Reste-t-il des indications de curage ganglionnaire dans les cancers épithéliaux de l’ovaire après l’essai LION ?

International audienceIn March 2019, Harter et al. published the results of the LION study (Lymphadenectomy in patients with advanced ovarian neoplasms) which raises the question of pelvic and para-aortic lymphadenectomy for patients with advanced-stage epithelial ovarian cancer (EOC). These results influenced the new French recommendations published in December 2018 by the French National Cancer Institute (INCa). Thus, it no longer seems consistent to perform a systematic lymphadenectomy for patients for whom there is no argument for nodal involvement, when a macroscopic complete peritoneal cytoreductive surgery has been performed. The question of preoperative lymph node assessment is therefore essential, whereas more than half of the patients in the LION study had metastatic lymph node involvement that was histologically proven. For the assessment of lymph node status by imaging, superior sensitivity for Positron Emission Tomography is demonstrated in comparison with CT-scan or Magnetic Resonance Imaging. Nevertheless, thoraco-abdomino-pelvic CT-scan with contrast injection remains the gold standard for this indication. In the absence of suspected involvement, supra-renal, mesenteric, coelio-hepatic, and cardio-phrenic lymphadenectomy are not recommended. Lymphadenectomies should always be performed in the other situations of EOC management apart from the rare case of stage 1 expansile subtype mucinous carcinoma. The aim of this review is to discuss lymphadenectomy indications for the surgical management of EOC by taking into account new data from the scientific literature

Consultation personnalisée d'évaluation du risque de cancer du sein: premiers résultats

International audienceIntroductionIn France, participation in the organized breast cancer screening program remains insufficient. A personalized approach adapted to the risk factors for breast cancer (RBC) should make screening more efficient. A RBC evaluation consultation would therefore make it possible to personalize this screening. Here we report our initial experience.Material and methodThis is a prospective study on women who were seen at the RBC evaluation consultation and analyzing: their profile, their risk assessed according to Tyrer Cuzick model (TC) ± Mammorisk© (MMR), the existence of an indication of oncogenetic consultation (Eisinger and Manchester score), their satisfaction and the recommended monitoring.ResultsAmong the women who had had a TCS and/or MMR evaluation of SCR (n = 153), 76 (50%) had a high risk (n = 67) or a very high risk (n = 9). Almost half (47%) had a possible (15%) or certain (32%) indication to an oncogenetic consultation. Regarding this consultation, 98% of women were satisfied or very satisfied. In total, 60% of women had a change in screening methods.ConclusionThis RBC evaluation consultation satisfies women and for a majority of them, modifies their methods of breast cancer screening.IntroductionL’adhésion en France au programme de dépistage organisé du cancer du sein demeure insuffisante. Une approche personnalisée adaptée aux facteurs de risque de cancer du sein (RCS) permettrait une meilleure efficience du dépistage. Une consultation d’évaluation du RCS permettrait donc de personnaliser ce dépistage. Nous rapportons ici notre expérience initiale.Matériel et méthodeIl s’agit d’une étude prospective portant sur les femmes ayant été vues à la consultation d’évaluation du RCS et analysant : leur profil, leur risque évalué selon les modèles de Tyrer Cuzick (TC) ± Mammorisk© (MMR), l’existence d’une indication de consultation d’oncogénétique (scores d’Eisinger et de Manchester), leur satisfaction et la surveillance préconisée.RésultatsParmi les femmes ayant eu une évaluation du RCS par le modèle TC et/ou MMR (n = 153), 76 (50 %) avaient un risque élevé (n = 67) ou très élevé (n = 9). Près de la moitié (47 %) avait une indication possible (15 %) ou certaine (32 %) à une consultation d’oncogénétique. Concernant cette consultation, 98 % des femmes étaient satisfaites ou très satisfaites. Au total, 60 % des femmes ont eu un changement des modalités de surveillance.ConclusionCette consultation d’évaluation du RCS satisfait les femmes et pour une majorité d’entre elles, modifie les modalités de leur surveillance mammaire