ICANS, 17 Rue Albert Calmette, 67033, Strasbourg,Cedex, France
| | - Xavier Fritel
- Centre Hospitalo-universitaire de Poitiers, 2 Rue de La Milétrie, 86021, Poitiers, France
| | - Carole Mathelin
- CHRU Avenue Molière, 67200, Strasbourg et ICANS, 17 Rue Albert Calmette, 67033, Strasbourg,Cedex, France.
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Chargari C, Wasserman J, Gabro A, Canlobre G, Spano JP, Uzan C, Maingon P. Vulvar Carcinoma: Standard of Care and Perspectives. J Clin Oncol 2024; 42:961-972. [PMID: 38315939 DOI: 10.1200/jco.23.01187] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/24/2023] [Accepted: 11/14/2023] [Indexed: 02/07/2024] Open
Abstract
PURPOSE Treatment of vulvar carcinoma (VC) is challenging. The objectives of this review were to describe for clinicians the epidemiologic and clinical aspects of VC, the standard of care in terms of primary local treatment and systemic therapies, and the recent innovations and perspectives emerging from translational research in immuno-oncology. DESIGN We conducted a comprehensive review outlying the clinical aspects and biologic background of vulvar cancer, highlighting modern treatment strategies on the basis of a personalized approach. RESULTS Epidemiologic data showed a recent rise in incidence of VC, attributed to human papillomavirus. Surgery is the mainstay of primary treatment, but multimodal approaches are frequently required in the presence of adverse prognosis histopathologic factors. Chemoradiation is indicated when organ-sparing surgery is not feasible. However, inability to achieve high locoregional control rates in advanced cases and the morbidity associated with local treatments are still key issues. Recent clinical data showed the benefit of individualized strategies combining organ-sparing surgical strategies, less invasive lymph node staging procedures, and refinement in radiotherapy modalities. Among the most important research area, there is a sound rationale for testing modern systemic approaches such as immune checkpoint inhibitors in selected patients with recurrent and/or metastatic tumors. Although no specific data exist for VC, the role of supportive care and post-treatment rehabilitation strategies is also crucial. CONCLUSION There are still insufficient studies dedicated to patients with VC. Public health programs for prevention, screening, and early diagnosis are required, and clinical research should be strengthened to provide high-quality clinical evidence and improve patients' oncologic and functional outcomes.
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Affiliation(s)
- Cyrus Chargari
- Service d'oncologie radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
| | - Johanna Wasserman
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
- Service d'oncologie médicale, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
| | - Alexandra Gabro
- Service d'oncologie radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
| | - Geoffroy Canlobre
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
- Service de chirurgie et cancérologie gynécologique et mammaire, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- INSERM UMR S938, Biologie et Thérapeutique des cancers, Paris, France
| | - Jean-Philippe Spano
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
- Service d'oncologie médicale, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
| | - Catherine Uzan
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
- Service de chirurgie et cancérologie gynécologique et mammaire, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- INSERM UMR S938, Biologie et Thérapeutique des cancers, Paris, France
| | - Philippe Maingon
- Service d'oncologie radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
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Mathelin C, Brousse S, Schmitt M, Taris N, Uzan C, Molière S, Vaysse C. [Updated surgical indications and quality and safety indicators in the management of infiltrative breast carcinoma]. Gynecol Obstet Fertil Senol 2024; 52:125-131. [PMID: 38122844 DOI: 10.1016/j.gofs.2023.12.003] [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] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Breast surgery is the cornerstone of breast cancer treatment. Its indications and procedures are constantly evolving. To update best practices, four questions were submitted to the Senology Commission (SC) of the Collège national des gynécologues et obstétriciens français (CNGOF), covering the indications and modalities of tumor surgery: (1) initially, (2) following neoadjuvant systemic treatment, (3) in case of local recurrence, and (4) the quality and safety of care indicators applicable to this surgery. METHODS The CNGOF SC essentially based its responses on the clinical practice recommendations and guidelines of the French Cancer Institute concerning invasive carcinomas of the breast. Exclusion criteria were carcinoma in situ, sarcoma and axillary surgery. RESULTS To define the type of breast surgery, knowledge of four parameters is essential: the patient's level of risk, the presence of metastases, the size of the breast tumor and its focality (assessed by the clinical/mammography/ultrasound tripod). (1) In the case of initial management, the 6 indications for mastectomy are patient choice (particularly in case of high risk), contraindication to radiotherapy, inflammatory cancer (T4d), surgery with positive margins (after several surgical intervention), surgery that cannot be performed as a monobloc in the case of tumors with multiple foci, and poor expected aesthetic results. All other situations should be treated conservatively. (2) The same criteria apply after neoadjuvant systemic treatment, with conservative treatment still possible whatever the size (excluding carcinomatous mastitis) and focality of the initial tumor. (3) In case of local recurrence, total mastectomy is the reference treatment, with a second conservative treatment reserved for patients with no risk factors for a second recurrence, and no poor prognostic factors, after validation in a multidisciplinary meeting. (4) Four quality and safety indicators apply to breast surgery: it must be performed after obtaining a histological diagnosis, within less than 6 weeks of mammography, in a single surgery in over 80% of cases, and followed by local radiotherapy in the case of conservative treatment. CONCLUSION The indications and modalities of breast surgery are evolving rapidly. To improve aesthetic results, oncoplastic techniques, immediate breast reconstruction, and preservation of the skin or nipple-areolar complex need to be further developed and evaluated in the long-term. These developments must necessarily be accompanied in France by a training policy for breast surgeons.
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Affiliation(s)
- Carole Mathelin
- Service de chirurgie, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France; CHRU, avenue Molière, 67200 Strasbourg, France.
| | - Susie Brousse
- Service de chirurgie, centre Eugène-Marquis, avenue de la Bataille Flandres-Dunkerque, 35042 Rennes cedex, France.
| | - Martin Schmitt
- Service de radiothérapie, CHR Metz-Thionville, hôpital de Mercy, 1, allée du Château, 57085 Metz cedex, France.
| | - Nicolas Taris
- Service d'onco-génétique, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France.
| | - Catherine Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, Sorbonne université, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Sébastien Molière
- Service d'imagerie de la femme, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France; Service de radiologie B, CHU de Strasbourg, avenue Molière, 67200 Strasbourg, France.
| | - Charlotte Vaysse
- Service de chirurgie gynécologique oncologique, IUCT-Oncopole, CHU de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
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Azuar AS, Uzan C, Mathelin C, Vignes S. [Update of indications and techniques for the management of lymphedema after breast cancer surgery]. Gynecol Obstet Fertil Senol 2024; 52:142-148. [PMID: 38190967 DOI: 10.1016/j.gofs.2023.12.008] [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] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 12/30/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVES Upper limb lymphedema secondary to breast cancer treatment is the leading cause of lymphedema in France. Despite improved surgical practices and de-escalation of radiotherapy, the risk of lymphedema after breast cancer still affects 5-20% of patients, with this variation depending on the measurement method used and the population studied. Lymphedema has a negative impact on quality of life and body image, and their possible occurrence remains a major concern for all women treated for breast cancer. The Sénologie Commission of the Collège national des gynécologues et obstétriciens français (CNGOF) asked four specialists in breast surgery or lymphology to prepare a summary on the prevention, medical and surgical management of lymphedema after breast cancer treatment, and to discuss the medical and surgical innovations currently being evaluated. METHODS This synthesis was based on national and international guidelines on the management of upper limb lymphedema after breast surgery and a recent review of the literature focusing on the years 2020-2023. RESULTS From a preventive point of view, the restrictive instructions imposed for a long time (reduction in physical activity or the carrying of loads, air travel, exposure to the sun or cold, etc.) have altered patients' quality of life and should no longer be recommended. A good understanding of risk factors enables us to target preventive actions. Examples include obesity, a sedentary lifestyle, axillary clearance, radiotherapy of the axillary fossa in addition to axillary clearance, total mastectomy, taxanes or anti-HER-2 therapies in the adjuvant phase. Resumption of physical activity, minimally invasive axillary surgery, de-escalation of radiotherapy and breast-conserving surgical procedures have all demonstrated their preventive value. When lymphedema does occur, early management, through complete decongestive physiotherapy, can help reduce its volume and prevent its long-term worsening. CONCLUSION Surgical (lymph node transplants, lympho-vascular anastomoses) and medical (prolymphangiogenic growth factors) approaches to lymphedema treatment are numerous, but require long-term evaluation of their efficacy and adverse effects.
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Affiliation(s)
- Anne-Sophie Azuar
- Service de chirurgie et cancérologie gynécologique et mammaire, centre hospitalier de Grasse, chemin de Clavary, 06130 Grasse, France.
| | - Catherine Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Carole Mathelin
- Service de chirurgie, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France; CHRU, avenue Molière, 67200 Strasbourg, France.
| | - Stéphane Vignes
- Unité de lymphologie, Centre de référence des lymphœdèmes primaires, membre de la filière FAVA-Multi et du Réseau européen VASCERN, hôpital de Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
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Tuil A, Bergeron C, Lucet JV, Dabi Y, Favier A, Da Maia E, Uzan C, Mergui JL, Canlorbe G. Vulvar biopsy: Punch biopsy or cervical forceps biopsy? J Gynecol Obstet Hum Reprod 2023; 52:102667. [PMID: 37709202 DOI: 10.1016/j.jogoh.2023.102667] [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: 08/03/2023] [Accepted: 09/12/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES The primary objective of our study is to investigate the rate of non-contributory biopsies between punch biopsy(PB) and cervical forceps biopsy(CFB) for a vulvar lesion seen in consultation. The secondary objective of our study is to evaluate the rate of underestimation of a more severe lesion for patients who have undergone vulvar excision. MATERIAL AND METHOD This is a retrospective, descriptive, and comparative study conducted at three centers. The study population consisted of patients who underwent vulvar biopsy between 2017 and 2022 in a gynecological surgery consultation at two French hospitals, as well as a city office. The biopsy techniques used were punch or cervical forceps biopsy. Quantitative variables were analyzed using the Mann-Whitney test, while Pearson's or Fisher's Xi2 tests were used for qualitative variables. The significance level was set at 5%. RESULTS We conducted a retrospective study of 179 vulvar biopsies, of which 100 were punch biopsies and 79 were cervical forceps biopsies, from a total of 107 patients. There was no significant difference in the rate of non-contributory biopsies between the PB and CB groups (p = 1). When analyzing the secondary endpoint of our study, which included 68 patients who underwent vulvectomy after vulvar biopsy, we found that 66 patients (97%) had a good correlation between the pathology of the vulvar biopsy and that of the vulvectomy specimen. CONCLUSION Vulvar biopsy techniques using punch or cervical forceps appear to have similar diagnostic performance and are associated with comparable and low rates of underestimation of invasive lesions.
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Affiliation(s)
- Anthony Tuil
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 26 rue Lazare Carnot, Paris 75013, France.
| | | | - Justine Varinot Lucet
- Service d'anatomie et de Cytologie Pathologiques, Hôspital Tenon, AP-HP, Paris, France
| | - Yohann Dabi
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - Amélia Favier
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - Elisabeth Da Maia
- Service d'anatomie et de cytologie pathologiques, Pitié-Salpêtrière, AP-HP, Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 26 rue Lazare Carnot, Paris 75013, France; Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, Paris 75012, France; University Institute of Cancer, Sorbonne University, Paris 75013, France
| | - Jean-Luc Mergui
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 26 rue Lazare Carnot, Paris 75013, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 26 rue Lazare Carnot, Paris 75013, France; Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, Paris 75012, France; University Institute of Cancer, Sorbonne University, Paris 75013, France
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Lenfant L, Canlorbe G, Belghiti J, Kreaden US, Hebert AE, Nikpayam M, Uzan C, Azaïs H. Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis. J Robot Surg 2023; 17:2647-2662. [PMID: 37856058 PMCID: PMC10678826 DOI: 10.1007/s11701-023-01724-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/06/2023] [Accepted: 09/17/2023] [Indexed: 10/20/2023]
Abstract
The potential benefits and limitations of benign hysterectomy surgical approaches are still debated. We aimed at evaluating any differences with a systematic review and meta-analysis. PubMed, MEDLINE, and EMBASE databases were last searched on 6/2/2021 to identify English randomized controlled trials (RCTs), prospective cohort and retrospective independent database studies published between Jan 1, 2010 and Dec 31, 2020 reporting perioperative outcomes following robotic hysterectomy versus laparoscopic, open, or vaginal approach (PROSPERO #CRD42022352718). Twenty-four articles were included that reported on 110,306 robotic, 262,715 laparoscopic, 189,237 vaginal, and 554,407 open patients. The robotic approach was associated with a shorter hospital stay (p < 0.00001), less blood loss (p = 0.009), and fewer complications (OR: 0.42 [0.27, 0.66], p = 0.0001) when compared to the open approach. The main benefit compared to the laparoscopic and vaginal approaches was a shorter hospital (R/L WMD: - 0.144 [- 0.21, - 0.08], p < 0.0001; R/V WMD: - 0.39 [- 0.70, - 0.08], p = 0.01). Other benefits seen were sensitive to the inclusion of database studies. Study type differences in outcomes, a lack of RCTs for robotic vs. open comparisons, learning curve issues, and limited robotic vs. vaginal publications are limitations. While the robotic approach was mainly comparable to the laparoscopic approach, this meta-analysis confirms the classic benefits of minimally invasive surgery when comparing robotic hysterectomy to open surgery. We also reported the advantages of robotic surgery over vaginal surgery in a patient population with a higher incidence of large uterus and prior surgery.
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Affiliation(s)
- Louis Lenfant
- Department of Urology, Academic Hospital Pitié-Salpêtrière, APHP, Sorbonne Université, 75013, Paris, France
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Geoffroy Canlorbe
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Jérémie Belghiti
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Usha Seshadri Kreaden
- Biostatistics & Global Evidence Management, Intuitive Surgical Inc, Sunnyvale, CA, USA
| | - April E Hebert
- Biostatistics & Global Evidence Management, Intuitive Surgical Inc, Sunnyvale, CA, USA
| | - Marianne Nikpayam
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Catherine Uzan
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Henri Azaïs
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France.
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP, Centre, Université de Paris Cité, Paris, France.
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Guével E, Priou S, Lamé G, Wassermann J, Bey R, Uzan C, Chatellier G, Belkacemi Y, Tannier X, Guillerm S, Flicoteaux R, Gligorov J, Cohen A, Benderra M, Teixeira L, Daniel C, Hersant B, Tournigand C, Kempf E. Impact of the COVID-19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study. Cancer Med 2023; 12:20918-20929. [PMID: 37909210 PMCID: PMC10709737 DOI: 10.1002/cam4.6637] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The SARS CoV-2 pandemic disrupted healthcare systems. We compared the cancer stage for new breast cancers (BCs) before and during the pandemic. METHODS We performed a retrospective multicenter cohort study on the data warehouse of Greater Paris University Hospitals (AP-HP). We identified all female patients newly referred with a BC in 2019 and 2020. We assessed the timeline of their care trajectories, initial tumor stage, and treatment received: BC resection, exclusive systemic therapy, exclusive radiation therapy, or exclusive best supportive care (BSC). We calculated patients' 1-year overall survival (OS) and compared indicators in 2019 and 2020. RESULTS In 2019 and 2020, 2055 and 1988, new BC patients underwent cancer treatment, and during the two lockdowns, the BC diagnoses varied by -18% and by +23% compared to 2019. De novo metastatic tumors (15% and 15%, p = 0.95), pTNM and ypTNM distributions of 1332 cases with upfront resection and of 296 cases with neoadjuvant therapy did not differ (p = 0.37, p = 0.3). The median times from first multidisciplinary meeting and from diagnosis to treatment of 19 days (interquartile 11-39 days) and 35 days (interquartile 22-65 days) did not differ. Access to plastic surgery (15% and 17%, p = 0.08) and to treatment categories did not vary: tumor resection (73% and 72%), exclusive systemic therapy (13% and 14%), exclusive radiation therapy (9% and 9%), exclusive BSC (5% and 5%) (p = 0.8). Among resected patients, the neoadjuvant therapy rate was lower in 2019 (16%) versus 2020 (20%) (p = 0.02). One-year OS rates were 99.3% versus 98.9% (HR = 0.96; 95% CI, 0.77-1.2), 72.6% versus 76.6% (HR = 1.28; 95% CI, 0.95-1.72), 96.6% versus 97.8% (HR = 1.09; 95% CI, 0.61-1.94), and 15.5% versus 15.1% (HR = 0.99; 95% CI, 0.72-1.37), in the treatment groups. CONCLUSIONS Despite a decrease in the number of new BCs, there was no tumor stage shift, and OS did not vary.
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Affiliation(s)
- Etienne Guével
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Sonia Priou
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
- CentraleSupélec, Laboratoire Génie IndustrielUniversité Paris‐SaclayGif‐sur‐YvetteFrance
| | - Guillaume Lamé
- CentraleSupélec, Laboratoire Génie IndustrielUniversité Paris‐SaclayGif‐sur‐YvetteFrance
| | - Johanna Wassermann
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Pitié Salpétrière University HospitalSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
| | - Romain Bey
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Catherine Uzan
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of gynecology, Pitié Salpétrière University HospitalSorbonne UniversitéParisFrance
| | - Gilles Chatellier
- Department of medical informatics, Assistance Publique Hôpitaux de Paris, Centre‐Université de Paris (APHP‐CUP)Université Paris CItéParisFrance
| | - Yazid Belkacemi
- Assistance Publique–Hôpitaux de Paris, Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Xavier Tannier
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
| | - Sophie Guillerm
- Assistance Publique–Hôpitaux de Paris, Department of radiation therapy, Saint Louis University HospitalUniversité Paris CitéCréteilFrance
| | - Rémi Flicoteaux
- Assistance Publique–Hôpitaux de ParisDepartment of medical informationParisFrance
| | - Joseph Gligorov
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Tenon University HospitalSorbonne UniversitéParisFrance
| | - Ariel Cohen
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Marc‐Antoine Benderra
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Tenon University HospitalSorbonne UniversitéParisFrance
| | - Luis Teixeira
- Assistance Publique–Hôpitaux de Paris, Department of senology, Saint Louis Teaching HospitalUniversité Paris CitéParisFrance
| | - Christel Daniel
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
| | - Barbara Hersant
- Assistance Publique – Hôpitaux de Paris, Department of plastic surgery, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Christophe Tournigand
- Assistance Publique – Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Emmanuelle Kempf
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
- Assistance Publique – Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
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Lavoué V, Favier A, Frank S, Boutet G, Azuar AS, Brousse S, Golfier F, Uzan C, Vaysse C, Molière S, Boisserie-Lacroix M, Kermarrec E, Seror JY, Delpech Y, Luporsi É, Maugard CM, Taris N, Chabbert-Buffet N, Sabah J, Alghamdi K, Fritel X, Mathelin C. [Place of breast self-examination in screening strategies. French College of Gynecologists and Obstetricians (CNGOF) recommendations for clinical practice]. Gynecol Obstet Fertil Senol 2023; 51:437-447. [PMID: 37652173 DOI: 10.1016/j.gofs.2023.08.003] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES Breast cancer is the most common female cancer in the world. In France, over 60,000 new cases are currently diagnosed, and 12,000 deaths are attributed to it annually. Numerous studies have shown that the risk of metastatic disease increases with tumor volume. In this context, it is useful to assess whether the regular practice of breast self-examination (BSE) has an impact on the number of cancers diagnosed, their stage, the treatments used and mortality. DESIGN the CNGOF's Commission de Sénologie (CS), composed by 17 experts and 3 invited members, drew up these recommendations. No funding was provided for the development of these recommendations. The CS respected and followed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method to assess the quality of the evidence on which the recommendations were based. METHODS The CS studied 16 questions concerning BSE, individualizing four groups of women (general population, women aged over 75, high-risk women, and women previously treated for breast cancer). For each situation, it was determined whether the practice of BSE compared with abstention from this examination led to the detection of more breast cancers and/or recurrences and/or reduced treatment and/or increased survival. RESULTS BSE should not be recommended for women in the general population, who otherwise benefit from a clinical breast examination (by the attending physician or gynecologist) from the age of 25, and from organized screening from 50 to 74 (strong recommendation). However, in the absence of data on the role of BSE in patients aged over 75, those at high risk of breast cancer and those previously treated for breast cancer, the CS was unable to issue recommendations. Thus, if women in these latter categories wish to undergo BSE, they must be given rigorous training in the technique, and information on the benefits and risks observed in the general population. Finally, the CS invites all women who detect a change or abnormality in their breasts to consult a healthcare professional without delay. CONCLUSION BSE is not recommended for women in the general population. No recommendation can be established for women aged over 75, those at high risk of breast cancer and those previously treated for breast cancer.
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Affiliation(s)
- Vincent Lavoué
- Service de gynécologie, CHU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - Amélia Favier
- Gynécologie-obstétrique et médecine de la reproduction - maternité, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Sophie Frank
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - Gérard Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | | | - Susie Brousse
- Service d'oncologie chirurgicale, centre Eugène-Marquis, Unicancer, Rennes, France
| | - François Golfier
- Service de chirurgie gynécologique et cancérologique - obstétrique, hospices civils de Lyon, CHU Lyon Sud, Lyon, France
| | - Catherine Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - Charlotte Vaysse
- Service de chirurgie oncologique, institut universitaire du cancer de Toulouse-Oncopole, CHU de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Sébastien Molière
- Imagerie du sein, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg, France
| | | | - Edith Kermarrec
- Service de radiologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Jean-Yves Seror
- Imagerie Duroc, 9 ter, boulevard Montparnasse, 75006 Paris, France
| | - Yann Delpech
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France
| | - Élisabeth Luporsi
- Oncologie médicale et oncogénétique, hôpital de Mercy, CHR Metz-Thionville, 1, allée du Château, 57085 Metz, France
| | - Christine M Maugard
- Service de génétique oncologique clinique, unité de génétique oncologique moléculaire, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Nicolas Taris
- Service de génétique oncologique, ICANS, 17, rue Calmette, 67200 Strasbourg, France
| | | | - Jonathan Sabah
- CHRU de Strasbourg, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France
| | - Khalid Alghamdi
- CHRU de Strasbourg, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France
| | - Xavier Fritel
- Centre hospitalo-universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Carole Mathelin
- CHRU de Strasbourg, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
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9
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Simon A, Badachi Y, Ropers J, Laurent I, Dong L, Da Maia E, Bourcier A, Canlorbe G, Uzan C. Value of high-resolution full-field optical coherence tomography and dynamic cell imaging for one-stop rapid diagnosis breast clinic. Cancer Med 2023; 12:19500-19511. [PMID: 37772663 PMCID: PMC10587972 DOI: 10.1002/cam4.6560] [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: 06/19/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Full-field optical coherence tomography combined with dynamic cell imaging (D-FFOCT) is a new, simple-to-use, nondestructive, quick technique that can provide sufficient spatial resolution to mimic histopathological analysis. The objective of this study was to evaluate diagnostic performance of D-FFOCT for one-stop rapid diagnosis breast clinic. METHODS Dynamic full-field optical coherence tomography was applied to fresh, untreated breast and nodes biopsies. Four different readers (senior and junior radiologist, surgeon, and pathologist) analyzed the samples without knowing final histological diagnosis or American College of Radiology classification. The results were compared to conventional processing and staining (hematoxylin-eosin). RESULTS A total of 217 biopsies were performed on 152 patients. There were 144 breast biopsies and 61 lymph nodes with 101 infiltrative cancers (49.27%), 99 benign lesions (48.29%), 3 ductal in situ carcinoma (1.46%), and 2 atypias (0.98%). The diagnostic performance results were as follow: sensitivity: 77% [0.7;0.82], specificity: 64% [0.58;0.71], PPV: 74% [0.68;0.78], and NPV: 75% [0.72;0.78]. A large image atlas was created as well as a diagnosis algorithm from the readers' experience. CONCLUSION With 74% PPV and 75% NPV, D-FFOCT is not yet ready to be used in clinical practice to identify breast cancer. This is mainly explained by the lack of experience and knowledge of this new technic by the four lectors. By training with the diagnosis algorithm and the image atlas, radiologists could have better outcomes allowing quick detection of breast cancer and lymph node involvement. Deep learning could also be used, and further investigation will follow.
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Affiliation(s)
- Alexis Simon
- Department of Radiology, Pitié‐Salpêtrière HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Yasmina Badachi
- Department of Radiology, Pitié‐Salpêtrière HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Jacques Ropers
- Clinical Research Unit, Pitié‐Salpêtrière HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Isaura Laurent
- Clinical Research Unit, Pitié‐Salpêtrière HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Lida Dong
- Department of Pathology, Pitié‐Salpêtrière HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Elisabeth Da Maia
- Department of Pathology, Pitié‐Salpêtrière HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Agnès Bourcier
- Department of Gynaecological and Breast Surgery and OncologyAssistance Publique des Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Geoffroy Canlorbe
- Department of Gynaecological and Breast Surgery and OncologyAssistance Publique des Hôpitaux de Paris (AP‐HP)ParisFrance
- Centre de Recherche Saint‐Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and TherapeuticsSorbonne UniversityParisFrance
- Institut Universitaire de Cancérologie (IUC)Sorbonne UniversityParisFrance
| | - Catherine Uzan
- Department of Gynaecological and Breast Surgery and OncologyAssistance Publique des Hôpitaux de Paris (AP‐HP)ParisFrance
- Centre de Recherche Saint‐Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and TherapeuticsSorbonne UniversityParisFrance
- Institut Universitaire de Cancérologie (IUC)Sorbonne UniversityParisFrance
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10
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Molière S, Boutet G, Azuar AS, Boisserie-Lacroix M, Brousse S, Golfier F, Kermarrec É, Lavoué V, Seror JY, Uzan C, Vaysse C, Lodi M, Mathelin C. [Lipofilling in the management of breast cancer: An update based on a literature review and national and international guidelines]. Gynecol Obstet Fertil Senol 2023; 51:471-480. [PMID: 37419415 DOI: 10.1016/j.gofs.2023.07.001] [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] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/01/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Lipomodelling (LM) is an increasingly used technique to reconstruct or correct an aesthetic defect linked to a loss of substance. In France, the Haute Autorité de santé (HAS) published recommendations in 2015 and 2020 concerning the conditions of use of LM on the treated and contralateral breast. These appear to be inconsistently followed. METHODS Twelve members of the Senology Commission of the Collège national des gynécologues-obstétriciens français (French College of Gynecologists and Obstetricians) reviewed the carcinological safety of LM and the clinical and radiological follow-up of patients after breast cancer surgery, based on French and international recommendations and a review of the literature. The bibliographic search was conducted via Medline from 2015 to 2022, selecting articles in French and English and applying PRISMA guidelines. RESULTS A total of 14 studies on the oncological safety of LM, 5 studies on follow-up and 7 guidelines were retained. The 14 studies (6 retrospective, 2 prospective and 6 meta-analyses) had heterogeneous inclusion criteria and variable follow-up, ranging from 38 to 120 months. Most have shown no increased risk of locoregional or distant recurrence after LM. A retrospective case-control study (464 LMs and 3100 controls) showed, in patients who had no recurrence at 80 months, a subsequent reduction in recurrence-free survival after LM in cases of luminal A cancer, highlighting the number of lost to follow-up (more than 2/3 of luminal A cancers). About follow-up after LM, the 5 series showed the high frequency after LM of clinical mass and radiological images (in ¼ of cases), most often corresponding to cytosteatonecrosis. Most of the guidelines highlighted the uncertainties concerning oncological safety of LM, due to the lack of prospective data and long-term follow-up. DISCUSSION AND PERSPECTIVES The members of the Senology Commission agree with the conclusions of the HAS working group, in particular by advising against LM "without cautionary periods", excessively, or in cases of high risk of relapse, and recommend clear, detailed information to patients before undergoing LM, and the need for postoperative follow-up. The creation of a national registry could address most questions regarding both the oncological safety of this procedure and the modalities of patient follow-up.
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Affiliation(s)
- S Molière
- Imagerie du Sein, CHRU, avenue Molière, 67200 Strasbourg, France.
| | - G Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - A-S Azuar
- Centre hospilalier Clavary, chemin de Clavary, 06130 Grasse, France.
| | - M Boisserie-Lacroix
- Unité de radiologie-sénologie, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France.
| | - S Brousse
- Service d'oncologie chirurgicale, centre Eugène-Marquis, Unicancer, Rennes, France.
| | - F Golfier
- Service de chirurgie gynécologique et cancérologique - obstétrique, hospices civils de Lyon, CHU de Lyon Sud, Lyon, France.
| | - É Kermarrec
- Service de radiologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
| | - V Lavoué
- Service de gynécologie, CHU, 16, boulevard de Bulgarie, 35200 Rennes, France.
| | - J-Y Seror
- 9, terrasse boulevard Montparnasse, 75006 Paris, France.
| | - C Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - C Vaysse
- Service de chirurgie oncologique, institut universitaire du cancer de Toulouse-Oncopole, CHU de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France.
| | - M Lodi
- CHRU, avenue Molière, 67200 Strasbourg, France.
| | - C Mathelin
- CHRU, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
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11
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Bloomfield J, Berville S, Belghiti J, Nikpayam M, Uzan C, Canlorbe G. [How I do… A marsupialisation of a cyst of the Bartholin gland's duct]. Gynecol Obstet Fertil Senol 2023; 51:487-490. [PMID: 37517660 DOI: 10.1016/j.gofs.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Joy Bloomfield
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Assistance publique des Hôpitaux de Paris (AP-HP), 47/83, boulevard de l'Hôpital, 75013 Paris, France.
| | | | - Jérémie Belghiti
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Assistance publique des Hôpitaux de Paris (AP-HP), 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - Marianne Nikpayam
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Assistance publique des Hôpitaux de Paris (AP-HP), 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - Catherine Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Assistance publique des Hôpitaux de Paris (AP-HP), 47/83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne université, Inserm UMR-S 938, biologie et thérapeutiques du cancer, centre de recherche Saint-Antoine (CRSA), 75012 Paris, France
| | - Geoffroy Canlorbe
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Assistance publique des Hôpitaux de Paris (AP-HP), 47/83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne université, Inserm UMR-S 938, biologie et thérapeutiques du cancer, centre de recherche Saint-Antoine (CRSA), 75012 Paris, France
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12
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Bartin R, Delangle R, Mergui JL, Azaïs H, Bolze PA, Philip CA, Kerbage Y, Raimond E, Lecointre L, Carcopino X, Castela M, Uzan C, Canlorbe G. Impact of cervical excisional dimensions on endocervical margins status in adenocarcinoma in situ of the uterine cervix: A multicenter study from the FRANCOGYN group. J Gynecol Obstet Hum Reprod 2023; 52:102622. [PMID: 37321399 DOI: 10.1016/j.jogoh.2023.102622] [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: 05/02/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Excisional procedures have a central role in the management of adenocarcinoma in situ of the cervix (AIS). We aimed to evaluate the relationship between the excisional specimen dimensions and the endocervical margin status. METHODS We conducted a multicentric retrospective study in seven French centers. All cases with proven AIS on a colposcopic biopsy and undergoing an excisional procedure afterwards were included in the analysis. We evaluated the impact of excision length, along with the lateral and anteroposterior diameters on the endocervical margin status. An additional subgroup analysis of the impact of maternal age on endocervical margin status was also conducted. RESULTS Of the 101 cases of AIS diagnosed on initial biopsy, 95 underwent a primary excisional procedure, among which 80% (n = 76/95) had uninvolved endocervical margins and 20% (n = 19/95) had positive endocervical margins. The excisional specimen length was not significantly related to the endocervical margin status. Conversely, both lateral and antero-posterior diameters were significantly correlated with the negative endocervical margins status: OR = 1,19, 95% CI [1.03, 1.40], p = 0.025, for the lateral diameter and OR = 1.34, 95% CI [1.14, 1.64], p = 0.001 for the antero-posterior diameter. The median lateral diameter was 20 mm, IQR (18, 24) in case of endocervical negative margins vs. 18 mm IQR (15, 24) in case of positive endocervical margins (p = 0.039), and the median anteroposterior diameter was 17 mm IQR (15, 20) in case of negative endocervical margins vs 14 mm IQR (11, 15) in case of positive endocervical margins (p = 0.004), respectively. Additionally, in patients over 45 years old, endocervical margin were more likely to be positive despite similar excisional dimensions (7/17 (41%) of positive endocercival margins before 45 years old vs 12/78 (15%) after, p = 0.039) CONCLUSIONS: Endocervical margin statues were significantly related to the transverse diameters (lateral and anteroposterior diameters), but not to the excision specimen length. Reducing the excised length may lead to fewer post-procedure complications but would still allow to obtain a large proportion of negative endocervical margins.
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Affiliation(s)
- Raphael Bartin
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France
| | - Romain Delangle
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France
| | - Jean-Luc Mergui
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France
| | - Henri Azaïs
- Gynecologic and Breast Oncologic Surgery Department, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Pierre-Adrien Bolze
- Department of Gynecologic and Oncologic Surgery and Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Université Lyon 1, France
| | - Charles-Andre Philip
- Department of Gynecologic and Oncologic Surgery and Obstetrics, CHU Lyon Croix-Rousse, Université Lyon 1, France
| | - Yohan Kerbage
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Lise Lecointre
- Department of Surgical Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Mathieu Castela
- Scarcell Therapeutics, 101 rue de Sèvres, 75006 Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; University Institute of Cancer, Sorbonne University, 75013 Paris, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; University Institute of Cancer, Sorbonne University, 75013 Paris, France.
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13
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Renaudeau C, Gimbergues P, Guillot E, Chauvet MP, Gutowski M, Jouve E, Rauch P, Cohen M, Faure C, Padeano MM, Ceccato V, Uzan C, Bats AS, Charitansky H, Dupré PF, Reynard A, Alran S, Bendavid-Athias C, Campion L, Doutriaux I, Classe JM. Abstract OT1-09-01: Axillary surgery de-escalation after neoadjuvant chemotherapy in breast cancer patients with initially involved node: the GANEA 3 trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot1-09-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: In breast cancer patients, neoadjuvant chemotherapy (NAC) allows to obtain pathological complete response (pCR). In case of initially involved node before NAC, pCR after NAC could make it possible to avoid axillary surgery. The aim of our study was to address parameters to build a tool able to accurately select patients at a high probability of axillary pCR after NAC. Method: GANEA 3 was a French prospective multi institutional cohorts of breast cancer patients with a proven axillary involved node treated with NAC (NCT03630913). Initially involved node was clipped before treatment. Each patient received, before and after NAC, a bilateral mammography, a Magnetic Resonance Imaging (MRI), an axillary sonography. After NAC breast, conservative or radical, and axillary surgery, were performed. Breast surgery allowed to measure breast tumor residual and to perform a Sataloff classification. Targeted axillary detection (TAD) was defined as the combination of the resection of the clipped node and SLN dissection. Axillary clipped node, sentinel lymph node (SLN) and axillary lymph node dissection (ALND) were always performed. ALND allowed to assess the false negative rate (FNR) of axillary clipped node and SLN dissection. A total of 500 included patients is planned to close this still ongoing trial. Results : From January 2019 to March 2022, 405 patients were included from 18 institutions. We present here the results of the 260 first patients, who experienced a complete treatment with NAC courses and post NAC breast and axillary surgery. Among these patients, SBR grade was III in 52%, OR and PR were positive in 59% and 46% respectively, HER2 was overexpressed in 40%, 26% were triple negative and pCR was present in 28%. FNR of the SLN detection was 21.1%, 9% for the clipped node alone and 6% for the TAD. Histopronostic grading, progesteron receptors, HER2 expression, MRI results and Sataloff grading of breast residual tumor were indepently linked with global pCR (breast and axilla) in multivariate analysis. The Area Under the Curve (AUC) model was 0.91 with 82% correctly patients classified. The false negative rate of no pCR classified patients was 14%. Conclusion : Intermediate results of Ganea 3 trial showed that operable breast cancer patients with an initially involved axillary node treated with NAC, showed that TAD allows to reduce the FNR of axillary surgery. Patients with histopronostic grade 3, negative progesteron receptors, HER2 overexpression, a normal MRI after NAC and a breast Sataloff A, have a low risk of axillary tumour residual burden and could be safely spare from any axillary surgery. Large prospective trials are needed to confirm the safety of this surgical de-escalation.
Citation Format: Céline Renaudeau, Pierre Gimbergues, Eugénie Guillot, Marie-Pierre Chauvet, Marian Gutowski, Eva Jouve, Philippe Rauch, Monique Cohen, Christelle Faure, Marie-Martine Padeano, Vivien Ceccato, Catherine Uzan, Anne-Sophie Bats, Hélène Charitansky, Pierre-François Dupré, Augustin Reynard, Séverine Alran, Cécile Bendavid-Athias, Loïc Campion, Isabelle Doutriaux, Jean-Marc Classe. Axillary surgery de-escalation after neoadjuvant chemotherapy in breast cancer patients with initially involved node: the GANEA 3 trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-09-01.
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Affiliation(s)
| | | | | | | | | | | | - Philippe Rauch
- 7Institut de Cancérologie Lorraine - Alexis Vautrin Nancy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jean-Marc Classe
- 21Institut de cancérologie de l’ouest - Centre René Gauducheau Saint Herblain
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Deluche E, Marti C, Jochum F, Bendifallah S, Azaïs H, Deidier J, Cockenpot V, Menoux I, Kissel M, Balaya V, Betrian S, Mathevet P, Chargari C, Gouy S, Genestie C, Uzan C, Devouassoux-Shisheboran M, Guyon F, Akladios C, Body N, Guani B. [Application in France of the 2021 European recommendations on endometrial cancer]. Bull Cancer 2023; 110:55-68. [PMID: 36462971 DOI: 10.1016/j.bulcan.2022.11.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022]
Abstract
The latest European recommendations of the European Societies of Gynecological Oncology (ESGO), Radiotherapy and Oncology (ESTRO) and Anatomopathology (ESP) concerning the management of patients with endometrial cancer were published in 2021. On behalf of the French Society of Gynecologic Oncology (SFOG) and the SFOG campus, we wish to summarize for the French-speaking readership the main measures with a more specific application for France. We also incorporate data from a Delphi survey conducted with a panel of French and French-speaking Swiss experts. The data presented in this article relate to histo-molecular characteristics, radiological data of endometrial cancer, and management of low-risk, intermediate-risk, intermediate-high-risk, and metastatic cancers. The aim of this review article is to show the application of the latest international recommendations to clinicians and pathologists for the implementation of these recommendations.
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Affiliation(s)
- Elise Deluche
- Service d'Oncologie Médicale, 2, avenue Martin Luther King, Limoges, France.
| | - Carolin Marti
- Université de Lausanne, UNIL, Lausanne, Suisse; Service de gynécologie obstétrique, HFR, Fribourg, Suisse
| | - Floriane Jochum
- Université Paris-Saclay, département de Gynécologie, Institut Curie, Paris, France; Hopitaux Universitaires de Strasbourg, département de Gynécologie et d'Obstétrique, Strasbourg, France
| | | | - Henri Azaïs
- Hôpital Européen Georges Pompidou, Service de chirurgie oncologique gynécologique et mammaire, Paris, France
| | - Jonas Deidier
- Hôpital Universitaire Paris Ouest Site G Pompidou AP-HP, département de Radiologie, Paris, France
| | | | - Inès Menoux
- ICANS, département de Radiothérapie, Strasbourg, France
| | - Manon Kissel
- Département de Radiothérapie, institut Curie, Paris, France
| | - Vincent Balaya
- Hôpital Foch, département de Gynécologie, Suresnes, France
| | - Sarah Betrian
- IUCT Oncopole, département d'oncologie médicale, Toulouse, France
| | - Patrice Mathevet
- Université de Lausanne, UNIL, Lausanne, Suisse; CHUV, département de Gynécologie et d'Obstétrique, Lausanne, Suisse
| | - Cyrus Chargari
- Gustave Roussy, département de radio-oncologie, Paris, France
| | - Sebastien Gouy
- Gustave Roussy, département de gynécologie oncologie chirurgicale, Paris, France
| | | | - Catherine Uzan
- AP-HP, Hôpital de la Pitié Salpêtrière, département de gynécologie et d'obstétrique, Paris, France; Institut Universitaire de cancérologie, Sorbonne Université, Paris, France
| | | | - Frederic Guyon
- Institut Bergonié, département d'oncologie chirurgicale, Bordeaux, France
| | - Cherif Akladios
- Hopitaux Universitaires de Strasbourg, département de Gynécologie et d'Obstétrique, Strasbourg, France
| | - Noémie Body
- Institut de Cancérologie de l'Ouest (ICO), département d'Oncologie Chirurgicale, Angers, France
| | - Benedetta Guani
- Université de Lausanne, UNIL, Lausanne, Suisse; CHUV, département de Gynécologie et d'Obstétrique, Lausanne, Suisse; Université de Fribourg, UNIFR, Fribourg, Suisse
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Zaoui M, Morel M, Louadj L, Ferrand N, Lamazière A, Uzan C, Canlorbe G, Atlan M, Sabbah M. Adipocytes secretome from normal and tumor breast favor breast cancer invasion by metabolic reprogramming. Clin Transl Oncol 2022; 25:1389-1401. [PMID: 36520383 DOI: 10.1007/s12094-022-03035-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adipose tissue is a major component of breast stroma. This study focused on delineating the effects of adipose stem cells (ASCs) derived from breast of healthy women and cancer patients with normal or tumor breast cells. METHODS The ASCs were induced to differentiate into adipocytes, and the subsequent adipocyte conditioned media (ACM) were evaluated for their fatty acid profile, adipokine secretion and influence on proliferation, migration and invasion on tumoral (MCF-7 and SUM159) and normal (HMEC) human breast cell lines. RESULTS An enrichment of arachidonic acid was observed in ACM from tumor tissues. Adipose tissues from tumor free secrete twice as much leptin than those from proximal or distal to the tumor. All ACMs display proliferative activity and favor invasiveness of SUM159 cells compared to MCF-7 and HMEC. All ACMs induced lipid droplets accumulation in MCF-7 cells and increased CD36 expression in tumor cells. CONCLUSION We conclude that among secreted factors analyzed, only arachidonic acid and leptin levels did discriminate ASCs from tumor-bearing and tumor-free breasts emphasizing the importance that other cell types could contribute to the adipose tissue secretome in a tumor context.
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Affiliation(s)
- Maurice Zaoui
- Team Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Institut Universitaire de Cancérologie, Sorbonne University, INSERM UMR_S 938, 75012, Paris, France
| | - Mehdi Morel
- Team Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Institut Universitaire de Cancérologie, Sorbonne University, INSERM UMR_S 938, 75012, Paris, France
| | - Lila Louadj
- Team Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Institut Universitaire de Cancérologie, Sorbonne University, INSERM UMR_S 938, 75012, Paris, France
| | - Nathalie Ferrand
- Team Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Institut Universitaire de Cancérologie, Sorbonne University, INSERM UMR_S 938, 75012, Paris, France
| | - Antonin Lamazière
- UMR 70203, Laboratory of Biomolecules, Institut National de La Santé Et de La Recherche Médicale (INSERM), École Normale Supérieure, AP-HP, 75012, Paris, France
| | - Catherine Uzan
- Team Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Institut Universitaire de Cancérologie, Sorbonne University, INSERM UMR_S 938, 75012, Paris, France
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique des Hôpitaux de Paris (AP-HP)Pitié-Salpêtrière University Hospital, 75013, Paris, France
| | - Geoffroy Canlorbe
- Team Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Institut Universitaire de Cancérologie, Sorbonne University, INSERM UMR_S 938, 75012, Paris, France
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique des Hôpitaux de Paris (AP-HP)Pitié-Salpêtrière University Hospital, 75013, Paris, France
| | - Michael Atlan
- Department of Plastic Surgery, Reconstructive, Aesthetic, Microsurgery and Tissue Regeneration, Tenon Hospital, Institut Universitaire de Cancérologie, AP-HP, 75020, Paris, France
| | - Michèle Sabbah
- Team Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Institut Universitaire de Cancérologie, Sorbonne University, INSERM UMR_S 938, 75012, Paris, France.
- Centre National de la Recherche Scientifique (CNRS), 75012, Paris, France.
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Uzan C. [New developments in endometrial cancer: 10 key messages]. Rev Prat 2022; 72:750-751. [PMID: 36511963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Catherine Uzan
- Cheffe du service de chirurgie et cancérologie gynécologique et mammaire, hôpital La Pitié- Salpêtrière, Sorbonne Université, Paris, France
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Uzan C, Canlorbe G, Chabbert-buffet N. O-276 Reproductive outcomes and fertility-sparing in women with Borderline ovarian tumors. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The standard treatment of BOT is defined as a total abdominal hysterectomy and bilateral salpingo-oophorectomy, peritoneal cytology, omentectomy and multiple peritoneal biopsies. These procedures allowed to perform an adequate staging, most of the time no adjuvant treatment is necessary except in case of associated invasive peritoneal implants. The prognosis of BOT is excellent. However, late recurrences (after 5 or 10 years) can be observed. Conservative surgery is defined as preservation of the uterus and at least part of one ovary, in order to preserve fertility. BOT arise in a young population, for whom fertility is a major issue. The global recurrence risk is estimated at 13%. The rate of recurrence is correlated with the type of conservative treatment used (salpingo-oophorectomy or cystectomy) with a higher rate of between 10 and 42% in patients undergoing cystectomy. In the case of bilateral serous BOT, if technically feasible, bilateral cystectomy should be performed to improve pregnancy rates. For serous BOT e cystectomy can be performed (tumour can be bilateral for 20% of these patients) with a close follow up by ultrasound. For mucinous BOT, salpingo-oophorectomy is recommended to avoid rare but at risk invasive recurrence, (these lesions are usually unilateral). A complete evaluation must be performed preoperatively including MRI with evaluation of possible safe functional ovarian tissue and oncofertility consultation to discuss if fertility preservation technique can be proposed before surgery.
The observed pregnancy rates observed after conservative surgery are between 32 and 88%. Different factors can influence fertility rates: type of conservative treatment, age of the patient (with almost a quarter of the live birth occurring after recurrence with no more further event to date, a second fertility-sparing surgery after local borderline recurrence can be proposed in the case of pregnancy project), histologic subtype of the tumour (better with mucinous versus serous), the use of a laparoscopic approach and the use of a 2- or 3-step surgery (initial, restaging, second look).
In spite of conservative management in BOT, some patients will experience infertility. In vitro fertilization (IVF) procedures have not been significantly associated with a specific increase in BOT or ovarian cancer rates. In vitro data suggest that gonadotropins and/or high dose of estrogens don’t induce a borderline cell cultures proliferation. Analyzing all series reporting IVF and BOT, the pooled estimate for pregnancy was 80% (95% CI: 68–92%). The pooled estimate for recurrence was 23% (95% CI: 6–39%). The rate of recurrence in these women is ‘low’ though this is probably due to the fact that women who are selected as eligible for ART have a better prognosis and more often early-stage BOT. However, there is a real need for fertility preservation expert centers associating oncologists and fertility experts who can evaluate conservative management of BOT along with alternative therapeutic options to preserve fertility as well as ART.
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Affiliation(s)
- C Uzan
- Sorbonne University, Department of Breast and Gynecologic surgery- Hopital Pitié Salpêtrière , Paris, France
| | - G Canlorbe
- Sorbonne University, Department of Breast and Gynecologic Surgery- Hôpital Pitié Salpêtrière , Paris, France
| | - N Chabbert-buffet
- Sorbonne University, Department of Obstetrics and Gynecology- Hopital Tenon , Paris, France
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Bloomfield J, Sabbah M, Castela M, Mehats C, Uzan C, Canlorbe G. Clinical Value and Molecular Function of Circulating MicroRNAs in Endometrial Cancer Regulation: A Systematic Review. Cells 2022; 11:cells11111836. [PMID: 35681531 PMCID: PMC9180151 DOI: 10.3390/cells11111836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 02/06/2023] Open
Abstract
This systematic review of literature highlights the different microRNAs circulating in the serum or plasma of endometrial cancer patients and their association with clinical and prognostic characteristics in endometrial cancer. This study also investigates the molecular functions of these circulating microRNAs. According to this systematic review, a total of 33 individual circulating miRs (-9, -15b, -20b-5p, -21, -27a, -29b, -30a-5p, -92a, -99a, -100, -135b, -141, -142-3p, -143-3p, -146a-5p, -150-5p, -151a-5p, -186, -195-5p, -199b, -200a, -203, -204, -205, -222, -223, -301b, -423-3p, -449, -484, -887-5p, -1228, and -1290) and 6 different panels of miRs (“miR-222/miR-223/miR-186/miR-204”, “miR-142-3p/miR-146a-5p/miR-151a-5p”, “miR-143-3p/miR-195-5p/miR-20b-5p/miR-204-5p/miR-423-3p/miR-484”, “mir-9/miR-1229”, “miR-9/miR-92a”, and “miR-99a/miR-199b”) had a significant expression variation in EC patients compared to healthy patients. Also, seven individual circulating miRs (-9, -21, -27a, -29b, -99a, -142-3p, and -449a) had a significant expression variation according to EC prognostic factors such as the histological type and grade, tumor size, FIGO stage, lymph node involvement, and survival rates. One panel of circulating miRs (“-200b/-200c/-203/-449a”) had a significant expression variation according to EC myometrial invasion. Further studies are needed to better understand their function and circulation.
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Affiliation(s)
- Joy Bloomfield
- Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, 75020 Paris, France; (J.B.); (M.S.); (C.U.)
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, 75013 Paris, France
| | - Michèle Sabbah
- Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, 75020 Paris, France; (J.B.); (M.S.); (C.U.)
- Centre National de la Recherche Scientifique (CNRS), 75012 Paris, France
| | - Mathieu Castela
- Scarcell Therapeutics, 101 Rue de Sèvres, 75006 Paris, France;
| | - Céline Mehats
- U1016, CNRS, UMR8104, Institut Cochin, INSERM, Université de Paris, 75014 Paris, France;
| | - Catherine Uzan
- Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, 75020 Paris, France; (J.B.); (M.S.); (C.U.)
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, 75013 Paris, France
- Institut Universitaire de Cancérologie (IUC), 75020 Paris, France
| | - Geoffroy Canlorbe
- Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, 75020 Paris, France; (J.B.); (M.S.); (C.U.)
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, 75013 Paris, France
- Institut Universitaire de Cancérologie (IUC), 75020 Paris, France
- Correspondence:
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Ambille Dit Haure M, Aubry G, Delangle R, Belghiti J, Nikpayam M, Uzan C, Canlorbe G. [How I do… An inguinofemoral lymphadenectomy in vulvar cancer]. Gynecol Obstet Fertil Senol 2022; 50:494-496. [PMID: 35189394 DOI: 10.1016/j.gofs.2022.02.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Affiliation(s)
- M Ambille Dit Haure
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - G Aubry
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - R Delangle
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Belghiti
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Nikpayam
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Uzan
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Canlorbe
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Uzan C. [Nouveautés dans les cancers de l'ovaire : 10 messages clés]. Rev Prat 2022; 72:642. [PMID: 35899666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Catherine Uzan
- cheffe du service de chirurgie et cancérologie gynécologique et mammaire, hôpital La Pitié- Salpêtrière, Sorbonne Université, Paris, France
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Li H, Kolanska K, Prades M, Touboul C, Uzan C, Chabbert Buffet N. [Préservation de la fertilité avant traitement d'un cancer de l'ovaire]. Rev Prat 2022; 72:621-626. [PMID: 35899661] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
FERTILITY PRESERVATION BEFORE OVARIAN MALIGNANCY TREATMENT While most ovarian epithelial malignancies affect postmenopausal women, 12% occur in reproductive age patients. In addition, borderline ovarian tumors and rare non epithelial ovarian tumors are diagnosed in young patients as well. The prognosis of early-stage epithelial tumors, non-epithelial and frontier tumors is good. Increased knowledge in this specific field now allows the development of fertility preservation strategies. They include conservative surgery when applicable, associated with oocyte and / or ovarian tissue cryopreservation. Indications remain limited, and any decision must be validated by a multidisciplinary expert committee. The different strategies depend on specific tumoral or genetic context.
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Affiliation(s)
- Hélène Li
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP Sorbonne Université
| | - Kamila Kolanska
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP Sorbonne Université - Plateforme de préservation de la fertilité, AP-HP - Institut universitaire de cancérologie, AP-HP, Sorbonne Université
| | - Marie Prades
- Plateforme de préservation de la fertilité, AP-HP - Institut universitaire de cancérologie, AP-HP, Sorbonne Université - Service de biologie de la reproduction, hôpital Tenon, AP-HP Sorbonne Université
| | - Cyril Touboul
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP Sorbonne Université - Plateforme de préservation de la fertilité, AP-HP - Institut universitaire de cancérologie, AP-HP, Sorbonne Université
| | - Catherine Uzan
- Service de biologie de la reproduction, hôpital Tenon, AP-HP Sorbonne Université - Service de chirurgie mammaire et gynécologique, hôpital La Pitié- Salpêtrière, AP-HP, Sorbonne Université
| | - Nathalie Chabbert Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP Sorbonne Université - Plateforme de préservation de la fertilité, AP-HP - Institut universitaire de cancérologie, AP-HP, Sorbonne Université
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Rocher G, Azaïs H, Favier A, Uzan C, Castela M, Moawad G, Lavoué V, Morandi X, Nyangoh Timoh K, Canlorbe G. Relationships between pelvic nerves and levator ani muscle for posterior sacrocolpopexy: an anatomic study. Surg Radiol Anat 2022; 44:891-898. [DOI: 10.1007/s00276-022-02955-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
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Benoit L, Delangle R, Van NT, Villefranque V, Koskas M, Belghiti J, Uzan C, Canlorbe G. [Feasibility and security of laparoscopic (± robotic) total hysterectomy in outpatient surgery: A French multicenter retrospective study]. Gynecol Obstet Fertil Senol 2022; 50:374-381. [PMID: 34979303 DOI: 10.1016/j.gofs.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the feasibility and safety of total hysterectomy by laparoscopic approach (± robot assisted) in ambulatory. MATERIALS AND METHODS French three-center retrospective study including 165 patients who had laparoscopic (± robot assisted) total hysterectomy scheduled as outpatients from January 2016 to December 2020. Clinical and perioperative data were collected. Factors associated with outpatient failure and rehospitalization were evaluated. RESULTS The outpatient success rate was 92.7%. Factors associated with outpatient failure were incision time>13:00, large volume of blood loss, intraoperative complications with Oslo score≥2, uterine weight≥250g, indication for benign pathology, and robot-assisted approach. Among patients managed as outpatients, 7.2% were rehospitalized at a mean of 10 days from surgery. The factors associated with rehospitalization were the use of an effective antiaggregant or anticoagulant treatment and the use of intraoperative adhesiolysis. Four patients (2.6%) underwent revision surgery. CONCLUSION Minimally invasive hysterectomy can be performed as an outpatient procedure even in cases of malignant pathology. Age and body mass index are not associated with an increased risk of failure or re-hospitalization within one month.
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Affiliation(s)
- L Benoit
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - R Delangle
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - N T Van
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - V Villefranque
- Service de gynécologie obstétrique, Hôpital Simone-Veil, 95600 Eaubonne, France
| | - M Koskas
- Service de gynécologie obstétrique, Bichat, université de Paris, AP-HP, 75018 Paris, France
| | - J Belghiti
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Inserm UMR_S_938, Cancer Biology and Therapeutics, centre de recherche Saint-Antoine (CRSA), Sorbonne Université, 75012 Paris, France
| | - G Canlorbe
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Inserm UMR_S_938, Cancer Biology and Therapeutics, centre de recherche Saint-Antoine (CRSA), Sorbonne Université, 75012 Paris, France.
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Mathelin C, Barranger E, Boisserie-Lacroix M, Boutet G, Brousse S, Chabbert-Buffet N, Coutant C, Daraï E, Delpech Y, Duraes M, Espié M, Fornecker L, Golfier F, Grosclaude P, Hamy AS, Kermarrec E, Lavoué V, Lodi M, Luporsi É, Maugard CM, Molière S, Seror JY, Taris N, Uzan C, Vaysse C, Fritel X. [Non-genetic indications for risk reducing mastectomies: Guidelines of the National College of French Gynecologists and Obstetricians (CNGOF)]. Gynécologie Obstétrique Fertilité & Sénologie 2022; 50:107-120. [PMID: 34920167 DOI: 10.1016/j.gofs.2021.12.005] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To determine the value of performing a risk-reducting mastectomy (RRM) in the absence of a deleterious variant of a breast cancer susceptibility gene, in 4 clinical situations at risk of breast cancer. DESIGN The CNGOF Commission of Senology, composed of 26 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The Commission of Senology adhered to the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted. METHODS The Commission of Senology considered 8 questions on 4 topics, focusing on histological, familial (no identified genetic abnormality), radiological (of unrecognized cancer), and radiation (history of Hodgkin's disease) risk. For each situation, it was determined whether performing RRM compared with surveillance would decrease the risk of developing breast cancer and/or increase survival. RESULTS The Commission of Senology synthesis and application of the GRADE method resulted in 11 recommendations, 6 with a high level of evidence (GRADE 1±) and 5 with a low level of evidence (GRADE 2±). CONCLUSION There was significant agreement among the Commission of Senology members on recommendations to improve practice for performing or not performing RRM in the clinical setting.
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Affiliation(s)
- Carole Mathelin
- CHRU, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | | | | | - Gérard Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - Susie Brousse
- CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France.
| | | | - Charles Coutant
- Département d'oncologie chirurgicale, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21079 Dijon cedex, France.
| | - Emile Daraï
- Hôpital Tenon, service de gynécologie-obstétrique, 4, rue de la Chine, 75020 Paris, France.
| | - Yann Delpech
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France.
| | - Martha Duraes
- CHU de Montpellier, 191, avenue du Doyen-Giraud, 34295 Montpellier cedex, France.
| | - Marc Espié
- Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Luc Fornecker
- Département d'onco-hématologie, ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | - François Golfier
- Centre hospitalier Lyon Sud, bâtiment 3B, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | | | | | - Edith Kermarrec
- Hôpital Tenon, service de radiologie, 4, rue de la Chine, 75020 Paris, France.
| | - Vincent Lavoué
- CHU, service de gynécologie, 16, boulevard de Bulgarie, 35200 Rennes, France.
| | | | - Élisabeth Luporsi
- Oncologie médicale et oncogénétique, CHR Metz-Thionville, hôpital de Mercy, 1, allée du Château, 57085 Metz, France.
| | - Christine M Maugard
- Service de génétique oncologique clinique, unité de génétique oncologique moléculaire, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| | | | | | - Nicolas Taris
- Oncogénétique, ICANS, 17, rue Albert-Calmette, 67033 Strasbourg, France.
| | - Catherine Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - Charlotte Vaysse
- Service de chirurgie oncologique, CHU Toulouse, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France.
| | - Xavier Fritel
- Centre hospitalo-universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
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Mathelin C, Barranger E, Boisserie-Lacroix M, Boutet G, Brousse S, Chabbert-Buffet N, Coutant C, Daraï E, Delpech Y, Duraes M, Espié M, Golfier F, Hamy AS, Kermarrec E, Lavoué V, Lodi M, Luporsi É, Maugard C, Molière S, Seror JY, Taris N, Uzan C, Vaysse C, Fritel X. [Techniques and complications of non-genetic risk reducing mastectomies: Guidelines of the National College of French Gynecologists and Obstetricians (CNGOF)]. Gynecol Obstet Fertil Senol 2022; 50:121-129. [PMID: 34922037 DOI: 10.1016/j.gofs.2021.12.006] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Based on an updated review of the international literature covering the different surgical techniques and complications of risk reducing mastectomies (RRM) in non-genetic context, the Commission of Senology (CS) of the College National des Gynécologues Obstétriciens Français (CNGOF) aimed to establish recommendations on the techniques to be chosen and their implementation. DESIGN The CNGOF CS, composed of 24 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The CS adhered to and followed the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted. METHODS The CS considered 6 questions in 4 thematic areas, focusing on oncologic safety, risk of complications, aesthetic satisfaction and psychological impact, and preoperative modalities. RESULTS The application of the GRADE method resulted in 7 recommendations, 6 with a high level of evidence (GRADE 1±) and 1 with a low level of evidence (GRADE 2±). CONCLUSION There was significant agreement among the CS members on recommendations for preferred surgical techniques and practical implementation.
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Affiliation(s)
- C Mathelin
- CHRU, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | - E Barranger
- Centre Antoine-Lacassagne, 36, avenue de Valombrose, 06189 Nice, France
| | | | - G Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33 000 Bordeaux, France
| | - S Brousse
- CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | | | - C Coutant
- Département d'oncologie chirurgicale, centre Georges-François-Leclerc, 1, rue du Pr Marion, 21079 Dijon cedex, France
| | - E Daraï
- Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Y Delpech
- Centre Antoine Lacassagne, 33, avenue de Valombrose, 06189 Nice, France
| | - M Duraes
- CHU de Montpellier, 191, avenue du Doyen-Giraud, 34295 Montpellier cedex, France
| | - M Espié
- Hôpital St Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - F Golfier
- Centre hospitalier Lyon Sud, bâtiment 3B, 165, chemin du Grand-Revoyet, 69495 Pierre Benite, France
| | - A S Hamy
- Institut Curie, 26, rue d'Ulm, 75248 Paris, France
| | - E Kermarrec
- Service de radiologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - V Lavoué
- Service de gynécologie, CHU, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - M Lodi
- CHU, avenue Molière, 67200 Strasbourg, France
| | - É Luporsi
- Oncologie médicale et oncogénétique, hôpital de Mercy, CHR Metz-Thionville, 1, allée du Château, 57085 Metz, France
| | - C Maugard
- Service de génétique oncologique clinique et unité de génétique oncologique moléculaire, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg
| | - S Molière
- Imagerie du sein, CHRU, avenue Molière 67200 Strasbourg, France
| | - J-Y Seror
- Cabinet privé, 9 ter boulevard Montparnasse, 75006 Paris, France
| | - N Taris
- Oncogénétique, ICANS, 17, rue Albert Calmette, 67033 Strasbourg, France
| | - C Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - C Vaysse
- Service de chirurgie oncologique, CHU de Toulouse, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - X Fritel
- Centre hospitalo-universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Veron L, Wehrer D, Uzan C. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women. JAMA 2022; 327:283-284. [PMID: 35040893 DOI: 10.1001/jama.2021.22299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lucie Veron
- Cancer Medicine Department, Gustave Roussy Institute, Villejuif, France
| | - Delphine Wehrer
- Cancer Medicine Department, Gustave Roussy Institute, Villejuif, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière Hospital, Paris, France
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Egloff C, Mergui JL, Uzan C, Canlorbe G. [Management of HPV-induced cervical lesions in immunosuppressed patients - Review of the literature]. Gynecol Obstet Fertil Senol 2022; 50:82-92. [PMID: 34768006 DOI: 10.1016/j.gofs.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Current French recommendations for the management of cervical lesions related to human papilloma virus (HPV) infection are limited to general population. Patients who are immunocompromised appear to be at increased risk of induced HPV lesions. The objective of this review is to summarize the various existing data about risk of induced HPV lesions in immunocompromised patients to specify the management. METHODS The Medline database was searched through the Pubmed portal, as well as the recommendations of various international learned societies. RESULTS Situations with an increased risk are regardless of treatment: Human Immunodeficiency Virus (HIV) infection, transplants, lupus. Patients with chronic inflammatory bowel disease (IBD) and rheumatoid arthritis are at increased risk only when immunosuppressive therapy is required. Screening for dysplasic intraepithelial lesions in HIV+ patients should be more sustained than in the general population. Due to lack of data, recommendations for other conditions have been extrapolated from the management of HIV+ patients. HPV vaccination is effective in these populations, particularly at times when the immune system is the most effective. DISCUSSION Identified immunocompromised populations are at higher risk of induced HPV lesions due to an incomplete immune response and should be screened on a sustained basis. In addition, HPV vaccination should be encouraged.
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Affiliation(s)
- C Egloff
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-L Mergui
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Société Française de Colposcpopie et de Pathologie Cervico-Vaginale (SFCPCV)
| | - C Uzan
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Universié, Inserm UMR S938 « Biologie et thérapeutique des cancers », Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - G Canlorbe
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Société Française de Colposcpopie et de Pathologie Cervico-Vaginale (SFCPCV); Sorbonne Universié, Inserm UMR S938 « Biologie et thérapeutique des cancers », Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France.
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Akladios C, Daraï É, Golfier F, Lecuru F, Collinet P, Uzan C, Lavoué V, Guyon F, Ferron G, Querleu D. [A curriculum based certification of competence in gynaecologic surgical oncology]. ACTA ACUST UNITED AC 2021; 50:26-32. [PMID: 34774853 DOI: 10.1016/j.gofs.2021.07.003] [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: 04/08/2021] [Accepted: 07/04/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies, the SFOG, the CNGOF, the SFCO and the SCGP, supported by the CNU of Obstetrics &Gynaecology- and UNICANCER, agreed to materialize this course and attest it by a certification awarded by a national jury. MATERIAL AND METHODS The national committee of certification in gynaecological oncology made up of 10 members, representing the 6 concerned organizations, set itself 5 objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification. RESULTS Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including 20 advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including 4 parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021. CONCLUSION The optimisation of the surgical management of patients treated for gynaecological cancer is achieved through the identification of a training course and the certification, by a national jury, of the skills of surgeons who have completed it.
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Affiliation(s)
- C Akladios
- Hôpitaux universitaires de Strasbourg, CHU de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - É Daraï
- Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Golfier
- Centre hospitalier Lyon Sud CHEM Grand Revoyet, hôpital Lyon Sud-Lyon, 69310 Pierre-Bénite, France
| | - F Lecuru
- Institut Curie-Paris, institut Curie Ensemble hospitalier - site de Paris, 26, rue d'Ulm, 75005 Paris, France
| | - P Collinet
- Hôpital Jeanne-de-Flandre-Lille, avenue Eugene-Avinée, 59000 Lille, France
| | - C Uzan
- Hôpital de la Pitié Salpêtrière, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - V Lavoué
- Centre Eugène-Marquis, hôpital Sud, CHU de Rennes, avenue Bataille Flandres-Dunkerque C S 44229, 35042 Rennes, France
| | - F Guyon
- Institut Bergonié, centre de lutte contre le cancer (CLCC) de la région Nouvelle-Aquitaine, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - G Ferron
- Institut universitaire du cancer de Toulouse ONCOPOLE Iuct O, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - D Querleu
- Société européenne d'oncologie gynécologique, 7, allée du Niger, 31000 Toulouse, France
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Bizot A, Karimi M, Rassy E, Heudel PE, Levy C, Vanlemmens L, Uzan C, Deluche E, Genet D, Saghatchian M, Giacchetti S, Grenier J, Patsouris A, Dieras V, Pierga JY, Petit T, Ladoire S, Jacot W, Benderra MA, De Jesus A, Delaloge S, Lambertini M, Pistilli B. Multicenter evaluation of breast cancer patients' satisfaction and experience with oncology telemedicine visits during the COVID-19 pandemic. Br J Cancer 2021; 125:1486-1493. [PMID: 34588616 PMCID: PMC8480754 DOI: 10.1038/s41416-021-01555-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, teleconsultation was implemented in clinical practice to limit patient exposure to COVID-19 while monitoring their treatment and follow-up. We sought to examine the satisfaction of patients with breast cancer (BC) who underwent teleconsultations during this period. METHODS Eighteen centres in France and Italy invited patients with BC who had at least one teleconsultation during the first wave of the COVID-19 pandemic to participate in a web-based survey that evaluated their satisfaction (EORTC OUT-PATSAT 35 and Telemedicine Satisfaction Questionnaire [TSQ] scores) with teleconsultation. RESULTS Among the 1299 participants eligible for this analysis, 53% of participants were undergoing standard post-treatment follow-up while 22 and 17% were currently receiving active anticancer therapy for metastatic and localised cancers, respectively. The mean satisfaction scores were 77.4 and 73.3 for the EORTC OUT-PATSAT 35 and TSQ scores, respectively. In all, 52.6% of participants had low/no anxiety. Multivariable analysis showed that the EORTC OUT-PATSAT 35 score correlated to age, anxiety score and teleconsultation modality. The TSQ score correlated to disease status and anxiety score. CONCLUSION Patients with BC were satisfied with oncology teleconsultations during the COVID-19 pandemic. Teleconsultation may be an acceptable alternative follow-up modality in specific circumstances.
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Affiliation(s)
- Alexandra Bizot
- Medical Oncology Department, Gustave Roussy, Villejui, France
| | - Maryam Karimi
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, University Paris-Saclay, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Elie Rassy
- Medical Oncology Department, Gustave Roussy, Villejui, France
| | | | - Christelle Levy
- Institut Normand du Sein, Centre Francois Baclesse, Caen, France
| | | | - Catherine Uzan
- Breast and Gynecologic Surgery, Assistance Publique - Hopitaux De Paris, Paris, France
| | - Elise Deluche
- Medical Oncology Department, CHU Limoges - Hopital Dupuytren, Limoges, France
| | - Dominique Genet
- Medical Oncology Department, Clinique Chenieux, Limoges, France
| | | | | | - Juline Grenier
- Medical Oncology Department, Institut Ste Catherine, Avignon, France
| | - Anne Patsouris
- Medical Oncology Department, ICO - Institut de Cancérologie de l'Ouest Nantes-Angers, Angers, France
| | - Véronique Dieras
- Medical Oncology Department, Centre Eugene - Marquis, Rennes, France
| | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie & St Cloud, Université de Paris, Paris, France
| | - Thierry Petit
- Medical Oncology Department, Centre Paul Strauss Centre de Lutte contre le Cancer, Strasbourg, France
| | - Sylvain Ladoire
- Medical Oncology Department, Centre Georges-François Leclerc (Dijon), Dijon, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier University, INSERM, U1194, Montpellier, France
| | | | - Anne De Jesus
- Patient Relationship Coordination, Gustave Roussy, Villejuif, France
| | | | - Matteo Lambertini
- Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
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Favier A, Boinon D, Salviat F, Mazouni C, De Korvin B, Tunon C, Salomon AV, Doutriaux-Dumoulin I, Vaysse C, Marchal F, Boulanger L, Chabbert-Buffet N, Zilberman S, Coutant C, Espié M, Cortet M, Boussion V, Cohen M, Fermeaux V, Mathelin C, Michiels S, Delaloge S, Uzan C, Charles C. [Surgery or not on an atypical breast lesion? Taking anxiety into account in shared decision support from a prospective cohort of 300 patients]. ACTA ACUST UNITED AC 2021; 50:142-150. [PMID: 34562643 DOI: 10.1016/j.gofs.2021.09.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Organized and individual breast screening have been accompanied by an increase in the detection of "atypical breast lesions (ABL)". Recently, the NOMAT multicenter study proposed a predictive model of the risk of developing breast cancer after detection of an ABL in order to avoid surgical removal of "low-risk" lesions. It also aimed to provide information on psychological experience, in particularly anxiety, to assist in the shared medical decision process. METHODS Three hundred women undergoing surgery for ABL were included between 2015 and 2018 at 18 French centers. Women completed questionnaires before and after surgery assessing their level of anxiety (STAI-State, STAI-Trait), their level of tolerance to uncertainty, their perceived risk of developing a breast cancer, and their satisfaction with the management care. RESULTS One hundred nighty nine patients completed the STAI-Status before and after surgery. Overall, a decrease in anxiety level (35.4 vs 42.7, P<0.001) was observed. Anxious temperament and greater intolerance to uncertainty were significantly associated swith decreased anxiety (33%), whereas younger age was associated with increased anxiety (8%). CONCLUSION Surgery for ABL seems to be associated with only a few cases with an increase in anxiety and seems to increase the perception of the risk of developing breast cancer. Taking into account the psychological dimension remains in all cases essential in the process of shared therapeutic decision.
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Affiliation(s)
- A Favier
- AP-HP (Assistance Publique des hôpitaux de Paris), department of gynecological and breast surgery and oncology, Pitié-Salpêtrière University Hospital, Paris, France.
| | - D Boinon
- Psycho-oncology unit, Gustave-Roussy, université Paris-Saclay, Villejuif, France; Université de Paris, LPPS, 92100 Boulogne Billancourt, France
| | - F Salviat
- Service de biostatistique et d'épidémiologie, Gustave-Roussy, Villejuif, France; CESP Inserm U1018, université Paris-Saclay, université Paris-Saclay, Villejuif, France
| | | | - B De Korvin
- Radiology center, centre Eugène-Marquis, CLCC, Rennes, France
| | - C Tunon
- Institut Bergonié, Bordeaux, France
| | - A-V Salomon
- Institut Curie, université Paris-Sciences Lettres, Inserm U934, département de médecine diagnostique et théranostique, Paris, France
| | | | - C Vaysse
- Département de chirurgie, CHU-Toulouse, institut universitaire du cancer de Toulouse-Oncopole, Toulouse, France
| | - F Marchal
- Institut de cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | | | | | - S Zilberman
- Hôpital Tenon, Sorbonne university, Paris, France
| | - C Coutant
- Centre Georges François Leclerc, Dijon, France
| | - M Espié
- University of Paris, Breast Unit, hôpital Saint-Louis, AP-HP, Paris, France
| | - M Cortet
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - V Boussion
- Centre Jean-Perrin, Clermont-Ferrand, France
| | - M Cohen
- Institut Paoli Calmettes, Marseille, France
| | - V Fermeaux
- Service de pathologie, CHU Dupuytren, Limoges, France
| | - C Mathelin
- Les Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - S Michiels
- Service de biostatistique et d'épidémiologie, Gustave-Roussy, Villejuif, France; CESP Inserm U1018, université Paris-Saclay, université Paris-Saclay, Villejuif, France
| | | | - C Uzan
- AP-HP (Assistance Publique des hôpitaux de Paris), department of gynecological and breast surgery and oncology, Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, Inserm UMR_S_938, "Cancer Biology and Therapeutics", centre de recherche Saint-Antoine (CRSA), Paris, France; Institut universitaire de cancérologie (IUC), Paris, France
| | - C Charles
- Université de Bordeaux, Bordeaux Population Health (U1219), équipe méthodes pour la recherche interventionnelle en santé des populations (MéRISP), Bordeaux, France
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Canlorbe G, Chabbert-Buffet N, Uzan C. Fertility-Sparing Surgery for Ovarian Cancer. J Clin Med 2021; 10:jcm10184235. [PMID: 34575345 PMCID: PMC8466872 DOI: 10.3390/jcm10184235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/22/2022] Open
Abstract
(1) Background: although most patients with epithelial ovarian cancer (EOC) undergo radical surgery, patients with early-stage disease, borderline ovarian tumor (BOT) or a non-epithelial tumor could be offered fertility-sparing surgery (FSS) depending on histologic subtypes and prognostic factors. (2) Methods: we conducted a systematic review to assess the safety and fertility outcomes of FSS in the treatment of ovarian cancer. We queried the MEDLINE, PubMed, Cochrane Library, and Cochrane (“Cochrane Reviews”) databases for articles published in English or French between 1985 and 15 January 2021. (3) Results: for patients with BOT, FSS should be offered to young women with a desire to conceive, even if peritoneal implants are discovered at the time of initial surgery. Women with mucinous BOT should undergo initial unilateral salpingo-oophorectomy, whereas cystectomy is an acceptable option for women with serous BOT. Assisted reproductive technology (ART) can be initiated in patients with stage I BOT if infertility persists after surgery. For patients with EOC, FSS should only be considered after staging for women with stage IA grade 1 (and probably 2, or low-grade in the current classification) serous, mucinous or endometrioid tumors. FSS could also be offered to patients with stage IC grade 1 (or low-grade) disease. For women with serous, mucinous or endometrioid high-grade stage IA or low-grade stage IC1 or IC2 EOC, bilateral salpingo-oophorectomy and uterine conservation could be offered to allow pregnancy by egg donation. Finally, FSS has a large role to play in patients with non- epithelial ovarian cancer, and particularly women with malignant ovarian germ cell tumors.
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Affiliation(s)
- Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France;
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France;
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
- Correspondence:
| | - Nathalie Chabbert-Buffet
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France;
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
- Department of Gynaecology, Obstetrics and Reproductive Medicine, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020 Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France;
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France;
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
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Azaïs H, Canlorbe G, Uzan C, Belghiti J. ASO Author Reflection: Fertility-Sparing Surgery for Early-Stage Cervical Cancer-What Perspectives Between Oncological Prognosis and Obstetrical Future? Ann Surg Oncol 2021; 29:681-682. [PMID: 34490530 DOI: 10.1245/s10434-021-10780-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Henri Azaïs
- Department of Gynecologic and Breast Oncological Surgery, AP-HP, European Georges-Pompidou University Hospital, Paris, France.
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
| | - Catherine Uzan
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jérémie Belghiti
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
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Belghiti J, Favier A, Uzan C, Motton S, Canlorbe G, Azaïs H. Robotic Radical Trachelectomy with Primary Vaginal Closure to Spare Fertility in Young Patients with Early-Stage Cervical Cancer. Ann Surg Oncol 2021; 29:679-680. [PMID: 34370139 DOI: 10.1245/s10434-021-10550-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our aim was to present the surgical technique of robotic radical trachelectomy (RRT) for early-stage squamous cell cervical cancer in women with a desire to preserve fertility. DESIGN A surgical case to illustrate the entire surgical technique of RRT and sentinel lymph node dissection. Institutional Review Board approval was not required for this video presentation. SETTING University hospital. INTERVENTIONS A 30-year-old patient with one child and no medical history. Pap smear and cervical biopsy were in favor of high-grade squamous intraepithelial lesion, and a conization procedure allowed the diagnosis of a 15 mm squamous cell carcinoma (International Federation of Gynecology and Obstetrics [FIGO] 1B1). An RRT was performed to preserve the fertility of this young patient, after bilateral sentinel lymph node dissection to ensure the absence of nodal metastasis. The trachelectomy specimen was negative at final pathology examination and the disease was confirmed as stage 1B1 (FIGO 2018). There were no surgical complications and no adjuvant treatment was indicated. Fertility-sparing surgery is acceptable for women of childbearing age who want to become pregnant. CONCLUSION Minimally invasive surgery is safe, effective, and particularly adapted for women who wish to preserve their fertility without compromising oncological outcomes.1-2 This option may be safely proposed in expert centers for tumors smaller than 2 cm, with primary vaginal closure, and without use of a uterine manipulator.3 Complete information about oncological and obstetrical outcomes is mandatory and patients should agree to comply with a close follow-up protocol.
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Affiliation(s)
- Jérémie Belghiti
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
| | - Amélia Favier
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
| | - Catherine Uzan
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
| | - Stéphanie Motton
- Department of Surgical Oncology, University Institute of Cancer (IUCT), Oncopôle, Toulouse, France
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
| | - Henri Azaïs
- Department of Gynecologic and Breast Oncological Surgery, European Georges-Pompidou Hospital, Paris, France.
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Akladios C, Daraï É, Golfier F, Lecuru F, Collinet P, Uzan C, Lavoué V, Guyon F, Ferron G, Querleu D. [National certification for gynecological cancer surgery]. Bull Cancer 2021; 108:806-812. [PMID: 34217437 DOI: 10.1016/j.bulcan.2021.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies: the SFOG, the CNGOF, the SFCO and the SCGP supported by the CNU of Obstetrics & Gynaecology, and UNICANCER agreed to materialize this course and attest it by a certification awarded by a national jury. MATERIAL AND METHODS The national committee of certification in gynaecological oncology made up of ten members, representing the 6 concerned organizations, set itself five objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification. RESULTS Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including twenty advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including four parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021.
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Affiliation(s)
- Cherif Akladios
- Hôpitaux universitaires de Strasbourg, CHU de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - Émile Daraï
- AP-HP, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - François Golfier
- Hôpital Lyon Sud-Lyon, centre hospitalier Lyon Sud CHEM Grand Revoyet, 69310 Pierre-Bénite, France
| | - Fabrice Lecuru
- Institut Curie-Paris, Institut Curie Ensemble hospitalier - Site de Paris, 26, rue d'Ulm, 75005 Paris, France
| | - Pierre Collinet
- Hôpital Jeanne-de-Flandre-Lille, avenue Eugene-Avinée, 59000 Lille, France
| | - Catherine Uzan
- AP-HP, Hôpital de la Pitié Salpêtrière, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Vincent Lavoué
- Hôpital Sud Centre Eugène-Marquis, CHU de Rennes, avenue Bataille Flandres-Dunkerque C S 44229, 35042 Rennes, France
| | - Frederic Guyon
- Institut Bergonié, centre de lutte contre le cancer (CLCC) de la région Nouvelle-Aquitaine, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Gwenael Ferron
- Institut universitaire du cancer de Toulouse ONCOPOLE Iuct O, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - Denis Querleu
- Société européenne d'oncologie gynécologique, 7, allée du Niger, 31000 Toulouse, France
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Salviat F, Charles C, Uzan C. Shall patients' anxiety influence surgical decisions for atypical breast lesions? A substudy of the prospective NOMAT trial. Breast Cancer Res Treat 2021; 187:597-599. [PMID: 33710438 DOI: 10.1007/s10549-021-06165-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/24/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Flore Salviat
- Service de Biostatistique Et D'Epidémiologie, Gustave Roussy, 94805, Villejuif, France.,CESP INSERM U1018, Université Paris-Sud, Université Paris-Saclay, 94805, Villejuif, France
| | - Cécile Charles
- Psycho-Oncology Unit, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Catherine Uzan
- AP-HP (Assistance Publique - Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France. .,Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM, UMR_S_938 « Cancer Biology and Therapeutics », Paris, France. .,Institut Universitaire de Cancérologie (IUC), Paris, France.
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Favier A, Rocher G, Larsen AK, Delangle R, Uzan C, Sabbah M, Castela M, Duval A, Mehats C, Canlorbe G. MicroRNA as Epigenetic Modifiers in Endometrial Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13051137. [PMID: 33800944 PMCID: PMC7961497 DOI: 10.3390/cancers13051137] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/02/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Endometrial cancer (EC) is the 2nd most common gynecologic cancer worldwide. MicroRNAs (miRNAs) are small noncoding RNAs that contribute to epigenetic regulation. The objective of this systematic review is to summarize our current knowledge on the role of miRNAs in the epigenetic deregulation of tumor-related genes in EC. It includes all miRNAs reported to be involved in EC including their roles in DNA methylation and RNA-associated silencing. This systematic review should be useful for development of novel strategies to improve diagnosis and risk assessment as well as for new treatments aimed at miRNAs, their target genes or DNA methylation. Abstract The objective of this systematic review is to summarize our current knowledge on the influence of miRNAs in the epigenetic deregulation of tumor-related genes in endometrial cancer (EC). We conducted a literature search on the role of miRNAs in the epigenetic regulation of EC applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following terms were used: microRNA, miRNA, miR, endometrial cancer, endometrium, epigenetic, epimutation, hypermethylation, lynch, deacetylase, DICER, novel biomarker, histone, chromatin. The miRNAs were classified and are presented according to their function (tumor suppressor or onco-miRNA), their targets (when known), their expression levels in EC tissue vs the normal surrounding tissue, and the degree of DNA methylation in miRNA loci and CpG sites. Data were collected from 201 articles, including 190 original articles, published between November 1, 2008 and September 30, 2020 identifying 313 different miRNAs implicated in epigenetic regulation of EC. Overall, we identified a total of 148 miRNAs with decreased expression in EC, 140 miRNAs with increased expression in EC, and 22 miRNAs with discordant expression levels. The literature implicated different epigenetic phenomena including altered miRNA expression levels (miR-182, -230), changes in the methylation of miRNA loci (miR-34b, -129-2, -130a/b, -152, -200b, -625) and increased/decreased methylation of target genes (miR-30d,-191). This work provides an overview of all miRNAs reported to be involved in epigenetic regulation in EC including DNA methylation and RNA-associated silencing. These findings may contribute to novel strategies in diagnosis, risk assessment, and treatments aimed at miRNAs, their target genes or DNA methylation.
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Affiliation(s)
- Amélia Favier
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; (A.K.L.); (C.U.); (M.S.)
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; (G.R.); (R.D.)
- Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Unité Mixte de Recherche Scientifique 938 and SIRIC CURAMUS, INSERM, Sorbonne Université, 75012 Paris, France;
- Correspondence: (A.F.); (G.C.)
| | - Grégoire Rocher
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; (G.R.); (R.D.)
- Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Unité Mixte de Recherche Scientifique 938 and SIRIC CURAMUS, INSERM, Sorbonne Université, 75012 Paris, France;
| | - Annette K. Larsen
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; (A.K.L.); (C.U.); (M.S.)
| | - Romain Delangle
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; (G.R.); (R.D.)
| | - Catherine Uzan
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; (A.K.L.); (C.U.); (M.S.)
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; (G.R.); (R.D.)
| | - Michèle Sabbah
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; (A.K.L.); (C.U.); (M.S.)
| | - Mathieu Castela
- Scarcell Therapeutics, 101 rue de Sèvres, 75006 Paris, France;
| | - Alex Duval
- Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Unité Mixte de Recherche Scientifique 938 and SIRIC CURAMUS, INSERM, Sorbonne Université, 75012 Paris, France;
| | - Céline Mehats
- U1016, CNRS, UMR8104, Institut Cochin, INSERM, Université de Paris, 75014 Paris, France;
| | - Geoffroy Canlorbe
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; (A.K.L.); (C.U.); (M.S.)
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; (G.R.); (R.D.)
- Correspondence: (A.F.); (G.C.)
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Belghiti J, Pinar U, Roupret M, Belghiti J, Uzan C, Canlorbe G, Betser L, Iquille J, Roussel A, Castier Y, Mordant P, Valverde A. [Robots set up in the operating theater]. Rev Prat 2021; 71:335-340. [PMID: 34161044] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
"Robots set up in the operating theater. The patient's benefit after a minimally invasive approach stimulated the robotic approach of abdominal and thoracic surgical procedures. Although much more expensive, the robots improve the vision of the operating field, the precision of the gestures with a faster training course for the surgeon who operates more comfortably. Surgeons eager for technological progress quickly adopted this technique in urology and gynecology and then in thoracic and digestive procedures. In France, the support for this innovation by academic and medical institutions is limited by several factors including the supremacy of Intuitive which imposes its prices, the absence of scientifically proven superiority, the absence of surveys under the responsibility of scientific societies and the lack of criteria concerning the surgeon training."
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Affiliation(s)
- Jacques Belghiti
- "Professeur émérite de chirurgie, université de Paris-Diderot ; ancien membre du collège de la Haute Autorité de santé et président de la Commission d'évaluation des actes et des dispositifs médicaux, Paris, France"
| | - Ugo Pinar
- "Service d'urologie de l'hôpital La Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France"
| | - Morgan Roupret
- "Service d'urologie de l'hôpital La Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France"
| | - Jérémie Belghiti
- "Service de chirurgie et cancérologie gynécologique, hôpital La Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France"
| | - Catherine Uzan
- "Service de chirurgie et cancérologie gynécologique, hôpital La Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France"
| | - Geoffroy Canlorbe
- "Service de chirurgie et cancérologie gynécologique,hôpital La Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France"
| | - Léa Betser
- "Service de chirurgie vasculaire, thoracique, et transplantation pulmonaire, hôpital Bichat, AP-HP Université de Paris, Paris, France"
| | - Jules Iquille
- "Service de chirurgie vasculaire, thoracique, et transplantation pulmonaire, hôpital Bichat, AP-HP Université de Paris, Paris, France"
| | - Arnaud Roussel
- "Service de chirurgie vasculaire, thoracique, et transplantation pulmonaire, hôpital Bichat, AP-HP Université de Paris, Paris, France"
| | - Yves Castier
- "Service de chirurgie vasculaire, thoracique, et transplantation pulmonaire, hôpital Bichat, AP-HP Université de Paris, Paris, France"
| | - Pierre Mordant
- "Service de chirurgie vasculaire, thoracique, et transplantation pulmonaire, hôpital Bichat, AP-HP Université de Paris, Paris, France"
| | - Alain Valverde
- Groupe hospitalier Diaconesses Croix-Saint-Simon, 125, rue d'Avron, 75020, Paris, France
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Haimeur Y, Canlorbe G, Gonthier C, Belghiti J, Uzan C, Azaïs H. [How I do… a laparoscopic lateral ovarian transposition with uterine fixation before pelvic radiation therapy]. Gynecol Obstet Fertil Senol 2021; 49:204-207. [PMID: 32919089 DOI: 10.1016/j.gofs.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Y Haimeur
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France
| | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France; Sorbonne Université, Paris, France
| | - C Gonthier
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France
| | - J Belghiti
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France; Sorbonne Université, Paris, France
| | - H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France.
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Renaudeau C, Rouzier R, Gimbergues P, Gutowski M, Jouve E, Rauch P, Coutant C, Faure C, Uzan C, Dupré PF, Ceccato V, N'go C, Reynard A, Doutriaux I, Campion L, Classe JM. Abstract PS1-43: Axillary surgery after neoadjuvant chemotherapy in patients treated for an operable breast cancer with a proven initially positive axillary node: Preliminary results of identification and removal of the initially positive axillary node. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps1-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BackgroundAlmost half of the patient with initially metastatic axillary node, treated with neoadjuvantchemotherapy (NAC) for a large operable breast cancer, has no axillary lymph node involvementat the time of surgery after NAC. Sentinel lymph node detection (SLND), performed after NAC,has a high false negative rate (FNR) when compared to FNR after primary surgery. GANEA 3 isa French prospective multi institutional ongoing trial, aimed at assessing the impact of targeting,before NAC, the initially positive node and removing it after NAC. The main objective of GANEA3 trial is the accuracy of this initially positive node to predict pathological status of the otheraxillary nodes after NAC. A total of 385 patients are required.ObjectiveThe current abstract assessed preliminary results of the detection rate of the clipped node and thedifferent methods to find it during axillary surgery based on the first 41 patients.Patients and MethodThis study is part of GANEA 3 Trial validated by scientific national board (clinicialtrials.gov:NCT03630913).Inclusion criteria: TNM stage T1-T3 N1 infiltrating breast carcinoma, indication of NAC, andsigned consent form,Exclusion criteria: more than 5 suspicious axillary nodes, inflammatory cancer, local relapse,mental disorder, pregnancy or no contraceptive method, contra-indication to NAC, NACinterrupted due to progressive disease.Design: Patients treated for an early breast cancer with NAC, axillary sonography with fine needlecytology before NAC to select patients with a proven lymph node involvement. Initially positive node identification warranted, for example with a clip. After NAC patients underwent the removalof the clipped node, a SLN detection with the combined method (patent blue and technetium) andan axillary lymph node dissection (ALND). In order to find the clipped node, during surgery thesurgeon attempted to find it with palpation and sonography. Each surgical specimen was then x-rayed before pathological examination.Studied parameters were clipped node and SLND detection rate, and the methods used to find theclipped node.ResultsFrom January 2019, to November 2019, 41 patients were enrolled, from 13 institutions, withinitially positive axillary node clipped, NAC courses and surgery after NAC.Median age was 53 (31-75), pathological subtype infiltrative ductal carcinoma (n=40) andinfiltrative lobular carcinoma (n=1), a median of 7 courses of NAC (1-16).SLN detection rate was 90% (37/41). A median number of 2 sentinel nodes were removed (1-7).The clipped node was removed in 100% of cases. The clipped node was identified by thesurgeon palpation (n=11), an axillary wire (n=13), per operative axillary sonography (n=4),surgical specimen radiography (n=11), the pathologist (n=2).The clipped node was part of SLN in 29 cases (70%). It was part of axillary lymphadenectomyspecimen in 6 cases (14.5%) and was find alone as an isolated node in 6 cases (14.5%).ConclusionThe clipped node was always found after NAC. It was mostly always part of SLN or ALNDspecimens. Further studies are needed in order to help the surgeon to remove only the clippednode.
Citation Format: Celine Renaudeau, Roman Rouzier, Pierre Gimbergues, Marian Gutowski, Eva Jouve, Philippe Rauch, Charles Coutant, Christelle Faure, Catherine Uzan, Pierre-François Dupré, Vivien Ceccato, Charlotte N'go, Augustin Reynard, Isabelle Doutriaux, Loic Campion, Jean-Marc Classe. Axillary surgery after neoadjuvant chemotherapy in patients treated for an operable breast cancer with a proven initially positive axillary node: Preliminary results of identification and removal of the initially positive axillary node [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-43.
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Affiliation(s)
| | | | | | | | - Eva Jouve
- 5InstitutUniversitaire de Cancerologie de Toulouse, Toulouse, France
| | | | | | | | | | | | | | - Charlotte N'go
- 12Centre Hospitalier Europeen Georges Pompidou, Paris, France
| | | | | | - Loic Campion
- 1Institut de Cancerologie de l'Ouest, Saint Herblain, France
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Sindou-Faurie T, Louis-Vahdat C, Oueld Es Cheikh E, Canlorbe G, Mergui JL, Uzan C, Azaïs H. Correction to: Evaluation of the efficacy of fractional CO 2 laser in the treatment of vulvar and vaginal menopausal symptoms. Arch Gynecol Obstet 2021; 303:965-966. [PMID: 33415440 DOI: 10.1007/s00404-020-05926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Sindou-Faurie
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - C Louis-Vahdat
- Medicine Cabinet, 126 boulevard Saint-Germain, 75006, Paris, France
| | - E Oueld Es Cheikh
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - G Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - J L Mergui
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - C Uzan
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - H Azaïs
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France.
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Azaïs H, Vignion-Dewalle AS, Carrier M, Augustin J, Da Maïa E, Penel A, Belghiti J, Nikpayam M, Gonthier C, Ziane L, Mordon S, Collinet P, Canlorbe G, Uzan C. Microscopic Peritoneal Residual Disease after Complete Macroscopic Cytoreductive Surgery for Advanced High Grade Serous Ovarian Cancer. J Clin Med 2020; 10:E41. [PMID: 33375564 PMCID: PMC7795826 DOI: 10.3390/jcm10010041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Epithelial ovarian cancers (EOC) are usually diagnosed at an advanced stage and managed by complete macroscopic cytoreductive surgery (CRS) and systemic chemotherapy. Peritoneal recurrence occurs in 60% of patients and may be due to microscopic peritoneal metastases (mPM) which are neither eradicated by surgery nor controlled by systemic chemotherapy. The aim of this study was to assess and quantify the prevalence of residual mPM after complete macroscopic CRS in patients with advanced high-grade serous ovarian cancer (HGSOC). METHODS A prospective study conducted between 1 June 2018 and 10 July 2019 in a single referent center accredited by the European Society of Gynecological Oncology for advanced EOC management. Consecutive patients presenting with advanced HGSOC and eligible for complete macroscopic CRS were included. Up to 13 peritoneal biopsies were taken from macroscopically healthy peritoneum at the end of CRS and examined for the presence of mPM. A mathematical model was designed to determine the probability of presenting at least one mPM after CRS. RESULTS 26 patients were included and 26.9% presented mPM. There were no differences in characteristics between patients with or without identified mPM. After mathematical analysis, the probability that mPM remained after complete macroscopic CRS in patients with EOC was 98.14%. CONCLUSION Microscopic PM is systematically present after complete macroscopic CRS for EOC and could be a relevant therapeutic target. Adjuvant locoregional strategies to conventional surgery may improve survival by achieving microscopic CRS.
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Affiliation(s)
- Henri Azaïs
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
- U1189-ONCO-THAI-Laser Assisted Therapy and Immunotherapies for On-cology, CHU Lille, Université de Lille, INSERM, F-59000 Lille, France; (A.-S.V.-D.); (L.Z.); (S.M.); (P.C.)
| | - Anne-Sophie Vignion-Dewalle
- U1189-ONCO-THAI-Laser Assisted Therapy and Immunotherapies for On-cology, CHU Lille, Université de Lille, INSERM, F-59000 Lille, France; (A.-S.V.-D.); (L.Z.); (S.M.); (P.C.)
| | - Marine Carrier
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
| | - Jeremy Augustin
- AP-HP, Pitié-Salpêtrière Hospital, Department of Pathology, 75013 Paris, France; (J.A.); (E.D.M.)
| | - Elisabeth Da Maïa
- AP-HP, Pitié-Salpêtrière Hospital, Department of Pathology, 75013 Paris, France; (J.A.); (E.D.M.)
| | - Alix Penel
- AP-HP, Pitié-Salpêtrière Hospital, Centre de Pharmaco-épidémiologie de l’APHP (CEPHEPI), 75013 Paris, France;
| | - Jérémie Belghiti
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
| | - Marianne Nikpayam
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
| | - Clémentine Gonthier
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
| | - Laurine Ziane
- U1189-ONCO-THAI-Laser Assisted Therapy and Immunotherapies for On-cology, CHU Lille, Université de Lille, INSERM, F-59000 Lille, France; (A.-S.V.-D.); (L.Z.); (S.M.); (P.C.)
| | - Serge Mordon
- U1189-ONCO-THAI-Laser Assisted Therapy and Immunotherapies for On-cology, CHU Lille, Université de Lille, INSERM, F-59000 Lille, France; (A.-S.V.-D.); (L.Z.); (S.M.); (P.C.)
| | - Pierre Collinet
- U1189-ONCO-THAI-Laser Assisted Therapy and Immunotherapies for On-cology, CHU Lille, Université de Lille, INSERM, F-59000 Lille, France; (A.-S.V.-D.); (L.Z.); (S.M.); (P.C.)
- CHRU Lille, Jeanne de Flandre Hospital, Department of Gynecology, 59000 Lille, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
- Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, 75020 Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne University, 75013 Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
- Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, 75020 Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne University, 75013 Paris, France
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Lambertini M, Peccatori FA, Demeestere I, Amant F, Wyns C, Stukenborg JB, Paluch-Shimon S, Halaska MJ, Uzan C, Meissner J, von Wolff M, Anderson RA, Jordan K. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines †. Ann Oncol 2020; 31:1664-1678. [PMID: 32976936 DOI: 10.1016/j.annonc.2020.09.006] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy; Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - F A Peccatori
- Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - I Demeestere
- Research Laboratory on Human Reproduction, Fertility Clinic, CUB-Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - F Amant
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium
| | - C Wyns
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - J-B Stukenborg
- NORDFERTIL Research Lab Stockholm, Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
| | - S Paluch-Shimon
- Division of Oncology, Sharrett Institute of Oncology, Hadassah University Hospital, Jerusalem, Israel
| | - M J Halaska
- Department of OB/GYN, 3(rd) Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - C Uzan
- Department of Breast and Gynecologic Surgery, APHP, Hospital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - J Meissner
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Germany
| | - M von Wolff
- University Women's Hospital, Division Gynecological Endocrinology and Reproductive Medicine, Bern, Switzerland
| | - R A Anderson
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Germany
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Bourdel N, Huchon C, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, Mathieu D'argent E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: Guidelines from the French national college of obstetricians and gynecologists (CNGOF). Eur J Obstet Gynecol Reprod Biol 2020; 256:492-501. [PMID: 33262005 DOI: 10.1016/j.ejogrb.2020.11.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 10/28/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
It is recommended to classify Borderline Ovarian Tumors (BOTs) according to the WHO classification. Transvaginal and suprapubic ultrasonography are recommended for the analysis of an ovarian mass (Grade A). In case of an undetermined ovarian lesion on ultrasonography, it is recommended to perform a pelvic MRI (Grade A) with a score for malignancy (ADNEX MR/O-RADS) (Grade C) included in the report and to formulate a histological hypothesis (Grade C). Pelvic MRI is recommended to characterize a tumor suspected of being BOT (Grade C). It is recommended to evaluate serum levels of HE4 and CA125 and to use the ROMA score for the diagnosis of indeterminate ovarian mass on imaging (grade A). If there is a suspicion of a mucinous BOT on imaging, serum levels of CA 19-9 may be proposed (Grade C). For Early Stages (ES) of BOT, if surgery without risk of tumor rupture is possible, laparoscopy with protected extraction is recommended over laparotomy (Grade C). For treatment of a bilateral serous ES BOT with a strategy to preserve fertility and/or endocrine function, bilateral cystectomy is recommended where possible (Grade B). For mucinous BOTs with a treatment strategy of fertility and/or endocrine function preservation, unilateral salpingo-oophorectomy is recommended (grade C). For mucinous BOTs treated by initial cystectomy, unilateral salpingo-oophorectomy is recommended (grade C). For serous or mucinous ES BOTs, routine hysterectomy is not recommended (Grade C). For ES BOTs, lymphadenectomy is not recommended (Grade C). For ES BOTs, appendectomy is recommended only in case of a macroscopically pathological appendix (Grade C). Restaging surgery is recommended in cases of serous BOTs with micropapillary architecture and an incomplete abdominal cavity inspection during initial surgery (Grade C). Restaging surgery is recommended for mucinous BOTs after initial cystectomy or in cases where the appendix was not examined (Grade C). If restaging surgery is decided for ES BOTs, the following procedures should be performed: peritoneal washing (grade C), omentectomy (grade B), complete exploration of the abdominal cavity with peritoneal biopsies (grade C), visualization of the appendix and appendectomy in case of a pathological macroscopic appearance (grade C) as well as unilateral salpingo-oophorectomy in case of a mucinous BOT initially treated by cystectomy (grade C). In advanced stages (AS) of BOT, it is not recommended to perform a lymphadenectomy as a routine procedure (Grade C). For AS BOT in a patient with a desire to fall pregnant, conservative treatment involving preservation of the uterus and all or part of the ovary may be proposed (Grade C). Restaging surgery aimed at removing all lesions, not performed initially, is recommended for AS BOTs (Grade C). After treatment, follow-up for a duration greater than 5 years is recommended due to the median recurrence time of BOTs (Grade B). It is recommended that a systematic clinical examination be carried out during follow-up of a treated BOT (Grade B). If the determination of tumor markers is normal preoperatively, the routine dosage of tumor markers in BOT follow-up is not recommended (Grade C). In case of an initial elevation in serum CA 125 levels, it is recommended to monitor CA 125 during follow up (Grade B). In case of conservative treatment, it is recommended to use transvaginal and transabdominal ultrasound during follow up of a treated BOT (Grade B). In the event of a BOT recurrence in a woman of childbearing age, a second conservative treatment may be proposed (Grade C). A consultation with a physician specialized in Assisted Reproductive Technique (ART) should be offered in the case of BOTs in women of childbearing age (Grade C). When possible, a conservative surgical strategy is recommended to preserve fertility in women of childbearing age (Grade C). In the case of optimally treated BOT, there is no evidence to contraindicate the use of ART. The use of hormonal contraception after serous or mucinous BOT is not contraindicated (Grade C). After management of mucinous BOT, for women under 45 years, given the benefit of Hormonal Replacement Therapy (HRT) on cardiovascular and bone risks, and the lack of hormone sensitivity of mucinous BOTs, it is recommended to offer HRT (Grade C). Over 45 years of age, HRT can be prescribed in case of a climacteric syndrome after individual benefit to risk assessment (Grade C).
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Affiliation(s)
- N Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - C Huchon
- Service de Gynécologie & Obstétrique, Hopital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France; Université de Paris, Paris, France.
| | - C Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France; Faculté De Médecine UPMC, Sorbonne Université, France
| | - H Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - S Bendifallah
- Service De Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
| | - P A Bolze
- Service De Chirurgie Gynécologique Et Oncologique, Obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - J L Brun
- Service De Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, Société Française De Gynéco Pathologie, 81 Rue Verte, 76000 Rouen, France
| | - G Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - P Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - E Chereau
- Service De Gynécologie Obstétrique, Hopital Saint Joseph, Marseille, France
| | - B Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | | | - M Devouassoux-Shisheboran
- Institut De Pathologie Multi-Sites Des HOSPICES CIVILS De LYON, Centre Hospitalier Lyon Sud, Centre De Biologie Et Pathologie Sud, 165 Chemin Du Grand Revoyet, 69495 Pierre Bénite. Société Française de Gynéco Pathologie, 81 Rue Verte, 76000 Rouen, France
| | - C Eymerit-Morin
- Service d'Anatomie Et Cytologie Pathologiques, Hôpital Tenon, HUEP, UPMC Paris VI, Sorbonne Universities, 4 rue de la Chine, 75020 Paris, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240 Malakoff, France
| | - R Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, Caen, France
| | - E Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - T Gauthier
- Service De Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 Av Dominique Larrey 87042 Limoges, France
| | - M Grynberg
- Service De Médecine De La Reproduction, Hôpital Antoine Béclère, 157 Rue De La Porte De Trivaux, 92140 Clamart, France
| | - M Koskas
- Service De Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - E Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - L Lecointre
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - J Levêque
- Département De Gynécologie Obstétrique Et Reproduction Humaine, 16, Boulevard De Bulgarie, 35000 CHU Anne De Bretagne, UFR Médecine Université de Rennes 1, Rennes, Bretagne, France
| | - F Margueritte
- Service De Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 Av Dominique Larrey, 87042 Limoges, France
| | - E Mathieu D'argent
- Service de Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
| | - K Nyangoh-Timoh
- Département De Gynécologie Obstétrique Et Reproduction Humaine, 16, Boulevard De Bulgarie, 35000 CHU Anne De Bretagne, UFR Médecine Université de Rennes 1, Rennes, Bretagne, France
| | - L Ouldamer
- Département De Gynécologie, Centre Hospitalier Universitaire De Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - J Raad
- Service De Médecine De La Reproduction, Hôpital Antoine Béclère, 157 Rue De La Porte De Trivaux, 92140 Clamart, France
| | - E Raimond
- Département de Gynécologie Obstétrique, Institut Alix De Champagne, CHU Reims, Reims, France
| | - R Ramanah
- Pôle Mère-Femme, CHU Besançon, 3 Boulevard Fleming, 25000 Besançon, France
| | - L Rolland
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | - P Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
| | - C Rousset-Jablonski
- Centre Léon Bérard, 28 Rue Laënnec, 69008, Lyon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - I Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - C Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - M Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital De Hautepierre, CHRU Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - E Daraï
- Service de Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
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Sindou-Faurie T, Louis-Vahdat C, Oueld Es Cheikh E, Canlorbe G, Mergui JL, Uzan C, Azaïs H. Evaluation of the efficacy of fractional CO 2 laser in the treatment of vulvar and vaginal menopausal symptoms. Arch Gynecol Obstet 2020; 303:955-963. [PMID: 33179118 DOI: 10.1007/s00404-020-05868-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/09/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The objective of this study was to evaluate the efficacy of fractional CO2 laser to manage vulvar and vaginal symptoms of Genitourinary Syndrome of Menopause (GSM) in postmenopausal women. METHODS All postmenopausal women with symptoms of GSM undergoing fractional CO2 laser treatment in our centers were asked to fill out a validated quality of life questionnaire (Global Quality of Life Questionnaire), Visual Analog Scale (VAS) for symptoms, a questionnaire on overall discomfort related to pelvic floor symptoms, and the Female Sexual Function Index (FSFI) at several points: before each session (three sessions at monthly intervals) and one 3 months after treatment completion. Statistical analysis compared pre-therapy data and data at 3 months of treatment. RESULTS Forty-six women were included with a mean age of 57.3 years (± 11.1 years). A significant improvement was demonstrated in vaginal dryness (p = 6.34 10-6) and for symptoms of stress urinary incontinence (p = 0.043). Among sexually active patients, there was a significant improvement in the degree of symptom discomfort affecting their satisfaction (p = 0.007), dyspareunia (p = 0.001) and sensitivity during sexual intercourse (p = 0.001). Significantly, more women were able to achieve (p = 0.026) and maintain (p = 0.018) lubrication during intercourse. CONCLUSION CO2 laser treatment seems to improve the quality of life and sexual health of patients as well as GSM symptoms at 3 months of treatment; long-term reevaluation is necessary to demonstrate that improvement persists over time.
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Affiliation(s)
- T Sindou-Faurie
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - C Louis-Vahdat
- Medicine Cabinet, 126 boulevard Saint-Germain, 75006, Paris, France
| | - E Oueld Es Cheikh
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - G Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - J L Mergui
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - C Uzan
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - H Azaïs
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France.
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Courcier H, Azaïs H, Belghiti J, Uzan C, Canlorbe G. Minimally invasive surgery for early-stage cervical cancer: Rediscovering the Schautheim robot-assisted procedure. J Gynecol Obstet Hum Reprod 2020; 50:101980. [PMID: 33186773 DOI: 10.1016/j.jogoh.2020.101980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/04/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The Laparoscopic Approach to Cervical Cancer (LACC) trial recently showed a significant inferiority of the minimally invasive surgery when we considered them both equivalent in the treatment of cervical cancer. The objective of this article is to describe and discuss the interest of the Schautheim procedure. SURGICAL TECHNIQUE The Schautheim is the association of a radical hysterectomy by laparoscopy/robot assisted or not as described by Wertheim after a primary vaginal closure, like the first step of Schauta's hysterectomy. This technique is described in ten steps, with a video material. DISCUSSION The return to open surgery could lead to a loss of benefits associated with the laparoscopic approach in terms of per and post-operative morbidity. One way to achieve similar results would be to prohibit the use of uterine manipulators and create a vaginal cuff. CONCLUSION Several authors suggest that early-stage cervical cancer patients could still be operated by laparoscopy without reducing overall survival or increasing risk of recurrence if certain measures are followed.
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Affiliation(s)
- Hélène Courcier
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Henri Azaïs
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France.
| | - Jérémie Belghiti
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Catherine Uzan
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France; NSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, France; Institut Universitaire de Cancérologie (IUC), Sorbonne University, Paris, France
| | - Geoffroy Canlorbe
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France; NSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, France; Institut Universitaire de Cancérologie (IUC), Sorbonne University, Paris, France
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Huchon C, Bourdel N, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, Mathieu D'argent E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: French guidelines from the CNGOF. Part 1. Epidemiology, biopathology, imaging and biomarkers. J Gynecol Obstet Hum Reprod 2020; 50:101965. [PMID: 33160106 DOI: 10.1016/j.jogoh.2020.101965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The incidence (rate per 100 000) of borderline ovarian tumors (BOTs) increases progressively with age, starting at 15-19 years and peaking at around 4.5 cases per 100 000 at an age of 55-59 years (LE3) with a median age of 46 years. The five year survival for FIGO stages I, II, III and IV is 99.7 % (95 % CI: 96.2-100 %), 99.6 % (95 % CI: 92.6-100 %), 95.3 % (95 % CI: 91.8-97.4 %) and 77.1 % (95 % CI: 58.0-88.3 %), respectively (LE3). An epidemiological association exists between the individual risk of BOT and family history of BOT and certain other cancers (pancreatic, lung, bone, leukemia) (LE3), a personal history of benign ovarian cyst (LE2), a personal history of tubo-ovarian infection (LE3), the use of a levonorgestrel intrauterine device (LE3), oral contraceptive use (LE3), multiparity (LE3), Hormonal replacement therapy (LE3), high consumption of Coumestrol (LE4), medical treatment for infertility with progesterone (LE3) and non-steroidal anti-inflammatory drug use (LE3). Screening for BOTs is not recommended for patients (Grade C). The overall risk of recurrence of BOTs varies between 2% and 24 %, with an overall survival greater than 94 % at 10 years, and the risk of an invasive recurrence of a BOT ranges from 0.5 % to 3.8 %. The use of scores and nomograms can be useful in assessing the risk of recurrence, and providing patients with information (Grade C). The WHO classification is recommended for classifying BOTs. It is recommended that the presence of a microinvasive focus (<5 mm) and microinvasive carcinoma (<5 mm with an atypical nuclei and a desmoplastic stroma reaction) within a BOT be reported. In cases of serous BOT, it is recommended to specify the classic histological subtype or micropapillary / cribriform type (Grade C). When confronted with a BOT, it is recommended that the invasive or non-invasive nature of peritoneal implants can be investigated based solely on the invasion and destruction of underlying adipose or peritoneal tissue which has a desmoplastic stromal reaction where in contact with the invasive clusters (Grade B). For bilateral mucinous BOTs and / or in cases with peritoneal implants or peritoneal pseudomyxoma, it is recommended to also look for a primitive digestive or pancreato-biliary cancer (Grade C). It is recommended to sample ovarian tumors suspected of being BOTs by focusing samples on vegetations and solid components, with at least 1 sample per cm in tumors with a size less than 10 cm and 2 samples per cm in tumors with a size greater than 10 cm (Grade C). In cases of BOTs and in the absence of macroscopic omental involvement after careful macroscopic examination, it is recommended to perform at least 4-6 systematic sampling blocks and to include all peritoneal implants (Grade C). It is recommended to consult an expert pathologist in gynecology when a BOT suspicion requires intraoperative extemporaneous histology (grade C). Endo-vaginal and suprapubic ultrasonography are recommended for the analysis of an ovarian mass (Grade A). In case of an undetermined ovarian lesion on ultrasonography, it is recommended that a pelvic MRI be performed (Grade A). To analyze an adnexal mass with MRI, it is recommended to use an MRI protocol with T2, T1, T1 Fat Sat, dynamic and diffusion sequences as well as gadolinium injection (Grade B). To characterize an adnexal mass with MRI, it is recommended to include a score system for malignancy (ADNEX MR/O-RADS) (Grade C) in the report and to formulate a histological hypothesis (Grade C). Pelvic MRI is recommended to characterize a tumor suspected of being a BOT (Grade C). Macroscopic MRI features should be analyzed to differentiate BOT subtypes (Grade C). Pelvic ultrasound is the first-line examination for the detection and characterization of adnexal masses during pregnancy (Grade C). Pelvic MRI is recommended from 12 weeks of gestation in case of an indeterminate adnexal mass and should provide a diagnostic score (Grade C). Gadolinium injection must be minimized as fetal impairment has been proven (Grade C). It is recommended that serum levels of HE4 and CA125 be evaluated and that the ROMA score for the diagnosis of an indeterminate ovarian mass on imaging be used (grade A). In case of suspicion of a mucinous BOT on imaging, dosage of serum levels of CA 19-9 can be considered (Grade C). If the determination of tumor markers is normal preoperatively, routine dosage of tumor markers in BOT follow-up is not recommended (Grade C). In case of preoperative elevation in tumor markers, the determination of serum CA 125 levels is recommended in the follow-up of BOT (Grade B). When conservative treatment of a BOT has been adopted, the use of endovaginal and transabdominal ultrasonography is recommended during follow-up (Grade B).
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Affiliation(s)
- Cyrille Huchon
- APHP. Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010 Paris, France.
| | - Nicolas Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - Cendos Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Henri Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Sofiane Bendifallah
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Pierre-Adrien Bolze
- Service de chirurgie gynécologique et oncologique, obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Jean-Luc Brun
- Service de Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, France; Société Française de Gynéco Pathologie, 81 rue verte, 76000 Rouen, France
| | - Geoffroy Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Pauline Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - Elisabeth Chereau
- Service de gynécologie obstétrique, Hopital Saint Joseph, 13005 Marseille, France
| | - Blandine Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | | | - Mojgan Devouassoux-Shisheboran
- Institut de Pathologie multi-sites des HOSPICES CIVILS de LYON, Centre Hospitalier Lyon Sud, Centre de biologie et pathologie Sud, 165 Chemin du Grand revoyet, 69495 Pierre Bénite, France; Société Française de Gynéco Pathologie, 81 rue verte, 76000 Rouen, France
| | - Caroline Eymerit-Morin
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Tenon, HUEP, 4 rue de la Chine, 75020 Paris, France; UPMC Paris VI, Sorbonne Universities, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240 Malakoff, France
| | - Raffaele Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, 14000 Caen, France
| | - Elodie Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
| | - Tristan Gauthier
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042 Limoges, France
| | - Michael Grynberg
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Martin Koskas
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
| | - Elise Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
| | - Lise Lecointre
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000 Strasbourg, France
| | - Jean Levêque
- Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, 35000 Rennes, France; CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000 Rennes, Bretagne, France
| | - Francois Margueritte
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042 Limoges, France
| | - Emmanuelle Mathieu D'argent
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Krystel Nyangoh-Timoh
- Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, 35000 Rennes, France; CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000 Rennes, Bretagne, France
| | - Lobna Ouldamer
- Département de Gynécologie, Centre hospitalier universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Jade Raad
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Emilie Raimond
- Département de Gynécologie Obstétrique, Institut Alix de Champagne, CHU Reims, 51000 Reims, France
| | - Rajeev Ramanah
- Pôle Mère-Femme, CHU Besançon, 3 boulevard Fleming, 25000 Besançon, France
| | - Lucie Rolland
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | - Pascal Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Christine Rousset-Jablonski
- Centre Léon Bérard, 28 Rue Laënnec, 69008, Lyon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - Isabelle Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Catherine Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Marie Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000 Strasbourg, France
| | - Emile Daraï
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
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Bourdel N, Huchon C, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, D'argent Mathieu E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: French guidelines from the CNGOF. Part 2. Surgical management, follow-up, hormone replacement therapy, fertility management and preservation. J Gynecol Obstet Hum Reprod 2020; 50:101966. [PMID: 33144266 DOI: 10.1016/j.jogoh.2020.101966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the Early Stages (ES) of Borderline Ovarian Tumor (BOT), if surgery without risk of tumor rupture is possible, then laparoscopy with protected extraction is recommended over laparotomy (Grade C). In case of bilateral serous ES BOT treatment with a strategy to preserve fertility and/or endocrine function, bilateral cystectomy is recommended if possible (Grade B). In case of mucinous BOT treatment with a strategy to preserve fertility and/or endocrine function, unilateral adnexectomy is recommended (grade C). In the case of a mucinous BOT in a patient who has had an initial cystectomy, unilateral adnexectomy is recommended (grade C). In the case of treatment of a serous ES BOT in a patient who has had an initial cystectomy, with a strategy to preserve fertility and/or endocrine function, restaging surgery for adnexectomy is not recommended in the absence of suspicious residual lesions at the time of surgery and/or postoperative imaging (reference ultrasonography or pelvic MRI) (grade C). For serous or mucinous ES BOTs, routine hysterectomy is not recommended (Grade C). In cases of ES BOTs, lymphadenectomy is not recommended (Grade C). For ES BOTs, appendectomy is recommended only if there is a macroscopically pathological aspect to the appendix (Grade C). Restaging surgery is recommended in case of a serous BOT with a micropapillary aspect and an unsatisfactory inspection of the abdominal cavity during initial surgery (Grade C). Restaging surgery is recommended in cases of mucinous BOT if only a cystectomy has been performed or if the appendix has not been evaluated (Grade C). If restaging surgery is decided for an ES BOT, the following procedures should be performed: peritoneal cytology (grade C), omentectomy (there is no data in literature to recommend which type of omentectomy should be performed) (grade B), complete exploration of the abdominal cavity with peritoneal biopsies (grade C), visualization of the appendix +/- appendectomy in case of pathological macroscopic appearance (grade C) and unilateral adnexectomy in case of a mucinous BOT (grade C). In advanced stages of BOT it is not recommended to perform a lymphadenectomy as a routine procedure (Grade C). In cases of an advanced stage BOT, in a patient with a desire to fall pregnant, conservative treatment involving preservation of the uterus and all or part of the ovary may be proposed after a multidisciplinary meeting (Grade C). Second surgery aimed at removing all lesions, if not performed initially, is recommended in cases of advanced stage BOT (Grade C). It is not recommended to perform completion surgery after conservative treatment (preservation of the ovaries and the uterus) and after the achievement of fertility desire for a serous BOT (Grade B). After treatment for a BOT, follow-up beyond 5 years is recommended due to the median time to recurrence (Grade B). It is recommended that a systematic clinical examination be carried out during follow-up of a treated BOT (Grade B). In the particular case of an initial elevation of CA 125 levels, it is recommended to monitor CA 125 during follow up (Grade B). In cases treated conservatively (ovarian and uterine conservation), it is recommended to use endovaginal and transabdominal ultrasonography during the follow up period (Grade B). In the event of a recurrence of a BOT, in a woman of childbearing age, a conservative treatment strategy can again be proposed (Grade C). In the presence of non-invasive BOT implants, conservative treatment may be considered after a first non-invasive recurrence in women who wish to preserve their fertility (Grade C). Pelvic MRI is recommended after 12 weeks of amenorrhea in case of an undetermined adnexal mass and should be concluded with a diagnostic score (Grade C). The injection of gadolinium, in case of pregnancy, should be discussed on a case-by-case basis due to the proven risks for the foetus (Grade C). If feasible, a laparoscopic approach should be preferred during pregnancy (Grade C). A consultation with a specialist reproductive physician should be offered to patients with a BOT and of childbearing age (Grade C). It is recommended that patients be provided with full information on the risk of decreased ovarian reserve following to surgical treatment. It is recommended that the ovarian reserve be evaluated prior to surgical management of a suspected BOT (Grade C). When possible, a conservative surgical strategy is recommended to preserve fertility in women of childbearing age (Grade C). There is no specific data on the management of infertility following to conservative treatment of BOT. In case of durable infertility following to conservative treatment of BOT, a consultation with a specialist reproductive physician is required (Grade C). In the case of optimally treated BOT, there is no evidence in literature to contraindicate the use of Assisted Reproductive Techniques (ART). The use of hormonal contraception after serous or mucinous BOT is not contraindicated (Grade C). After treatment of a mucinous BOT, for women aged under 45 years, given the benefit of hormonal replacement therapy (HRT) on cardiovascular and bone risks, and the lack of hormone-sensitivity of mucinous BOTs, it is recommended to offer HRT (Grade C). After treatment of a mucinous BOT, for women over 45 years of age, there is no argument to contraindicate the use of HRT. HRT can be prescribed in case of a climacteric syndrome, as part of an individual benefit to risk assessment (Grade C).
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Affiliation(s)
- Nicolas Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France
| | - Cyrille Huchon
- Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010, Paris, France.
| | - Cendos Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Henri Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013, Paris, France
| | - Sofiane Bendifallah
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Pierre-Adrien Bolze
- Service de chirurgie gynécologique et oncologique, obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Jean-Luc Brun
- Service de Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, Société Française de Gynéco Pathologie, 81 rue verte, 76000, Rouen, France
| | - Geoffroy Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013, Paris, France
| | - Pauline Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France
| | - Elizabeth Chereau
- Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Blandine Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005, Marseille, France
| | | | - Mojgan Devouassoux-Shisheboran
- Institut de Pathologie multi-sites des HOSPICES CIVILS de LYON, Centre Hospitalier Lyon Sud, Centre de biologie et pathologie Sud, 165 Chemin du Grand revoyet, 69495 Pierre Bénite, Société Française de Gynéco Pathologie, 81 rue verte, 76000, Rouen, France
| | - Caroline Eymerit-Morin
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Tenon, HUEP, 4 rue de la Chine, 75020, Paris, UPMC Paris VI, Sorbonne Universities, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240, Malakoff, France
| | - Raffaele Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, 14000, Caen, France
| | - Elodie Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018, Paris, France
| | - Tristan Gauthier
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042, Limoges, France
| | - Michael Grynberg
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Martin Koskas
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018, Paris, France
| | - Elise Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018, Paris, France
| | - Lise Lecointre
- Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000, Rennes, France
| | - Jean Levêque
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France; Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Francois Margueritte
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042, Limoges, France
| | - Emmanuelle D'argent Mathieu
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Krystel Nyangoh-Timoh
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France; Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Lobna Ouldamer
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France; Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005, Marseille, France
| | - Jade Raad
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Emilie Raimond
- Département de Gynécologie Obstétrique, Institut Alix de Champagne, CHU Reims, 51100, Reims, France
| | - Rajeev Ramanah
- Département de Gynécologie, Centre hospitalier universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Lucie Rolland
- Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Pascal Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Christine Rousset-Jablonski
- Pôle Mère-Femme, CHU Besançon, 3 boulevard Fleming, 25000, Besançon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - Isabelle Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Catherine Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013, Paris, France
| | - Marie Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000, Strasbourg, France
| | - Emile Daraï
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
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Boyer de Latour A, Popescu N, Uzan C, Gonthier C, Belghiti J, Canlorbe G, Azaïs H. [How I do… a perineal VAC therapy for the treatment of a disunion after vulvar surgery]. ACTA ACUST UNITED AC 2020; 49:553-556. [PMID: 33130257 DOI: 10.1016/j.gofs.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Indexed: 11/17/2022]
Affiliation(s)
- A Boyer de Latour
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France
| | - N Popescu
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France
| | - C Gonthier
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France
| | - J Belghiti
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France
| | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France
| | - H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France.
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Uzan C, Ndiaye-Guèye D, Nikpayam M, Oueld Es Cheikh E, Lebègue G, Canlorbe G, Azais H, Gonthier C, Belghiti J, Benusiglio PR, Séroussi B, Gligorov J, Uzan S. [First results of a breast cancer risk assessment and management consultation]. Bull Cancer 2020; 107:972-981. [PMID: 32977936 DOI: 10.1016/j.bulcan.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/11/2020] [Revised: 07/09/2020] [Accepted: 08/08/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In France, participation in the organized breast cancer screening program remains insufficient. A personalized approach adapted to the risk factors for breast cancer (RBC) should make screening more efficient. A RBC evaluation consultation would therefore make it possible to personalize this screening. Here we report our initial experience. MATERIAL AND METHOD This is a prospective study on women who were seen at the RBC evaluation consultation and analyzing: their profile, their risk assessed according to Tyrer Cuzick model (TC)±Mammorisk© (MMR), the existence of an indication of oncogenetic consultation (Eisinger and Manchester score), their satisfaction and the recommended monitoring. RESULTS Among the women who had had a TCS and/or MMR evaluation of SCR (n=153), 76 (50%) had a high risk (n=67) or a very high risk (n=9). Almost half (47%) had a possible (15%) or certain (32%) indication to an oncogenetic consultation. Regarding this consultation, 98% of women were satisfied or very satisfied. In total, 60% of women had a change in screening methods. CONCLUSION This RBC evaluation consultation satisfies women and for a majority of them, modifies their methods of breast cancer screening.
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Affiliation(s)
- Catherine Uzan
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm UMR S938 « Biologie et thérapeutique des cancers », Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France.
| | - Diaretou Ndiaye-Guèye
- AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - Marianne Nikpayam
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - Eva Oueld Es Cheikh
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - Geraldine Lebègue
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - Geoffroy Canlorbe
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm UMR S938 « Biologie et thérapeutique des cancers », Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - Henri Azais
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Clementine Gonthier
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Jeremie Belghiti
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - Patrick R Benusiglio
- AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France; AP-HP, groupe hospitalier Pitié-Salpêtrière, Sorbonne Université, département de génétique, UF d'oncogénétique, Paris, France
| | - Brigitte Séroussi
- AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France; Département de santé publique, Tenon, France; Sorbonne Université, université Sorbonne Paris Nord, Inserm, UMR S_1142, LIMICS, Paris, France
| | - Joseph Gligorov
- Inserm UMR S938 « Biologie et thérapeutique des cancers », Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France; AP-HP Tenon, Sorbonne Université, oncologie médicale, Paris, France
| | - Serge Uzan
- AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
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Uzan C, Mazouni C, Rossoni C, De Korvin B, de Lara CT, Cohen M, Chabbert N, Zilberman S, Boussion V, Vincent Salomon A, Espie M, Coutant C, Marchal F, Salviat F, Boulanger L, Doutriaux-Dumoulin I, Jouve E, Mathelin C, de Saint Hilaire P, Mollard J, Balleyguier C, Joyon N, Triki ML, Delaloge S, Michiels S. Prospective Multicenter Study Validate a Prediction Model for Surgery Uptake Among Women with Atypical Breast Lesions. Ann Surg Oncol 2020; 28:2138-2145. [PMID: 32920723 DOI: 10.1245/s10434-020-09107-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/28/2020] [Accepted: 08/18/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Diagnosis of atypical breast lesions (ABLs) leads to unnecessary surgery in 75-90% of women. We have previously developed a model including age, complete radiological target excision after biopsy, and focus size that predicts the probability of cancer at surgery. The present study aimed to validate this model in a prospective multicenter setting. - METHODS Women with a recently diagnosed ABL on image-guided biopsy were recruited in 18 centers, before wire-guided localized excisional lumpectomy. Primary outcome was the negative predictive value (NPV) of the model. RESULTS The NOMAT model could be used in 287 of the 300 patients included (195 with ADH). At surgery, 12 invasive (all grade 1), and 43 in situ carcinomas were identified (all ABL: 55/287, 19%; ADH only: 49/195, 25%). The area under the receiving operating characteristics curve of the model was 0.64 (95% CI 0.58-0.69) for all ABL, and 0.63 for ADH only (95% CI 0.56-0.70). For the pre-specified threshold of 20% predicted probability of cancer, NPV was 82% (77-87%) for all ABL, and 77% (95% CI 71-83%) for patients with ADH. At a 10% threshold, NPV was 89% (84-94%) for all ABL, and 85% (95% CI 78--92%) for the ADH. At this threshold, 58% of the whole ABL population (and 54% of ADH patients) could have avoided surgery with only 2 missed invasive cancers. CONCLUSION The NOMAT model could be useful to avoid unnecessary surgery among women with ABL, including for patients with ADH. CLINICAL TRIAL REGISTRATION NCT02523612.
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Affiliation(s)
- Catherine Uzan
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France. .,Sorbonne University, INSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Paris, France. .,Institut Universitaire de Cancérologie (IUC), Paris, France.
| | | | | | | | | | | | | | | | | | - Anne Vincent Salomon
- Institut Curie, Université Paris-Sciences Lettres, INSERM U934, Département de Médecine Diagnostique et Théranostique, Paris, France
| | - Marc Espie
- University of Paris, Hôpital Saint Louis, APHP, Paris, France
| | | | - Frederic Marchal
- Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - Flore Salviat
- Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Villejuif, France.,CESP INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | | | | | - Eva Jouve
- Institut Claudius Regaud-Oncopole, Toulouse, France
| | - Carole Mathelin
- Les Hôpitaux universitaires de Strasbourg, Strasbourg, France
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