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Biomedical subjects

M H Dilhuydy

Publications and source records attributed to M H Dilhuydy.

At least 19 recordsLinked to original sources
PubMed2002

["Standards, Options and Recommendations 2001" for radiotherapy in patients with non-metastatic infiltrating breast cancer. Update. National Federation of Cancer Campaign Centers (FNCLCC)].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of french cancer centers (FNCLCC), the 20 french cancer centers, and specialists from french public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines for non metastatic breast cancer patients according to the definitions of the Standards, Options and Recommendations project. METHODS: Data were identified by searching Medline, web sites, and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 148 independent reviewers. RESULTS: This article presents the chapter radiotherapy resulting from the 2001 update of the version first published in 1996. The modified 2001 version of the standards, options and recommendations takes into account new information published. The main recommendations are: (1) Breast irradiation after conservative surgery significantly decrease the risk of local recurrence (level of evidence A) and the decrease in the risk of local recidive after chest wall irradiation is greater as the number of risk factors for local recurrence increases (level of evidence A). (2) After conservative surgery, a whole breast irradiation should be performed at a minimum dose of 50 Gy in 25 fractions (standard, level of evidence A). (3) A boost in the tumour bed should be performed in women under 50 years, even if the surgical margins are free (standard, level of evidence B). (4) Internal mammary chain irradiation is indicated for internal or central tumours in the absence of axillary lymph node involvement (expert agreement) and in the presence of lymph node involvement (standard, level of evidence B1). (5) Sub- and supra-claviculr lymph node irradiation is indicated in patients with axillary node involvement (standard, level of evidence B1).

Adult↗
PubMed2001

Analysis of 676 cases of ductal carcinoma in situ of the breast from 1971 to 1995: diagnosis and treatment--the experience of one institute.

Six hundred seventy-six patients with ductal carcinoma in situ of the breast (DCIS) from 1971 to 1995 were included in the study. Computerized patient files were retrospectively analyzed. Clinical findings were less frequently reported to reveal DCIS after 1989. Positive mammographic findings were obtained in 87% of patients and were mainly represented by microcalcifications (79.4%). Treatment procedures were breast-conserving surgery (BCS) alone (37.5%), BCS followed by radiation (BCSR) (25.5%), or mastectomy (M) (37%). The actuarial local recurrence was 2.6% in the M group (94 months of follow-up), 14.5% in the BCS group (85,7 months of follow-up), and 7.5% in the BCSR group (78.8 months of follow-up). Predictive factors of recurrence in all patients were invaded margin status and age. In the BCS group, grade was also a predictive factor. The analysis per decade shows that the lesions currently diagnosed are less serious than those of the past. All the recurrence in patients with positive margins was in the same quadrant as the original lesion. This further emphasizes the need for clear margins.

Adult↗
PubMed2000

[ROC analysis comparing screen film mammography and digital mammography].

PURPOSE: To compare the diagnosis performances of radiologists on screen film versus digital mammography. MATERIAL: and methods: Two sets of 123 mammograms, screen film mammography and storage phosphor digital mammography, are studied comparatively with ROC analysis. RESULTS: Phantom study show that conventional method give better scores for usual tension but the detectability of smaller microcalcification is equivalent. To obtain with digital technic the same conventional score you have to increase the radiation dose. Roc Curves, simulated "detection" mode showed that radiologists performed with higher accuracy with conventional system but this difference is weekly statistically significant. ROC Curves, simulated "diagnostic" mode showed the same results wit no statistically significant difference but when the decision to go to the biopsy is the gold standard, ROC Curves were essentially equivalent for both film screen and digital mammography system. The readers consistently considered the digital mammograms to be less suspicious for cancer findings. The agreement study as proposed by the FDA indicate that probability of a positive digital mammograms given a positive screen film is 75% (threshold value 90%) and the probability of a negative digital mammograms given a negative analog film is 85% (threshold value 85%). CONCLUSION: Analysis of specific discrepancies indicate that spatial resolution is an essential limiting factor for digital method but high resolution phosphor plate are interesting in imaging treated breast, radioluscent lesion, fatty benign tumor, hamartoma, intramammary lymph node, breast with prosthesis.

Biopsy↗
PubMed2000

[Anthropological studies of the representations of menopause in a population of women invited to a mass screening for breast cancer in Bouches-du-Rhône and Charente].

This is an anthropological study of a target population (breast screening women) in the Bouches-du-Rhône and Charente regions of France. The occurrence of menopause is comparable in these two departments and depends on providing medical care which leads to breast screening. Menopause is natural for these women and is considered as a sign of ageing. Psychosomatic symptoms vary with sociocultural groups. Hormonal replacement therapy furthers breast screening. In the popular imagination, there is a deficit between nature (non-HRT) and culture (HRT). They take estrogen in the form of soy to offset this inadequacy, which creates a new cultural syncretism.

Anthropology, Cultural↗
PubMed2000

[Contribution to the study of the future of silicon-gel breast implants in mammary reconstruction after cancer: concerning 205 implants].

Long term follow-up of 187 women with mammary reconstruction using 205 silicone-gel implants enables a retrospective analysis of the evolution of both patients and their prosthesis. Most patients have not presented local or general disease related to implant leakages. However, these leakages are not uncommon, being present in nearly one-third of 38 explantations motivated by aesthetic considerations (of which 50% are capsular retractions). All the ruptured or pre-ruptured implants are more than seven years old. Leakage frequency sharply increases after ten years. Authors tried to assess the place of radiologic evaluations (digitized costal profile, ultrasound, MRI...) in order to detect deterioration of the prosthesis. Although suspicions raised by these evaluations have made it possible to adequately target the explantations, pathogenicity of silicone-gel implants appears low enough to confirm the predominance of clinical follow-up.

Breast Implants↗
PubMed1998

[Large core of nonpalpable breast lesions].

The development of breast cancer screening has radically changed the diagnostic approach to breast lesions. Stereotactic large-core breast biopsy was developed to reduce the number of unnecessary surgical excisional biopsies in the increasing number of patients with doubtful or suspicious mammogram findings. The methods used to evaluate this new technique are discussed, as well as results in terms of efficacy, factors that may influence efficacy, and difficulties in interpreting large-core biopsies. Recommendations regarding the harvesting and interpretation of stereotactic large-core biopsies are made.

Biopsy↗
PubMed1997

The debate over mass mammography: is it beneficial for women?

The authors discuss the controversy about mass screening for breast cancer in order to assess the soundness of a nationwide expansion of such programmes. Mass screening is second best because of the failure of prevention, therapeutic progress or ability to target high risk populations, but its efficacy reducing mortality is not clearly demonstrated and the chances of one woman being saved from participating are very low. Detrimental side-effects such as anxiety, false alarms, unnecessary biopsies, overdiagnosis and overtreatment and deficiency of psychological approach are reported. On the other hand, mass screening may save lives and if no recent study can provide absolute proof of efficacy, inefficacy of systematic mammography cannot be proven either, even concerning 40 49 years old women. Moreover, screening trials have allowed an improvement in medical practice, especially concerning quality and dose in mammography and radiographer's performance. Many questions remain unanswered about mass screening for breast cancer and the best way to achieve it.

Adult↗
PubMed1997

[Stereotaxic fine-needle aspirations of clinically latent breast cysts: an efficient and neat procedure].

The purpose was to evaluate the interest of stereotaxic fine-needle aspiration for round opacities when the ultrasound and echoguided punctures are inefficient; especially when women are under menopausal hormonal replacement therapy. Sixty stereotactic guided fine-needle aspirations detected by mammography have been performed between january 1990 and august 1996. The stereotaxic procedure is performed with a DMR unit (GE with Stereotix II). Stereotaxic views are done to verify needle position. After aspiration, cytologic examination is realised. Cystic fluid was always obtained and cytologic examination proved benign cysts in all cases. In 50 cases, cysts completely disappeared. There were 2 relapses that received after a second. This method is reliable for evaluation of non palpable mammographically detected opacities. The use of this technique spares the patient a surgical biopsy. This procedure enables women under menopausal hormone replacement therapy to continue the treatment.

Adult↗
PubMed1994

Measuring image texture to separate "difficult" from "easy" mammograms.

We are investigating computerized techniques for sorting mammograms according to whether the breast tissue is fatty or dense. The hypothesis is that areas of dense tissue are a major factor in making certain mammograms harder for both radiologists and computers to interpret. Being able to identify dense mammograms automatically could permit better use of the time and skills of expert radiologists by allowing the difficult mammograms to be examined by the most experienced readers. In addition, the scope for computer-aided detection of abnormalities might be increased by concentrating on the easier, fatty mammograms. The mammograms used in the experiment were classified independently by two radiologists, who agreed in almost all cases. A number of local statistical and texture measures were then computed for patches from digitizations of these mammograms. One of the measures (local skewness in tiles) gives a good separation between fatty and dense patches. This measure has been incorporated into an automated procedure that separates off approximately two thirds of the fatty mammograms. This finding has been replicated on mammograms taken from a UK screening programme. The relationship between the fatty/dense distinction and the classification proposed by Wolfe is discussed.

Adipose Tissue↗
PubMed1992

[Breast microcalcifications].

Microcalcifications of the breast are better recognized as the quality of mammographs is improving. The clinical examination and complementary modalities are often essential to evaluate their significance and point out to an indication for surgery. However, especially when the microcalcifications are detected during a systematic examination, a strict analysis of mammographs is essential. The number of useless punctures must be reduced, as their psychological impact and socioeconomic weight are already demonstrated. Although there is no consensus, most recent publications contain ideas converging on the selection of the indications for a histological control on the basis of an accurate semiological study.

Breast Diseases↗
PubMed1992

[Extramammary carcinoid tumor metastatic to the breast. Apropos of a case].

We report the case of a 42-year-woman treated for an appendicular carcinoid tumor with bilateral ovary metastases and mesenteric node involvement. After a systematic mammography, an infraclinical lesion of the breast was detected. Mammographic and echographic images revealed nodular mass with possibly malignant features. Fine-needle aspiration biopsy indicated malignancy. The definitive diagnosis of breast metastasis of a carcinoid tumor was made by biopsy. This case is related to 14 previously published cases. The authors emphasize the importance of making a precise histological diagnosis to avoid overtreatment of a metastatic lesion.

Adult↗
PubMed1991

[When must a mastopathy at risk be operated on? The viewpoint of the clinician, the radiologist, the surgeon, and the anatomopathologist].

The mastopathy is said to be truly "at risk" only when an anatomopathological examination has singled out certain criteria. At present, there is no medical treatment, particularly a hormonal one, capable of preventing the evolution towards a breast cancer. The indication for an operation could be based on a real score taking into account the age, the family history, the pregnancies, the fatness, the endogenous hormonal balance and the exogenous hormonal supply. In fact, above all considerations is the local mammary state, "the major mastoses", where a joint analytical study of: the clinical state, the mammography, the thermography and the cytopuncture is essential. The possibility of carrying out micro-biopsies under local anaesthesia is also underlined. Finally, we retain two big types of indication: of necessity. A lesion for which a doubt exists must be operated upon. The radiological location constitutes a considerable progress. Of principle. Namely in women with a heavy family history of breast cancer, a fortiori if the mammographies reveal dense, heterogeneous aspects, difficult to follow. Finally, the women for whom a previous biopsy has revealed lesions with an evolution potential (lobe neoplasia, extensive atypical epitheliosis). In conclusion, the indications are not often easy and is usually the object of a study of each case individually.

Adult↗
PubMed1990

[Pure ovarian dysgerminoma. Evaluation of experiences and definition of a therapeutic strategy].

The authors present a series of 10 pure dysgerminoma of the ovary treated between 1976 and 1984; mean age = 19.5 years, range 15-46 years. All patients had initial surgery: 8 annexectomies for 5 stages Ia and 3 stages IIIc nodal disease, 1 hysterectomy with bilateral adnexectomy for a 46 year old stade Ib patient and 1 case of salvage surgery for a progressive disease after a single adnexectomy. Two patients had no adjuvant therapy after initial adnexectomy (stage Ia tumors less than 10 cm in diameter). Four patients received a prophylactic subdiaphragmatic radiation therapy (3 stages Ia tumors larger than 10 cm, 1 stage Ib disease). Three patients received an irradiation for a subdiaphragmatic bulky disease and a prophylactic supradiaphragmatic irradiation (stage IIIc nodal disease). Two patients received chemotherapy, one for recurrence, the other for progressive disease. The authors discuss the therapeutic indications of pure dysgerminoma of the ovary, especially the conservative management of young patients wishing to preserve an hormonal and obstetric future and the value of radiologic and serologic follow-up. Recent data in the literature underline the efficacy of new combinations of cytotoxic agents and their role as an adjuvant of surgery in early as well as in advanced stages.

Actuarial Analysis↗
PubMed1989

[Cytologic diagnosis of breast angiosarcoma].

Angiosarcomas of the breast are exceedingly rare tumors that are only infrequently seen by pathologists examining fine-needle biopsy specimens. We report two cases in two women aged 52 and 57 years. Cytologic features are analyzed and differential diagnosis is discussed.

Biopsy, Needle↗
PubMed1989

[Psychologic reactions of patients at the announcement of a treatment plan for cancer of the breast. Apropos of 6 exemplary case reports].

Basing our clinical study on six typical cases, the different types of psychological responses to the announcement of the treatment options for patients with breast cancer are analysed by their frequency: anxiety with self-control, shunning of reality, questioning, anxiety attack, negation of the diagnosis or negation of the usefulness of the treatment. This classification allows the physician to recognize and analyse better the patient's reactions in order to establish the essential reciprocal trust for their complete observance to the most efficient treatment. Anxiety, linked to the meaning of the word cancer, is the most important component. The different reactions are caused by the patient psychological defenses mechanisms. As for the treatment, the real difficulty is to differentiate anxiety from reactional depression and from true depression. Treatment of anxiety should not be systematic and begins by reassuring the patient with a better patient-physician relationship.

Adult↗