Joint Practice Guidelines for Radionuclide Lymphoscintigraphy for Sentinel Node Localization in Oral/Oropharyngeal Squamous Cell Carcinoma

Involvement of the cervical lymph nodes is the most important prognostic factor for patients with oral/oropharyngeal squamous cell carcinoma (OSCC), and the decision of whether to electively treat patients with clinically negative necks remains a controversial topic. Sentinel node biopsy (SNB) provides a minimally invasive method for determining the disease status of the cervical node basin, without the need for a formal neck dissection. This technique potentially improves the accuracy of histologic nodal staging and avoids overtreating three-quarters of this patient population, minimizing associated morbidity. The technique has been validated for patients with OSCC, and larger-scale studies are in progress to determine its exact role in the management of this patient population. This document is designed to outline the current best practice guidelines for the provision of SNB in patients with early-stage OSCC, and to provide a framework for the currently evolving recommendations for its use. Preparation of this guideline was carried out by a multidisciplinary surgical/nuclear medicine/pathology expert panel under the joint auspices of the European Association of Nuclear Medicine (EANM) Oncology Committee and the Sentinel European Node Trial (SENT) Committee

Joint practice guidelines for radionuclide lymphoscintigraphy for sentinel node localization in oral/oropharyngeal squamous cell carcinoma

Involvement of the cervical lymph nodes is the most important prognostic factor for patients with oral/oropharyngeal squamous cell carcinoma (OSCC), and the decision whether to electively treat patients with clinically negative necks remains a controversial topic. Sentinel node biopsy (SNB) provides a minimally invasive method of determining the disease status of the cervical node basin, without the need for a formal neck dissection. This technique potentially improves the accuracy of histological nodal staging and avoids over-treating three-quarters of this patient population, minimizing associated morbidity. The technique has been validated for patients with OSCC, and larger-scale studies are in progress to determine its exact role in the management of this patient population. This article was designed to outline the current best practice guidelines for the provision of SNB in patients with early-stage OSCC, and to provide a framework for the currently evolving recommendations for its use. These guidelines were prepared by a multidisciplinary surgical/nuclear medicine/pathology expert panel under the joint auspices of the European Association of Nuclear Medicine (EANM) Oncology Committee and the Sentinel European Node Trial Committee

Chondroid tumors of the larynx: a clinicopathologic study of 19 cases, including two dedifferentiated chondrosarcomas

We studied 19 cases of chondroid tumors of the larynx: two chondrometaplastic nodules, two chondromas and 15 chondrosarcomas (including two dedifferentiated chondrosarcomas). One of chondromas recurred 18 months after resection because of inadequate surgical treatment. Chondrosarcomas were separated as low-grade (nine cases), intermediate (three cases), high-grade (one case), and dedifferentiated (two cases) according to histologic appearance. Chondrosarcomas are nearly always histologically low grade, make up the largest numbers of the neoplasms, and arise from the cricoid cartilage. Conservative surgical management, when possible, is advocated to preserve the larynx. Chondrometaplastic nodules are to be distinguished from chondrosarcoma and the rarely occurring chondroma. The nodules are not neoplastic and have a low to nil recurrent potential

La régression tumorale n'est pas un facteur de risque d'atteinte du ganglion sentinelle dans les mélanomes fins (indice de Breslow < or = 1 mm) [Tumour regression is not predictive for higher risk of sentinel node involvement in thin melanomas (Breslow thickness < or = 1 mm)]

Background: Thin melanomas (Breslow thickness &lt;= 1 mm) are considered highly curable. The aim of this study was to evaluate the correlation between histological tumour regression and sentinel lymph node (SLN) involvement in thin melanomas. Patients and methods: This was a retrospective single-centre study of 34 patients with thin melanomas undergoing SLN biopsy between April 1998 and January 2005. Results: The study included 14 women and 20 men of mean age 56.3 years. Melanomas were located on the neck (n = 3), soles (n = 4), trunk (n = 13) and extremities (n = 14). Pathological examination showed 25 SSM, four acral lentiginous melanomas, three in situ melanomas, one nodular melanoma and one unclassified melanoma with a mean Breslow thickness of 0.57 mm. Histological tumour regression was observed in 26 over 34 cases and ulceration was found in one case. Clark levels were as follows: I (n = 3), II (n = 20), III (n = 9), IV (n = 2). Growth phase was available in 15 cases (seven radial and eight vertical). Mitotic rates, available in 24 cases, were: 0 (n = 9), 1 (n = 11), 2 (n = 2), 3 (n = 1), 6 (n = 1). One patient with histological tumour regression (2.9% of cases and 3.8% of cases with regressing tumours) had a metastatic SLN. One patient negative for SLN had a lung relapse and died of the disease. Mean follow-up was 26.2 months. Conclusion: The results of the present study and the analysis of the literature show that histological regression of the primary tumour does not seem predictive of higher risk of SLN involvement in thin melanomas. This suggests that screening for SLN is not indicated in thin melanomas, even those with histological regression

Acceptabilité des professionnels de santé en France vis-à-vis de la politique de réseau de soins périnatals

International audienceBackground: For twenty years, most of industrial countries developed recommendations on regionalization of perinatal care. Perinatal regionalization is particularly aimed at improving morbidity and mortality outcomes of low birth weight newborns by transferring pregnant women to the maternity units having a medical or neonatal environment suited to the risks incurred by mothers or babies. Perinatal regionalization cannot be effective without being well accepted by the majority of professionals. The objectives of this study were then to identify professionals’expectations and objections to perinatal regionalisation and to compare them from a professional group to another one.Methods: Professionals of 3 French perinatal networks were under consideration: the Rhône, the Auvergne and the Gard-Lozère networks. The study included two stages: 1) a psychosociological qualitative study, based on professionals’interviews, aimed at identifying main concerns of professionals and developing a questionnaire; then 2) an epidemiological quantitative study, using this questionnaire within French networks. In the questionnaire, 8 dimensions explored the professionals’views: constraints related to regulation aspects and to the setting up of maternity units care levels, risk of loss of professionals’competence and prestige, consequences on medical practices, on inter-professional relationship, on work organization and financial aspects, and related to the new role of “private practice’professionals, legal consequences.Results: The response rate of the epidemiological study was 80%. The results permitted to construct 8 dimension scores describing the reasons of poor acceptability of regionalization. After taking into account the age, the sex, the network and the juridical status of the institution, the study revealed a significant poorer acceptability of regionalization by most of medical specialty groups (anesthetists, obstetricians, midwives and “private practice” professionals) compared with neonatologists, or by “private” professionals (professionals working in private clinics and “private practice” professionals) compared with professionals working in university or community hospitals. The study described also network setting up conditions related to its functioning.Conclusion: By identifying clearly professionals’objections and expectations, this study should facilitate improvement in the organization of studied perinatal networksPosition du problème : Depuis plus de 20 ans, la plupart des pays industriels développent la régionalisation des soins périnatals. L'un des objectifs principaux de la régionalisation est d'améliorer le devenir des enfants de petits poids en orientant les femmes « à risque d'accouchement prématuré » vers les maternités disposant d'un niveau de soins adapté pour la mère et pour le bébé. Mais la mise en place des réseaux ne peut être efficace sans être acceptée par les professionnels. L'objectif de cette étude était ainsi d'identifier les attentes des professionnels et de les comparer d'un groupe à un autre.Méthodes : La population étudiée incluait les professionnels de 3 réseaux périnatals (Rhône, Auvergne et Gard-Lozère). L'étude comprenait 2 étapes : la première, qualitative, psychosociologique, basée sur des entretiens individuels menés par des psychologues, avait pour but d'identifier les préoccupations des professionnels et de développer un questionnaire; la seconde, quantitative, épidémiologique, a utilisé ce questionnaire au sein des réseaux. Dans le questionnaire, 8 dimensions ont exploré le point de vue des professionnels : les contraintes relatives aux aspects réglementaires et à la mise en place des niveaux de soins des maternités, le risque de perte de compétence des professionnels, les conséquences sur les pratiques médicales, sur les relations interprofessionnelles, sur l'organisation du travail et les aspects financiers, le nouveau rôle des professionnels libéraux, et les conséquences juridiques.Résultats : le taux de réponse de l'étude épidémiologique était de 80 %. Les résultats ont permis de construire 8 scores décrivant l'acceptabilité des professionnels. Après ajustement sur l'âge, le sexe, le réseau et le statut juridique de l'institution, l'étude a révélé une moins bonne acceptabilité de la plu-part des professionnels (anesthésistes, obstétriciens, sage-femmes et praticiens libéraux) comparée à celle des néonatologistes, ou des professionnels travaillant dans des établissements privés comparée à ceux travaillant dans des établissements publics. En outre, l'étude a décrit certaines conditions de mise en oeuvre du réseau relatives à son fonctionnement.Conclusion : En identifiant clairement les attentes et objections des professionnels, cette étude devrait faciliter l'amélioration du fonctionnement des réseaux périnatals étudiés

Hearing impairment in patients with myotonic dystrophy type 2

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