Journal de gynécologie, obstétrique et biologie de la reproduction
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J Gynecol Obstet Biol Reprod (Paris) · Dec 2015
Review[Explorations of breast microcalcifications: Guidelines].
To assess imaging performances for the detection, characterization and biopsy of breast microcalcifications and make recommendations. ⋯ Digital mammography (DR [Direct Radiography] and CR [Computed Radiography]) and screen-film mammography demonstrate good performances for the detection and the characterization of breast microcalcifications. Systematic use of the 2013 edition of the BI-RADS lexicon is recommended for description and characterization of microcalcifications. Faced with BI-RADS 4 or 5 microcalcifications, breast ultrasound is recommended but a normal result does not eliminate the diagnosis of cancer and other examination should be performed. Literature review does not allow recommending digital breast tomosynthesis, elastography or MRI to analyze microcalcifications. In case of probably benign microcalcifications (BI-RADS 3), six months, one year and at least two years follow-up are recommended. In case a biopsy is indicated, it is recommended to use a vacuum-assisted macrobiopsy system with 11-gauges needles or bigger. If no calcification is visible on the radiography of the specimen, it is recommended to obtain additional samples.
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J Gynecol Obstet Biol Reprod (Paris) · Dec 2015
Review[Exploring a non-inflammatory clinical breast mass: Clinical practice guidelines].
The aim of the study was to assess the diagnostic value of physical examination, radiologic explorations and percutaneous procedures of the breast in the exploration of a non-inflammatory palpable mass, in order to propose guidelines. ⋯ Physical examination of a non-inflammatory palpable breast mass is not sufficient to eliminate a breast cancer (LE2). Mammography alone has a sensitivity between 70 and 95% for the diagnosis of breast cancer (LE3). Echography alone has a sensitivity of 98 to 100% for the diagnosis of breast cancer (LE2). The core needle biopsy has a better sensitivity and specificity than the fine-needle aspiration for breast cancer diagnosis (LE2). The association of mammography and 2D echography presents excellent sensitivity and negative predictive value (close to 100 %) to exclude a breast cancer (LE3). A double evaluation using mammography and echography is recommended in the exploration of a non-inflammatory palpable breast mass (grade B).
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J Gynecol Obstet Biol Reprod (Paris) · Dec 2015
Review[Postpartum psychological disorders: Screening and prevention after birth. Guidelines for clinical practice].
Focusing on the mother's postpartum psychological and psychiatric disorders. ⋯ The issue of screening and prevention of postpartum mental disorders is fundamental and requires involvement of all professional receiving parents and babies in the aftermath of the birth.
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J Gynecol Obstet Biol Reprod (Paris) · Dec 2015
Review[Shoulder dystocia: Guidelines for clinical practice--Short text].
To determine the available evidence to prevent and treat shoulder dystocia to attempt to decrease its related neonatal and maternal morbidity. ⋯ Shoulder dystocia remains a non-predictable obstetrics emergency. All physicians and midwives should know and perform obstetric maneuvers if needed quickly but without precipitation. A training program using simulation for the management of shoulder dystocia is encouraged for the initial and continuing formation of different actors in the delivery room (professional consensus).
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J Gynecol Obstet Biol Reprod (Paris) · Dec 2015
Review[Management of breast nipple discharge: Recommendations].
To investigate diagnostic value of imaging procedures and management strategies of the patients with nipple discharge (ND) to establish management recommendations. ⋯ Although, all ND require an systematic evaluation guided by clinical data, bloody ND could be a predictor of breast cancer risk among different colors of discharge particularly in patients of more than 50 years (LE2). The mammography and breast ultrasography are the imaging procedures to realize in first intention (grade C) but they turn out useful only when they detect radiological abnormalities (LE4). Galactography has only a localizing value of possible ductal abnormalities (when standard imaging procedures is not contributive) (LE4). Thus, in the diagnostic investigation of a suspicious ND, galactography it is not recommended in standard practice (grade C). The breast Magnetic Resonance Imaging (MRI) is recommended when breast standard imaging procedures are not contributive (grade C). The ND cytology is useful only if it is positive (i.e. reveal cancer cells). There is no proof on the diagnostic performance of the cytological analysis of the ND to allow a recommendation on its realization or not. In front of a suspicious ND, when breast-imaging procedures reveals an associated radiological lesion, an adapted percutaneous biopsy is recommended by percutaneous way (grade C). Vacuum-assisted breast biopsies is a diagnostic tool but can also be therapeutic allowing to avoid surgery in case of benign lesion but current literature data do not allow recommendations on the therapeutic aspect of vacuum-assisted breast biopsy (LE4). In the absence of associated radiological signal, and in case of reproducible bloody persistent ND, a pyramidectomy is recommended (grade C).