Prospective Multicenter Study Validate a Prediction Model for Surgery Uptake Among Women with Atypical Breast Lesions

International audienceBackground: 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

Advances in Lower Hybrid Current Drive for TOKAMAK long pulse operation: Technology & Physics

The paper gives a picture of the present status and understanding of technology and physics of Lower Hybrid Current Drive for long pulse operation in tokamaks, including the development of continuous wave (CW) high power klystrons, and its evolutions towards ITER. 3.7GH/ 700kW CW klystrons produced in series by Thales Electron Devices are now in operation on Tore Supra. First series of eight klystrons delivered more than 4MW to sustain non-inductive plasmas during 50 s. Moreover, a prototype of 500kW CW klystron operating at 5GHz developed for KSTAR by Toshiba Electron Tubes and Devices, and foreseen for ITER, is able to produce RF output powers of 300kW/ 800 s and 450kW/ 20 s on matched load. The situation on wave coupling and antennas is reported, with the latest Tore Supra results of the new CW Passive-Active Multi-junction (PAM) launcher: the antenna concept foreseen for ITER. First experiments with the PAM antenna in Tore Supra have provided extremely encouraging results in terms of power handling and coupling. Relevant ITER power density of ~25MW/m2 (2.7MW of power injected into the plasma) has been maintained over ~80 s. In addition, LH power of 2.7MW has been coupled at a plasma-antenna distance of 10 cm.110Yscopusothe