isabelle trop - Academia.edu (original) (raw)

Papers by isabelle trop

Research paper thumbnail of B 1 homogeneity in breast MRI at 3 T with dual-source radiofrequency transmission : An intraindividual comparison with 1 . 5 T

Target audience: Radiologists, engineers or physicists with an interest in breast imaging Purpose... more Target audience: Radiologists, engineers or physicists with an interest in breast imaging Purpose High field strength MRI remains challenging in many aspects. A well-known complication is the establishment of radiofrequency (RF) standing waves when a standard quadrature excitation is used, a phenomenon that can considerably reduce the transmit B1 homogeneity. For breast imaging, this B1 inhomogeneity manifests itself in the form of a left-right shading effect , with an impact on lesion enhancement ratios measured from dynamic contrast enhanced (DCE) acquisitions . A promising solution to the B1 inhomogeneity problems observed at 3T is the use of RF shimming. This approach uses multiple independent RF sources to optimize the transmit B1 field homogeneity. To our knowledge, the B1 homogeneity that can now be achieved through RF shimming using dual-source RF transmission at 3T for breast MRI has not been compared to that normally encountered at the clinical standard field strength of 1...

Research paper thumbnail of Should women 40 to 49 years of age be offered mammographic screening?

It is already accepted that women with an increased risk of developing breast cancer benefit from... more It is already accepted that women with an increased risk of developing breast cancer benefit from earlier annual screening. I believe that mammographic screening of all women in their 40s constitutes good practice. Seventy percent of breast cancer is diagnosed in women without any risk factors. So when should screening begin? Many believe that women younger than 50 very rarely get breast cancer. In 2000, 19 200 new breast cancers were diagnosed in Canada; 17% were in women 40 to 49 years of age; 24% were in women 50 to 59 years of age.¹ The arbitrary cutoff age of 50 used in early studies was based on the hypothesis that menopause changed the development and mammographic detectability of breast cancer, but there is nothing magical about the age of 50. In addition, breast cancer incidence has increased in recent decades. The number of patients diagnosed with breast cancer before age 50 increased more than threefold between 1953 through 1959 and 1993 through 1999. 2 In 1995, due to ch...

Research paper thumbnail of Breast Microcalcifications and Their Implications for Risk Assessment. A Brief Review

Journal of Insurance Medicine

Research paper thumbnail of Can MRI accurately identify which patients with operable breast cancer will have a pathologic complete response after neoadjuvant therapy?

Journal of Clinical Oncology

616 Background: With the introduction of targeted therapy based on tumor subtypes, an increasing ... more 616 Background: With the introduction of targeted therapy based on tumor subtypes, an increasing number of patients that receive neoadjuvant chemotherapy achieve a pathologic complete response (pCR). Previous studies have shown that the accuracy of MRI is poor at predicting the response to neoadjuvant chemotherapy in locally advanced and often non-resectable breast cancers, where the rate of pCR is low. The purpose of this study is to evaluate MRI’s ability to predict a pCR in operable breast cancers after neoadjuvant therapy. Methods: All patients enrolled in the NSABP B-40, B-41, FB-5 and FB-6 protocols in a single tertiary care centre, that had an MRI done before and after neoadjuvant therapy were reviewed. A radiologist, blinded to the pathology results, interpreted the pre- and post- treatment MRI’s and made a prediction as to whether or not patients would have a pCR. In this study, a true negative was defined as a reading of a complete response on MRI that was confirmed as a p...

Research paper thumbnail of Venous malformation of the pectoral muscle depicted on mammogram

Research paper thumbnail of How Well Are Radiology Residents Prepared for Practice After Training? A Survey of French-Speaking Quebec Recent Graduates and Department Chiefs

Canadian Association of Radiologists Journal

Objective: Radiology residents must fulfill a standardized curriculum to complete residency and p... more Objective: Radiology residents must fulfill a standardized curriculum to complete residency and pass a certification exam before they are granted a licence to practice. We sought to evaluate how well residency prepares trainees for practice as perceived by recent graduates and their department chiefs. Subjects and Methods: Radiologists who graduated from the 4 Quebec radiology residency programs between 2005 and 2016 (n = 237) and Quebec radiology department chiefs (n = 98) were anonymously surveyed. Two electronic surveys were created, for recent graduates (74 questions) and for department chiefs (11 questions), with multiple-choice questions and open questions covering all fields of radiology. Surveys were administered between April and June 2016 using the Association des radiologistes du Québec database. Results: Response rate was 75 (31.6%) of 237 from recent graduates and 96% rated their training as excellent or good. Satisfaction with training in computed tomography and magnet...

Research paper thumbnail of 149 Feasibility of magnetic resonance and computed tomography scan fusion for identification of the surgical bed following tumourectomy in view of partial breast irradiation

Radiotherapy and Oncology

Research paper thumbnail of 131 Planification of breast interstitial brachytherapy using magnetic resonance imaging and computed tomography scan fusion for localization of the surgical bed

Radiotherapy and Oncology

Research paper thumbnail of Accuracy of screening women at familial risk of breast cancer without a known gene mutation: Individual patient data meta-analysis

European journal of cancer (Oxford, England : 1990), Nov 1, 2017

Women with a strong family history of breast cancer (BC) and without a known gene mutation have a... more Women with a strong family history of breast cancer (BC) and without a known gene mutation have an increased risk of developing BC. We aimed to investigate the accuracy of screening using annual mammography with or without magnetic resonance imaging (MRI) for these women outside the general population screening program. An individual patient data (IPD) meta-analysis was conducted using IPD from six prospective screening trials that had included women at increased risk for BC: only women with a strong familial risk for BC and without a known gene mutation were included in this analysis. A generalised linear mixed model was applied to estimate and compare screening accuracy (sensitivity, specificity and predictive values) for annual mammography with or without MRI. There were 2226 women (median age: 41 years, interquartile range 35-47) with 7478 woman-years of follow-up, with a BC rate of 12 (95% confidence interval 9.3-14) in 1000 woman-years. Mammography screening had a sensitivity ...

Research paper thumbnail of 80 oral LOCALISATION OF THE SURGICAL CAVITY USING SUPINE MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY SCAN FUSION FOR PLANIFICATION OF BREAST INTERSTITIAL BRACHYTHERAPY

Radiotherapy and Oncology

Research paper thumbnail of Comparative Evaluation of Iodine-125 Radioactive Seed Localization and Wire Localization for Resection of Breast Lesions

Canadian Association of Radiologists Journal

Purpose Radioactive seed localization (RSL) uses a titanium seed labeled with iodine-125 energy f... more Purpose Radioactive seed localization (RSL) uses a titanium seed labeled with iodine-125 energy for surgery of nonpalpable breast lesions. RSL facilitates radiology–surgery scheduling and allows for improved oncoplasty compared with wire localization (WL). The purpose of this work was to compare the 2 techniques. Methods We performed a retrospective study of all breast lesions operated with RSL between February 2013 and March 2015 at our university institution, and compared with an equivalent number of surgeries performed with a single WL. Imaging and pathology reports were reviewed for information on guidance mode, accuracy of targeting, nature of excised lesion, size and volume of surgical specimen, status of margins, and reinterventions. Results A total of 254 lesions (247 women) were excised with RSL and compared with 257 lesions (244 women) whose surgery was guided by WL. Both groups were comparable in lesion pathology, guidance mode for RSL or WL positioning, and accuracy of t...

Research paper thumbnail of Abbreviated breast magnetic resonance protocol: Value of high-resolution temporal dynamic sequence to improve lesion characterization

European Journal of Radiology

To evaluate the added value of ULTRAFAST-MR sequence to an abbreviated FAST protocol in compariso... more To evaluate the added value of ULTRAFAST-MR sequence to an abbreviated FAST protocol in comparison with FULL protocol to distinguish benign from malignant lesions in a population of women, regardless of breast MR imaging indication. From March 10th to September 22th, 2014, we retrospectively included a total of 70 consecutive patients with 106 histologically proven lesions (58 malignant and 48 benign) who underwent breast MR imaging for preoperative breast staging (n=38), high-risk screening (n=7), problem solving (n=18), and nipple discharge (n=4) with 12 time resolved imaging of contrast kinetics (TRICKS) acquisitions during contrast inflow interleaved in a regular high-resolution dynamic MRI protocol (FULL protocol). Two readers scored MR exams as either positive or negative and described significant lesions according to Bi-RADS lexicon with a TRICKS images (ULTRAFAST), an abbreviated protocol (FAST) and all images (FULL protocol). Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for each protocol and compared with McNemar's test. For all readers, the combined FAST-ULTRAFAST protocol significantly improved the reading with a specificity of 83.3% and 70.8% in comparison with FAST protocol or FULL protocol, respectively, without change in sensitivity. By adding ULTRAFAST protocol to FAST protocol, readers 1 and 2 were able to correctly change the diagnosis in 22.9% (11/48) and 10.4% (5/48) of benign lesions, without missing any malignancy, respectively. Both interpretation and image acquisition times for combined FAST-ULTRAFAST protocol and FAST protocol were shorter compared to FULL protocol (p<0.001). Compared to FULL protocol, adding ULTRAFAST to FAST protocol improves specificity, mainly in correctly reclassifying benign masses and reducing interpretation and acquisition time, without decreasing sensitivity.

Research paper thumbnail of SEIN-WP-18 Approche et traitement par aspiration de l’abces mammaire. Revue de la litterature et algorithme de traitement

Research paper thumbnail of Lupus mastitis as a first manifestation of systemic disease: About two cases with a review of the literature

European journal of radiology, 2017

Lupus mastitis is an uncommon manifestation of systemic lupus erythematosus (SLE) that affects th... more Lupus mastitis is an uncommon manifestation of systemic lupus erythematosus (SLE) that affects the subcutaneous fat in the breast, much like lupus panniculitis, but additionally involves the mammary gland. We report on two women for whom lupus mastitis was the initial manifestation of SLE and provide a literature review of 34 additional cases reported in the Anglo-Saxon and French literature since 1971, making this the largest review to date. Lupus mastitis (LM) can manifest clinically as subcutaneous masses that may be painful, or may present cutaneous involvement such as thickening and discolouration. The radiologic manifestations of LM are broad and include calcifications, masses and asymmetries. Most often, excluding malignancy requires percutaneous biopsy, with histologic findings that are virtually pathognomonic for SLE. Thus, surgery is avoided and medical management can begin, antimalarial drugs and corticosteroids in most cases.

Research paper thumbnail of Is the Outcome at Surgery Different When Flat Epithelial Atypia and Lobular Neoplasia are Found in Association at Biopsy?

The British journal of radiology, Jan 24, 2017

To assess the impact on the final outcome at surgery of Flat Epithelial Atypia (FEA) when found c... more To assess the impact on the final outcome at surgery of Flat Epithelial Atypia (FEA) when found concomitantly with Lobular Neoplasia (LN) in biopsy specimens, compared to pure biopsy proven FEA. Institutional review board approval was obtained. A retrospective review of our database between 2009 and 2013 identified eighty-one women (mean age 54, range 38-90) with 81 FEA biopsy-proven lesions. These were pure or associated with LN only in respectively 59/81 (73%) and 22/81 (27%). Overall, 57/81 (70%) patients underwent surgery and 24/81 (30%) mammographic surveillance with a mean follow up of 36 months. FEA presented more often as microcalcifications in 68/81 (84%) of patients and were mostly amorphous in 49/68 (72%) . After excluding radio pathologically discordant cases, pure FEA proved to be malignant at surgery in 1/41 (2%; 95% CI 0.06-12.9). There was no statistically significant difference in the upgrade to malignancy whether FEA lesions were pure or associated to LN at biopsy ...

Research paper thumbnail of Les lésions papillaires du sein

Imagerie De La Femme, Dec 1, 2007

Les termes papillome, papillaire, micropapillaire, papillomateux et papillomatose sont souvent ut... more Les termes papillome, papillaire, micropapillaire, papillomateux et papillomatose sont souvent utilisés en pathologie mammaire pour désigner ou qualifier un type de prolifération épithéliale qui se caractérise par la formation de petites projections bourgeonnantes, ou papilles. Ces termes correspondent à diverses lésions mammaires qui peuvent être bénignes, atypiques ou malignes. Une connaissance approfondie de la pathologie de ces lésions mammaires, de leur traduction clinique et radiologique, et du risque de cancer du sein qui leur est associé permettra au radiologiste de proposer des recommandations appropriées au clinicien. Le but de cet article est de passer en revue les aspects pathologiques, cliniques et radiologiques des lésions papillaires du sein.

Research paper thumbnail of Fetal Thoracic Abnormalities: MR Imaging1

Radiology, Aug 1, 2003

PURPOSE: To elucidate the appearance of fetal thoracic abnormalities at prenatal magnetic resonan... more PURPOSE: To elucidate the appearance of fetal thoracic abnormalities at prenatal magnetic resonance (MR) imaging and determine whether MR imaging yields information additional to that obtained with ultrasonography (US). MATERIALS AND METHODS: US and MR ...

Research paper thumbnail of Les l�sions papillaires du sein

Imagerie De La Femme, 2007

Research paper thumbnail of Molecular Classification of Infiltrating and in Situ Breast Cancer: Towards Personalized Therapy?

Research paper thumbnail of Is the Risk of Malignancy at Surgery Greater When Flat Epithelial Atypia (FEA) and Lobular Neoplasia (LN) Are Found in Association at Biopsy?

ABSTRACT PURPOSE 1) To determine the frequency of malignancy at surgical excision of biopsy-prove... more ABSTRACT PURPOSE 1) To determine the frequency of malignancy at surgical excision of biopsy-proven pure FEA (2) to assess the significance of associated LN and residual microcalcifcations at biopsy on the final upgrade at surgery. METHOD AND MATERIALS Retrospective review of 8907 core needle biopsies (CNB) (2009-2012) identified 110 cases of FEA (12%). Patients with associated atypical ductal hyperplasia (ADH) and ipsilateral breast cancer were excluded. Eighty-one women (mean age 54, range 38-80) of whom 5 had 2 biopsies were included. The 86 FEA lesions were pure or associated with LN in respectively 63/86 (73%) and 23/86 (27%). Overall, 63 (73%) lesions were excised and 23 (27%) were followed up (mean follow up 12 months). RESULTS Malignancy was documented at surgery in 9 /63 (14 %) patients (4 DCIS and 5 low-grade invasive cancers). The most frequent radiologic presentation was a cluster of microcalcifcations (72/86 (84%) followed by a mass and distorsion, in respectively 12/86 (14%) and 2/86 (2%). CNB was performed with a 10G vacuum-assisted device or a 14G spring-loaded needle in respectively 76/86 (88 %) and 10/86 (12 %) patients. The association of FEA with LN, the size of the cluster of microcalcifications and the presence of residual microcalcifications post biopsy were not significantly associated with final upgrade at surgery. There was a statistically significant association between the two parameters, needle size and radiologic presentation on one side and final upgrade at surgery on the other: FEA presenting as a mass was significantly more often upgraded to malignancy than microcalcifications (p= 0.0012) as was FEA diagnosed at biopsy with a 14G versus 11G vacuum assisted needle (p= 0.0015). CONCLUSION The 14 % upgrade rate of FEA was not significantly affected by concomitant LN at biopsy. Surgical excision of all FEA lesions, including the pure ones, is warranted. When FEA presented as a mass, it was more likely to be upgraded to malignancy. CLINICAL RELEVANCE/APPLICATION FEA is a risk lesion with no clear guidelines regarding its management. Our 14 % upgrade rate was not affected by concomitant LN or residual calcificatioons. We recommend excision of all FEA lesions

Research paper thumbnail of B 1 homogeneity in breast MRI at 3 T with dual-source radiofrequency transmission : An intraindividual comparison with 1 . 5 T

Target audience: Radiologists, engineers or physicists with an interest in breast imaging Purpose... more Target audience: Radiologists, engineers or physicists with an interest in breast imaging Purpose High field strength MRI remains challenging in many aspects. A well-known complication is the establishment of radiofrequency (RF) standing waves when a standard quadrature excitation is used, a phenomenon that can considerably reduce the transmit B1 homogeneity. For breast imaging, this B1 inhomogeneity manifests itself in the form of a left-right shading effect , with an impact on lesion enhancement ratios measured from dynamic contrast enhanced (DCE) acquisitions . A promising solution to the B1 inhomogeneity problems observed at 3T is the use of RF shimming. This approach uses multiple independent RF sources to optimize the transmit B1 field homogeneity. To our knowledge, the B1 homogeneity that can now be achieved through RF shimming using dual-source RF transmission at 3T for breast MRI has not been compared to that normally encountered at the clinical standard field strength of 1...

Research paper thumbnail of Should women 40 to 49 years of age be offered mammographic screening?

It is already accepted that women with an increased risk of developing breast cancer benefit from... more It is already accepted that women with an increased risk of developing breast cancer benefit from earlier annual screening. I believe that mammographic screening of all women in their 40s constitutes good practice. Seventy percent of breast cancer is diagnosed in women without any risk factors. So when should screening begin? Many believe that women younger than 50 very rarely get breast cancer. In 2000, 19 200 new breast cancers were diagnosed in Canada; 17% were in women 40 to 49 years of age; 24% were in women 50 to 59 years of age.¹ The arbitrary cutoff age of 50 used in early studies was based on the hypothesis that menopause changed the development and mammographic detectability of breast cancer, but there is nothing magical about the age of 50. In addition, breast cancer incidence has increased in recent decades. The number of patients diagnosed with breast cancer before age 50 increased more than threefold between 1953 through 1959 and 1993 through 1999. 2 In 1995, due to ch...

Research paper thumbnail of Breast Microcalcifications and Their Implications for Risk Assessment. A Brief Review

Journal of Insurance Medicine

Research paper thumbnail of Can MRI accurately identify which patients with operable breast cancer will have a pathologic complete response after neoadjuvant therapy?

Journal of Clinical Oncology

616 Background: With the introduction of targeted therapy based on tumor subtypes, an increasing ... more 616 Background: With the introduction of targeted therapy based on tumor subtypes, an increasing number of patients that receive neoadjuvant chemotherapy achieve a pathologic complete response (pCR). Previous studies have shown that the accuracy of MRI is poor at predicting the response to neoadjuvant chemotherapy in locally advanced and often non-resectable breast cancers, where the rate of pCR is low. The purpose of this study is to evaluate MRI’s ability to predict a pCR in operable breast cancers after neoadjuvant therapy. Methods: All patients enrolled in the NSABP B-40, B-41, FB-5 and FB-6 protocols in a single tertiary care centre, that had an MRI done before and after neoadjuvant therapy were reviewed. A radiologist, blinded to the pathology results, interpreted the pre- and post- treatment MRI’s and made a prediction as to whether or not patients would have a pCR. In this study, a true negative was defined as a reading of a complete response on MRI that was confirmed as a p...

Research paper thumbnail of Venous malformation of the pectoral muscle depicted on mammogram

Research paper thumbnail of How Well Are Radiology Residents Prepared for Practice After Training? A Survey of French-Speaking Quebec Recent Graduates and Department Chiefs

Canadian Association of Radiologists Journal

Objective: Radiology residents must fulfill a standardized curriculum to complete residency and p... more Objective: Radiology residents must fulfill a standardized curriculum to complete residency and pass a certification exam before they are granted a licence to practice. We sought to evaluate how well residency prepares trainees for practice as perceived by recent graduates and their department chiefs. Subjects and Methods: Radiologists who graduated from the 4 Quebec radiology residency programs between 2005 and 2016 (n = 237) and Quebec radiology department chiefs (n = 98) were anonymously surveyed. Two electronic surveys were created, for recent graduates (74 questions) and for department chiefs (11 questions), with multiple-choice questions and open questions covering all fields of radiology. Surveys were administered between April and June 2016 using the Association des radiologistes du Québec database. Results: Response rate was 75 (31.6%) of 237 from recent graduates and 96% rated their training as excellent or good. Satisfaction with training in computed tomography and magnet...

Research paper thumbnail of 149 Feasibility of magnetic resonance and computed tomography scan fusion for identification of the surgical bed following tumourectomy in view of partial breast irradiation

Radiotherapy and Oncology

Research paper thumbnail of 131 Planification of breast interstitial brachytherapy using magnetic resonance imaging and computed tomography scan fusion for localization of the surgical bed

Radiotherapy and Oncology

Research paper thumbnail of Accuracy of screening women at familial risk of breast cancer without a known gene mutation: Individual patient data meta-analysis

European journal of cancer (Oxford, England : 1990), Nov 1, 2017

Women with a strong family history of breast cancer (BC) and without a known gene mutation have a... more Women with a strong family history of breast cancer (BC) and without a known gene mutation have an increased risk of developing BC. We aimed to investigate the accuracy of screening using annual mammography with or without magnetic resonance imaging (MRI) for these women outside the general population screening program. An individual patient data (IPD) meta-analysis was conducted using IPD from six prospective screening trials that had included women at increased risk for BC: only women with a strong familial risk for BC and without a known gene mutation were included in this analysis. A generalised linear mixed model was applied to estimate and compare screening accuracy (sensitivity, specificity and predictive values) for annual mammography with or without MRI. There were 2226 women (median age: 41 years, interquartile range 35-47) with 7478 woman-years of follow-up, with a BC rate of 12 (95% confidence interval 9.3-14) in 1000 woman-years. Mammography screening had a sensitivity ...

Research paper thumbnail of 80 oral LOCALISATION OF THE SURGICAL CAVITY USING SUPINE MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY SCAN FUSION FOR PLANIFICATION OF BREAST INTERSTITIAL BRACHYTHERAPY

Radiotherapy and Oncology

Research paper thumbnail of Comparative Evaluation of Iodine-125 Radioactive Seed Localization and Wire Localization for Resection of Breast Lesions

Canadian Association of Radiologists Journal

Purpose Radioactive seed localization (RSL) uses a titanium seed labeled with iodine-125 energy f... more Purpose Radioactive seed localization (RSL) uses a titanium seed labeled with iodine-125 energy for surgery of nonpalpable breast lesions. RSL facilitates radiology–surgery scheduling and allows for improved oncoplasty compared with wire localization (WL). The purpose of this work was to compare the 2 techniques. Methods We performed a retrospective study of all breast lesions operated with RSL between February 2013 and March 2015 at our university institution, and compared with an equivalent number of surgeries performed with a single WL. Imaging and pathology reports were reviewed for information on guidance mode, accuracy of targeting, nature of excised lesion, size and volume of surgical specimen, status of margins, and reinterventions. Results A total of 254 lesions (247 women) were excised with RSL and compared with 257 lesions (244 women) whose surgery was guided by WL. Both groups were comparable in lesion pathology, guidance mode for RSL or WL positioning, and accuracy of t...

Research paper thumbnail of Abbreviated breast magnetic resonance protocol: Value of high-resolution temporal dynamic sequence to improve lesion characterization

European Journal of Radiology

To evaluate the added value of ULTRAFAST-MR sequence to an abbreviated FAST protocol in compariso... more To evaluate the added value of ULTRAFAST-MR sequence to an abbreviated FAST protocol in comparison with FULL protocol to distinguish benign from malignant lesions in a population of women, regardless of breast MR imaging indication. From March 10th to September 22th, 2014, we retrospectively included a total of 70 consecutive patients with 106 histologically proven lesions (58 malignant and 48 benign) who underwent breast MR imaging for preoperative breast staging (n=38), high-risk screening (n=7), problem solving (n=18), and nipple discharge (n=4) with 12 time resolved imaging of contrast kinetics (TRICKS) acquisitions during contrast inflow interleaved in a regular high-resolution dynamic MRI protocol (FULL protocol). Two readers scored MR exams as either positive or negative and described significant lesions according to Bi-RADS lexicon with a TRICKS images (ULTRAFAST), an abbreviated protocol (FAST) and all images (FULL protocol). Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for each protocol and compared with McNemar's test. For all readers, the combined FAST-ULTRAFAST protocol significantly improved the reading with a specificity of 83.3% and 70.8% in comparison with FAST protocol or FULL protocol, respectively, without change in sensitivity. By adding ULTRAFAST protocol to FAST protocol, readers 1 and 2 were able to correctly change the diagnosis in 22.9% (11/48) and 10.4% (5/48) of benign lesions, without missing any malignancy, respectively. Both interpretation and image acquisition times for combined FAST-ULTRAFAST protocol and FAST protocol were shorter compared to FULL protocol (p<0.001). Compared to FULL protocol, adding ULTRAFAST to FAST protocol improves specificity, mainly in correctly reclassifying benign masses and reducing interpretation and acquisition time, without decreasing sensitivity.

Research paper thumbnail of SEIN-WP-18 Approche et traitement par aspiration de l’abces mammaire. Revue de la litterature et algorithme de traitement

Research paper thumbnail of Lupus mastitis as a first manifestation of systemic disease: About two cases with a review of the literature

European journal of radiology, 2017

Lupus mastitis is an uncommon manifestation of systemic lupus erythematosus (SLE) that affects th... more Lupus mastitis is an uncommon manifestation of systemic lupus erythematosus (SLE) that affects the subcutaneous fat in the breast, much like lupus panniculitis, but additionally involves the mammary gland. We report on two women for whom lupus mastitis was the initial manifestation of SLE and provide a literature review of 34 additional cases reported in the Anglo-Saxon and French literature since 1971, making this the largest review to date. Lupus mastitis (LM) can manifest clinically as subcutaneous masses that may be painful, or may present cutaneous involvement such as thickening and discolouration. The radiologic manifestations of LM are broad and include calcifications, masses and asymmetries. Most often, excluding malignancy requires percutaneous biopsy, with histologic findings that are virtually pathognomonic for SLE. Thus, surgery is avoided and medical management can begin, antimalarial drugs and corticosteroids in most cases.

Research paper thumbnail of Is the Outcome at Surgery Different When Flat Epithelial Atypia and Lobular Neoplasia are Found in Association at Biopsy?

The British journal of radiology, Jan 24, 2017

To assess the impact on the final outcome at surgery of Flat Epithelial Atypia (FEA) when found c... more To assess the impact on the final outcome at surgery of Flat Epithelial Atypia (FEA) when found concomitantly with Lobular Neoplasia (LN) in biopsy specimens, compared to pure biopsy proven FEA. Institutional review board approval was obtained. A retrospective review of our database between 2009 and 2013 identified eighty-one women (mean age 54, range 38-90) with 81 FEA biopsy-proven lesions. These were pure or associated with LN only in respectively 59/81 (73%) and 22/81 (27%). Overall, 57/81 (70%) patients underwent surgery and 24/81 (30%) mammographic surveillance with a mean follow up of 36 months. FEA presented more often as microcalcifications in 68/81 (84%) of patients and were mostly amorphous in 49/68 (72%) . After excluding radio pathologically discordant cases, pure FEA proved to be malignant at surgery in 1/41 (2%; 95% CI 0.06-12.9). There was no statistically significant difference in the upgrade to malignancy whether FEA lesions were pure or associated to LN at biopsy ...

Research paper thumbnail of Les lésions papillaires du sein

Imagerie De La Femme, Dec 1, 2007

Les termes papillome, papillaire, micropapillaire, papillomateux et papillomatose sont souvent ut... more Les termes papillome, papillaire, micropapillaire, papillomateux et papillomatose sont souvent utilisés en pathologie mammaire pour désigner ou qualifier un type de prolifération épithéliale qui se caractérise par la formation de petites projections bourgeonnantes, ou papilles. Ces termes correspondent à diverses lésions mammaires qui peuvent être bénignes, atypiques ou malignes. Une connaissance approfondie de la pathologie de ces lésions mammaires, de leur traduction clinique et radiologique, et du risque de cancer du sein qui leur est associé permettra au radiologiste de proposer des recommandations appropriées au clinicien. Le but de cet article est de passer en revue les aspects pathologiques, cliniques et radiologiques des lésions papillaires du sein.

Research paper thumbnail of Fetal Thoracic Abnormalities: MR Imaging1

Radiology, Aug 1, 2003

PURPOSE: To elucidate the appearance of fetal thoracic abnormalities at prenatal magnetic resonan... more PURPOSE: To elucidate the appearance of fetal thoracic abnormalities at prenatal magnetic resonance (MR) imaging and determine whether MR imaging yields information additional to that obtained with ultrasonography (US). MATERIALS AND METHODS: US and MR ...

Research paper thumbnail of Les l�sions papillaires du sein

Imagerie De La Femme, 2007

Research paper thumbnail of Molecular Classification of Infiltrating and in Situ Breast Cancer: Towards Personalized Therapy?

Research paper thumbnail of Is the Risk of Malignancy at Surgery Greater When Flat Epithelial Atypia (FEA) and Lobular Neoplasia (LN) Are Found in Association at Biopsy?

ABSTRACT PURPOSE 1) To determine the frequency of malignancy at surgical excision of biopsy-prove... more ABSTRACT PURPOSE 1) To determine the frequency of malignancy at surgical excision of biopsy-proven pure FEA (2) to assess the significance of associated LN and residual microcalcifcations at biopsy on the final upgrade at surgery. METHOD AND MATERIALS Retrospective review of 8907 core needle biopsies (CNB) (2009-2012) identified 110 cases of FEA (12%). Patients with associated atypical ductal hyperplasia (ADH) and ipsilateral breast cancer were excluded. Eighty-one women (mean age 54, range 38-80) of whom 5 had 2 biopsies were included. The 86 FEA lesions were pure or associated with LN in respectively 63/86 (73%) and 23/86 (27%). Overall, 63 (73%) lesions were excised and 23 (27%) were followed up (mean follow up 12 months). RESULTS Malignancy was documented at surgery in 9 /63 (14 %) patients (4 DCIS and 5 low-grade invasive cancers). The most frequent radiologic presentation was a cluster of microcalcifcations (72/86 (84%) followed by a mass and distorsion, in respectively 12/86 (14%) and 2/86 (2%). CNB was performed with a 10G vacuum-assisted device or a 14G spring-loaded needle in respectively 76/86 (88 %) and 10/86 (12 %) patients. The association of FEA with LN, the size of the cluster of microcalcifications and the presence of residual microcalcifications post biopsy were not significantly associated with final upgrade at surgery. There was a statistically significant association between the two parameters, needle size and radiologic presentation on one side and final upgrade at surgery on the other: FEA presenting as a mass was significantly more often upgraded to malignancy than microcalcifications (p= 0.0012) as was FEA diagnosed at biopsy with a 14G versus 11G vacuum assisted needle (p= 0.0015). CONCLUSION The 14 % upgrade rate of FEA was not significantly affected by concomitant LN at biopsy. Surgical excision of all FEA lesions, including the pure ones, is warranted. When FEA presented as a mass, it was more likely to be upgraded to malignancy. CLINICAL RELEVANCE/APPLICATION FEA is a risk lesion with no clear guidelines regarding its management. Our 14 % upgrade rate was not affected by concomitant LN or residual calcificatioons. We recommend excision of all FEA lesions