Apport de la TEP-FDG dans le staging initial des cancers du sein localement avancés traités par chimiothérapie néo-adjuvante

Axillary lymph node and distant metastases are unfavourable prognostic factors in breast cancer. The aim of our study was to evaluate the performance of PET-FDG in the staging of locally advanced breast cancer (LABC) treated with neoadjuvant chemotherapy (NAC) and surgery, and to compare the findings of pretherapeutic PET to those of axillary nodal status obtained by surgery after NAC (Sataloff classification). This retrospective study involved 89 patients with LABC explored at presentation by PET in addition to conventional clinical and imaging staging (CS). Breast cancer excision and axillary dissection were performed after NAC. PET and CS found an axillary involvement in 58 patients (65%) and 39 patients (44%), respectively. Compared to the histology of post-NAC axillary dissection, PET had sensitivity and specificity of 80% and 63%, respectively. PET revealed an extra-axillary lymph node involvement, not suspected by the CS, in 25 patients (28%). Bone and lung metastases, not suspected by the CS were found in two and one patients, respectively. A case of false-positive PET in the liver was observed (adenomatosis). This study confirms the value of PET in the initial staging of LABC, especially in assessing extra-axillary nodal status. In the determination of axillary status, PET has a high positive predictive value, cases of doubtful interpretation suggesting to perform ultrasound-guided fine needle aspiration in addition.     

Médecine nucléaire et imagerie multimodalités des tumeurs endocrines

Endocrine digestive tumors have various clinical presentations (familial history, hindgut, midgut or foregut origin, histological type, functionality, and evolution). Depending on their radio-isotopic and uptake characteristics, various SPECT and PET radiopharmaceuticals, especially with CT-hybrid acquisition, are accurate to precise localisation and extension. They may also help to define new prognostic factors, to complement the WHO, Grade and TNM ENETS classifications. Their place in the follow-up have yet to be evaluated.     

Intérêt de l’imagerie hybride TEMP-TDM pour la détection du ganglion sentinelle dans les cancers du sein

IntroductionSingle-Photon Emission Computed Tomography-Computed Tomography (SPECT-CT) is an hybrid technique which associates functional and morphological images. The aim of this study was to assess the role of SPECT-CT lymphoscintigraphy in sentinel node identification in patients with breast cancer.MethodsTwelve months prospective study was undertaken. Lymphoscintigraphy comprising planar and SPECT-CT acquisition was performed in 51 consecutive patients with breast cancer (mean age: 62 ± 11.3, range: 33–83 years). Planar and SPECT-CT images were interpreted separately and the two imaging techniques were compared with respect to their ability to identify sentinel node.ResultsAn add-value of SPECT-CT images was evidenced in 31% of cases: a more accurate anatomic localization in 21% of cases and identification of undeterminate sites of uptake in 10% of cases. Furthermore, SPECT-CT detected intramammary (4% of cases) and retromammary (2% of cases) sentinel nodes missed by planar imaging. SPECT-CT was more sensitive for internal mammary drainage detection (6% of cases). The added value proved higher in obese patients. Finally, functional and anatomical images fusion and three-dimensional overview provided clear and readily usable informations to the surgeon.ConclusionHybrid SPECT-CT imaging improves the preoperative localisation of sentinel nodes in patients with breast cancer, in particular in obese patients. SPECT-CT provides readily usable informations to the surgeon.     

Prise en charge du cancer du sein,avancées et perspectives

Breast cancer treatment has developed rapidly for the last 15 years, promoted by a better understanding of tumour growth biology. Targeted therapies have been rapidly expending: immunotherapy, targeted chemotherapy, endocrine therapy efficacy enhanced by mTOR inhibitors. Changes of molecular profiling tumours during the illness need to perform regularly biopsies and to adapt drugs. This article will focus on a high-level overview of main advances across systemic treatment.     

Dépistage du cancer du sein

The purpose of this article is to remind why and how the screening mammographic program has been developed in France, and generalized in 2004, and to explain what is the BI-RADS of ACR. Perspectives on emerging new technologies that may change breast cancer screening will be discussed.     

Place de l’imagerie dans l’évaluation de l’efficacité des traitements dans le cancer du sein

This paper describes, from the current literature, the role of various imaging methods to assess the response to therapy in breast cancer. Two different clinical situations are considered: neoadjuvant chemotherapy of locally advanced breast cancer and the metastastic breast cancer. Significant clinical data are available for three criteria: the volume of the tumour, the uptake of fluorodeoxyglucose using PET and the perfusion of the tumor evaluated either by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) or by PET using ¹⁵O water. ¹⁸F FDG PET allows prediction of the response after one or two cycles of neoadjuvant chemotherapy. New approaches will offer opportunities to refine the role of imaging in monitoring the response to chemotherapy. PET using thymidine as biomarker is promising in assessing the tissular proliferation. Estrogen analogs could be used to predict hormonally responsive breast cancer. Many other approaches, although less developed, might offer new insights in the response to therapy of breast cancer like magnetic resonance spectroscopy or optical imaging of hemoglobin oxygenation. Imaging also offers potential of monitoring the down-regulation of specialized receptors of the cell membrane in response to treatment: the most studied receptor in preclinical model has been the human epidermal growth factor receptor type 2 (HER2). Integrin, a family of cell adhesion receptor, is also an important target for imaging. Apoptosis, multidrug resistance and hypoxia can also be studied using appropriate biomarkers. To allow reliable multicenter trials of new drugs, these different imaging approaches still require an improved standardization of image acquisition and processing.     

Effets du rubidium et du césium sur la croissance et la nutrition minerale des characees

Résumé Le rubidium et le césium introduits à l'état de chlorure dans le milieu de culture ont à faible dose un effet stimulant sur la croissance de Chara fragilis et de Chara vulgaris. La résistance de ces végétaux à l'action toxique des deux ions est accrue par l'addition de potassium au milieu.Les analyses chimiques confirment que le rubidium et le césium sont antagonistes vis-à-vis du potassium et du sodium alors qu'ils ne modifient pas de manière significative le taux de calcium.

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Chara fragilis and Chara vulgaris were cultivated in a natural medium containing rubidium and caesium as chloride.The growth of Characeae was increased after culture in the solutions containing Rb and Cs in small amount. The resistance to the toxic effects of these two ions is enhanced if potassium chloride is added to the medium.Quantitative analyses indicate that Rb and Cs decrease the rate of Na and K but have no significative influence on the rate of Ca.

Université de Dijon, Laboratoire de Nutrition minérale des Végétaux     

Biostratigraphie des Miospores et des Chitinozoaires du Silurien supérieur et du Dévonien dans le bassin d'Illizi (S.E. du Sahara algérien)

Core samples from the Illizi basin yielded well preservedmiospores and Chitinozoa. The detailed study of the range of these microfossils allows accurate age assignment for upper Silurian and Devonian subsurface strata of the southeastern part of the algerian Sahara. On the other hand, these biostratigraphical data demonstrate the occurrence of important stratigraphical gaps related to recurrent emersions.     

Mode d'action et propriétés des facteurs inducteurs issus du mésenchyme gastrique et des mésenchymes hétérologues

Résumé Des expériences d'associations d'épithélium gastrique de foetus de Lapin et de mésenchyme homologue ou hétérologue, partielles ou par membrane filtrante interposée, mettent en évidence l'existence de deux types de facteurs inducteurs.Le premier facteur induit la morphogenèse de l'épithélium. Il est thermostable et hautement diffusible.Le deuxième facteur, organospécifique, est plus ou moins favorable à la différenciation de l'épithélium gastrique suivant la nature du mésenchyme. Faiblement diffusible et thermolabile, il est élaboré dans la phase cytoplasmique des cellules mésenchymateuses.

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Action and properties of inductive factors proceeding from gastric and heterologous mesenchymes

Summary Experimental associations of gastric epithelium of the Rabbit foetus with homologous or heterologous mesenchyme, separated by membrane filter or partially associated, permit us to prove the existence of two types of inductors.The first factor induces the epithelial morphogenesis. It is thermostable and highly diffusible.The second factor, organospecific, is more or less favorable to the differentiation of the gastric epithelium according to the nature of the mesenchyme. Lightly diffusible and thermolabile, it is elaborated in the cytoplasmic phase of the mesenchymal cells.

     

Intérêt complémentaire de la TEP/TDM au FDG et de l’imagerie conventionnelle dans le bilan initial et le suivi post-thérapeutique des cancers des VADS : recommandations et perspectives

Functional imaging by ¹⁸fluorodesoxyglucose (FDG) positron emission tomography (PET) and morphological imaging by computed tomography (CT) and magnetic resonance imaging (MRI) hold an important and complementary role in characterization of head and neck squamous cell carcinoma (HNSCC). Based on an exhaustive literature, the recommendations and perspectives of their use in the initial assessment and the post-therapeutic management of HNSCC are presented.