Clinical utility of a molecular test in adjuvant treatment decision making in women with endocrine-sensitive early stage breast cancer: a retrospective, single center one year experience

Background. Molecular tests for breast cancer (BC) risk assessment are reimbursed by health insurances in Switzerland since the beginning of year 2015. The main current role of these tests is to help oncologists to decide about the usefulness of adjuvant chemotherapy in patients with early stage endocrine-sensitive and human epidermal growth factor receptor 2 (HER2)-negative BC. These gene expression signatures aim at predicting the risk of recurrence in this subgroup. One of them (OncotypeDx/OT) also predicts distant metastases rate with or without the addition of cytotoxic chemotherapy to endocrine therapy. The clinical utility of these tests -in addition to existing so-called "clinico-pathological" prognostic and predictive criteria (e.g. stage, grade, biomarkers status)-is still debated. We report a single center one year experience of the use of one molecular test (OT) in clinical decision making. Methods. We extracted from the CHUV Breast Cancer Center data base the total number of BC cases with estrogen-receptor positive (ER+), HER2-negative early breast cancer (node negative (pN0) disease or micrometastases in up to 3 lymph nodes) operated between September 2014 and August 2015. For the cases from this group in which a molecular test had been decided by the tumor board, we collected the clinicopathologic parameters, the initial tumor board decision, and the final adjuvant systemic therapy decision. Results. A molecular test (OT) was done in 12.2% of patients with ER + HER2 negative early BC. The median age was 57.4 years and the median invasive tumor size was 1.7 cm. These patients were classified by ODX testing (Recurrence Score) into low-, intermediate-, and high risk groups, respectively in 27.2%, 63.6% and 9% of cases. Treatment recommendations changed in 18.2%, predominantly from chemotherapyendocrine therapy to endocrine treatment alone. Of 8 patients originally recommended chemotherapy, 25% were recommended endocrine treatment alone after receiving the Recurrence Score result. Conclusions. Though reimbursed by health insurances since January 2015, molecular tests are used moderately in our institution as per the decision of the multidisciplinary tumor board. It's mainly used to obtain a complementary confirmation supporting the decision of no chemotherapy. The OncotypeDx Recurrence Score results were in the intermediate group in 66% of the 9 tested cases but contributed to avoid chemotherapy in 2 patients during the last 12 months.

Ability of physicians to diagnose influenza and usefulness of a rapid influenza antigen test in febrile returning travelers: A randomized controlled trial.

BACKGROUND: Fever is a frequent cause of medical consultation among returning travelers. The objectives of this study were to assess whether physicians were able to identify patients with influenza and whether the use of an influenza rapid diagnostic test (iRDT) modified the clinical management of such patients. METHODS: Randomized controlled trial conducted at 2 different Swiss hospitals between December 2008 and November 2012. Inclusion criteria were 1) age ≥18 years, 2) documented fever of ≥38 °C or anamnestic fever + cough or sore throat within the last 4 days, 3) illness occurring within 14 days after returning from a trip abroad, 4) no definitive alternative diagnosis. Physicians were asked to estimate the likelihood of influenza on clinical grounds, and a single nasopharyngeal swab was taken. Thereafter patients were randomized into 2 groups: i) patients with iRDT (BD Directigen A + B) performed on the nasopharyngeal swab, ii) patients receiving usual care. A quantitative PCR to detect influenza was done on all nasopharyngeal swabs after the recruitment period. Clinical management was evaluated on the basis of cost of medical care, number of X-rays requested and prescription of anti-infective drugs. RESULTS: 100 eligible patients were referred to the investigators. 93 patients had a naso-pharyngeal swab for a PCR and 28 (30%) swabs were positive for influenza. The median probability of influenza estimated by the physician was 70% for the PCR positive cases and 30% for the PCR negative cases (p < 0.001). The sensitivity of the iRDT was only 20%, and specificity 100%. Mean medical cost for the patients managed with iRDT and without iRDT were USD 581 (95%CI 454-707) and USD 661 (95%CI 522-800) respectively. 14/60 (23%) of the patients managed with iRDT were prescribed antibiotics versus 13/33 (39%) in the control group (p = 0.15). No patient received antiviral treatment. CONCLUSION: Influenza was a frequent cause of fever among these febrile returning travelers. Based on their clinical assessment, physicians had a higher level of suspicion for influenza in PCR positive cases. The iRDT used in this study showed a disappointingly low sensitivity and can therefore not be recommended for the management of these patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT00821626.

Test automation of digital mammography device

Testing of a complex software is time consuming. Automated tools are available quite a lot for desktop applications, but for embedded systems a custom-made tool is required Building a complete test framework is a complicated task. Therefore, the test platform was built on top of an already existing tool, CANoe. CANoe is a tool for CAN bus analysis and node simulation. The functionality of CANoe was extended with LabVIEW DLL. The LabVIEW software was used for simulating hardware components of the embedded device As a result of the study, a platform was created where tests could be automated. Of the current test plan, 10 percent were automated and up to 60 percent could be automated with the current functionality.

Annuaire encyclopédique : politique, économie sociale, statistique, administration, sciences, littérature, beaux-arts, agriculture, commerce, industrie / publié par les directeurs de l'Encyclopédie du XIXe siècle

1861.

Annuaire encyclopédique : politique, économie sociale, statistique, administration, sciences, littérature, beaux-arts, agriculture, commerce, industrie / publié par les directeurs de l'Encyclopédie du XIXe siècle

1863.

Annuaire encyclopédique : politique, économie sociale, statistique, administration, sciences, littérature, beaux-arts, agriculture, commerce, industrie / publié par les directeurs de l'Encyclopédie du XIXe siècle

1859-1860.

Annuaire encyclopédique : politique, économie sociale, statistique, administration, sciences, littérature, beaux-arts, agriculture, commerce, industrie / publié par les directeurs de l'Encyclopédie du XIXe siècle

1865-1866.

Annuaire encyclopédique : politique, économie sociale, statistique, administration, sciences, littérature, beaux-arts, agriculture, commerce, industrie / publié par les directeurs de l'Encyclopédie du XIXe siècle

1869 (T9)-1871.

Annuaire encyclopédique : politique, économie sociale, statistique, administration, sciences, littérature, beaux-arts, agriculture, commerce, industrie / publié par les directeurs de l'Encyclopédie du XIXe siècle

1868 (T8).

Annuaire encyclopédique : politique, économie sociale, statistique, administration, sciences, littérature, beaux-arts, agriculture, commerce, industrie / publié par les directeurs de l'Encyclopédie du XIXe siècle

1867.

Annuaire encyclopédique : politique, économie sociale, statistique, administration, sciences, littérature, beaux-arts, agriculture, commerce, industrie / publié par les directeurs de l'Encyclopédie du XIXe siècle

1864.