Journal De Gynecologie Obstetrique Et Biologie De La Reproduction, 1998
Nous rapportons un cas de goitre foetal decouvert a 31 semaines d'amenorrhee (SA) par echogra... more Nous rapportons un cas de goitre foetal decouvert a 31 semaines d'amenorrhee (SA) par echographie. La ponction de sang foetal pratiquee a 33 SA permet le diagnostic d'une hypothyroidie foetale. Le bilan maternel est negatif. Avant qu'une decision de traitement in utero soit prise, l'enfant nait prematurement a 35 SA par cesarienne avec des signes cliniques d'hypothyroidie et un volumineux goitre non compressif homogene. La biologie confirme l'hypothyroidie. La scintigraphie thyroidienne a l'iode 123, couplee a un test au thyocyanate, est evocatrice de trouble de l'organification de l'iode. Les progres de l'echographie et des moyens d'abords du foetus permettent d'etudier la fonction thyroidienne foetale et d'envisager un traitement in utero. Les troubles congenitaux de l'hormonogenese representent 10 a 15 % des hypothyroidies neonatales; la presence d'un goitre neonatal, quoique inconstante, en est un element d'orientat...
Revue française de gynécologie et d'obstétrique, 1997
L'hysteroscopie operatoire est une technique bien codifiee aux avantages connus ; cependant, ... more L'hysteroscopie operatoire est une technique bien codifiee aux avantages connus ; cependant, il s'agit d'une chirurgie a part entiere qui comporte des risques que tout gynecologue et anesthesiste doit connaitre. Ces complications ne font l'objet que de quelques publications. Nous avons coordonne une enquete nationale multicentrique, prospective, dont le but etait d'evaluer sur une periode de 6 mois, l'incidence des complications de l'hysteroscopie, en s'adressant, non pas aux seuls centres de reference, mais a un eventail plus large de gynecologues francais. 120 medecins nous ont rapporte un total de 2757 hysteroscopies, parmi lesquelles 1759 (63,8 %) hysteroscopies operatoires et 998 (36,2 %) hysteroscopies diagnostiques. 27 complications nous ont ete adressees : une (0,1 %) dans le groupe des hysteroscopies diagnostiques : il s'agissait d'une perforation aux suites simples. 26 (1,48 %) dans le groupe des hysteroscopies operatoires dont 16 pe...
L'hysterosalpingographie conserve la premiere place parmi les explorations de l'appareil ... more L'hysterosalpingographie conserve la premiere place parmi les explorations de l'appareil genital feminin en cas de sterilite car elle permet a la fois l'evaluation de la permeabilite tubaire et l'exploration intra-uterine. L'echographie, non invasive, permet une orientation diagnostique mais reste peu performante dans le bilan d'une sterilite. L'hysteroscopie est indispensable lorsqu'une pathologie intra-uterine est suspectee et en presence d'antecedents de manoeuvres intra-uterines. Elle peut egalement permettre une approche therapeutique de certaines sterilites tubaires proximales
Revue française de gynécologie et d'obstétrique, 1992
: Between October 1986 and March 1990, 220 patients underwent surgical treatment for ovarian cyst... more : Between October 1986 and March 1990, 220 patients underwent surgical treatment for ovarian cysts. 156 of these patients underwent an initial celioscopy and could potentially benefit from celiosciopic treatment. The group mean age was 33.3 years. The circumstances under which the cysts were discovered usually consisted of pelvic pain or diagnosis during a routine examination. Twenty-four patients underwent laparotomy immediately after coelioscopy either due to a suspect macroscopic diagnosis either due to technical difficulties. 84.6 percent of the patients in the group were able to undergo celioscopic treatment only, essentially consisting of intraperitoneal cystectomy. The main advantages were the reduction in adherent sequelae in these women of a sexually active age, but also some financial savings related to the reduced duration of hospitalization and of sick leave. The theoretical reservations consist of the risk of malignancy and macroscopic diagnosis following coelioscopic exploration must be very restricted, with laparotomy whenever there is any doubt. No malignant tumor was escaped detection in this group.
L'HDD est une cause majeure de morbidite et de mortalite maternelle. Elle reste souvent impre... more L'HDD est une cause majeure de morbidite et de mortalite maternelle. Elle reste souvent imprevisible et brutale malgre l'existence de facteurs de risques. L'etiologie la plus frequente est l'atonie uterine. Une prise en charge rapide et adapte, menee conjointement avec l'anesthesiste, permet de reduire les complications. Chaque service doit disposer d'un protocole accessible rapidement et connu de tous. Le traitement comporte une reanimation et l'administration d'uterotoniques en cas d'atonie. L'echec du traitement medical doit conduire rapidement a une embolisation ou a une ligature des afferences vasculaires uterines.
Background Substantial evidence in the scientific literature supports the use of simulation for s... more Background Substantial evidence in the scientific literature supports the use of simulation for surgical education. However, curricula lack for complex laparoscopic procedures in gynecology. The objective was to evaluate the validity of a program that reproduces key specific components of a laparoscopic hysterectomy (LH) procedure until colpotomy on a virtual reality (VR) simulator and to develop an evidence-based and stepwise training curriculum. Methods This prospective cohort study was conducted in a Marseille teaching hospital. Forty participants were enrolled and were divided into experienced (senior surgeons who had performed more than 100 LH; n = 8), intermediate (surgical trainees who had performed 2-10 LH; n = 8) and inexperienced (n = 24) groups. Baselines were assessed on a validated basic task. Participants were tested for the LH procedure on a high-fidelity VR simulator. Validity evidence was proposed as the ability to differentiate between the three levels of experience. Inexperienced subjects performed ten repetitions for learning curve analysis. Proficiency measures were based on experienced surgeons' performances. Outcome measures were simulator-derived metrics and Objective Structured Assessment of Technical Skills (OSATS) scores. Results Quantitative analysis found significant inter-group differences between experienced intermediate and inexperienced groups for time (1369, 2385 and 3370 s; p \ 0.001), number of movements (2033, 3195 and 4056; p = 0.001), path length (3390, 4526 and 5749 cm; p = 0.002), idle time (357, 654 and 747 s; p = 0.001), respect for tissue (24, 40 and 84; p = 0.01) and number of bladder injuries (0.13, 0 and 4.27; p \ 0.001). Learning curves plateaued at the 2nd to 6th repetition. Further qualitative analysis found significant inter-group OSATS score differences at first repetition (22, 15 and 8, respectively; p \ 0.001) and second repetition (25.5, 19.5 and 14; p \ 0.001). Conclusions The VR program for LH accrued validity evidence and allowed the development of a training curriculum using a structured scientific methodology.
ABSTRACT Le lesioni intraepiteliali del collo dell’utero possono essere gestite mediante trattame... more ABSTRACT Le lesioni intraepiteliali del collo dell’utero possono essere gestite mediante trattamenti di exeresi, la conizzazione chirurgica e laser e la resezione con ansa, o mediante dei trattamenti destruenti, la vaporizzazione laser e la crioterapia. Qualunque sia la tecnica scelta, i principi di base da applicare sono gli stessi: la lesione e anche la totalità della zona di trasformazione devono essere distrutte o resecate e la distruzione o escissione deve essere sufficientemente profonda (superiore a 5 mm), per assicurare la distruzione o l’exeresi della totalità delle cripte ghiandolari, potenzialmente penetrate dal processo neoplastico. Questi trattamenti devono essere realizzati sotto controllo colposcopico diretto da un operatore esperto e ciò per guidare il gesto e realizzare un trattamento «su misura» allo stesso tempo completo, che si adatti alla topografia della lesione, ai limiti della zona di trasformazione e alla morfologia cervicale, restando, contemporaneamente, quanto più conservativi possibile. Dato che questi trattamenti hanno un’efficacia terapeutica equivalente, la scelta di un trattamento non è dettata da questo criterio, ma dalla conoscenza di vantaggi, inconvenienti e limiti di ogni tecnica e dalla loro messa in bilancio con l’età della paziente e il suo desiderio di gravidanza, nonché con la gravità della lesione cervicale, la sua sede e la sua superficie, che possono influenzare il potenziale evolutivo naturale della lesione con il rischio di averne inizialmente sottovalutato la gravità. L’utilizzo di tre criteri colposcopici, l’impressione colposcopica, il tipo di giunzione squamocolonnare e l’estensione della lesione, e di due criteri complementari, l’età della paziente e la concordanza dei risultati citologici (striscio) e istologici (biopsia cervicale), permetterebbe così di valutare il rischio di misconoscere una lesione cervicale invasiva allo stadio iniziale e di guidare il medico nella sua decisione terapeutica.
Archives of gynecology and obstetrics, Jan 24, 2015
To assess whether the use of direct colposcopic vision during excision therapy of cervical intrae... more To assess whether the use of direct colposcopic vision during excision therapy of cervical intraepithelial neoplasia (CIN) has an impact on the risk of treatment failure. Data from 285 patients who had had excision therapy with proven CIN at specimen histological analysis were reviewed. Primary endpoint was the occurrence of post-treatment failure defined by the histological diagnosis of CIN 2-3 during follow-up. Data were analysed according to the use of colposcopy at the time of initial therapy of CIN. The use of direct colposcopic vision (DCV) resulted in a significant reduction in the mean height (p = 0.008) and diameter (p < 0.001) of the excised specimen. Patients' median follow-up was 28.4 (±1.3) months. A total of 43 (15.2 %) patients were diagnosed with treatment failure. Compared to excisions performed without any use of colposcopy, DCV was not found to have any significant impact on the risk of treatment failure (HR: 0.58; 95 % CI 0.16-2.13, p = 0.412), neither whe...
The objective of this study was to evaluate the endometrial response to sexual steroids in organ ... more The objective of this study was to evaluate the endometrial response to sexual steroids in organ culture using two means: prostaglandin (PG) F2α output in medium culture and steroid receptor immunoexpression in tissue. Human endometrium samples were classified in homogeneous and heterogeneous proliferative or secretory subsets. In proliferative endometrium explant culture, progesterone (10–7 M) induced a significant decrease in PGF2α output, but this was not the case in secretory endometrium, whereas no significant effect of estradiol (10–8 M) was observed. Before culture, homogeneous and heterogeneous proliferative endometrium presented the same pattern of estradiol receptor (ER) and progesterone receptor (PR) expression evaluated by quantitative immunocytochemistry. After culture, immunoreactive ER and PR were detected on the explant. PR immunoexpression rates after culture were lower than before culture in glands on homogeneous proliferative and in stroma on heterogeneous prolife...
A new lethal case of nemaline myopathy is reported. The diagnosis was made by postmortem muscle b... more A new lethal case of nemaline myopathy is reported. The diagnosis was made by postmortem muscle biopsy. The child died before his first day of life. This is one of the very rare cases of nemaline myopathy with severe antenatal ultrasonographic signs: fetal hydrops and arthrogryposis. In a review of the literature other cases of the congenital rapidly fatal form are found, some of them with clinical decrease of fetal movements but only few authors report ultrasonographic signs. The diagnostic, histopathogenic, genetic and evolutive aspects of this heterogeneous disorder are analyzed. This congenital nonprogressive myopathy is not as benign as previously thought and may be an etiology of the lethal form of arthrogryposis multiplex congenita. The existence of ultrasonographic antenatal signs seems to be a factor of poor prognosis. In spite of recent genetic discoveries, there is at present no specific antenatal diagnosis. Consequently, muscle biopsy in lethal cases is very important to...
CK2α is a signalling molecule that participates in major events in solid tumour progression. The ... more CK2α is a signalling molecule that participates in major events in solid tumour progression. The aim of this study was to evaluate the prognostic significance of the immunohistochemical expression of CK2α in breast carcinomas. Quantitative measurements of immunohistochemical expression of 33 biomarkers using high-throughput densitometry, assessed on digitised microscopic tissue micro-array images were correlated with clinical outcome in 1000 breast carcinomas using univariate and multivariate analyses. In univariate analysis, CK2α was a significant prognostic indicator (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Moreover, a multivariable model allowed the selection of the best combination of the 33 biomarkers to predict patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; outcome through logistic regression. A nine-marker signature highly predictive of metastatic risk, associating SHARP-2, STAT1, eIF4E, pmapKAPk-2, pAKT, caveolin, VEGF, FGF-1 and CK2α permitted to classify well 82.32% of patients (specificity 81.59%, sensitivity 92.55%, area under ROC curve 0.939). Importantly, in a node negative subset of patients an even more (86%) clinically relevant association of eleven markers was found predictive of poor outcome. A strong quantitative CK2α immunohistochemical expression in breast carcinomas is individually a significant indicator of poor prognosis. Moreover, an immunohistochemical signature of 11 markers including CK2α accurately (86%) well classifies node negative patients in good and poor outcome subsets. Our results suggest that CK2α evaluation together with key downstream CK2 targets might be a useful tool to identify patients at high risk of distant metastases and that CK2 can be considered as a relevant target for potential specific therapy.
Journal De Gynecologie Obstetrique Et Biologie De La Reproduction, 1998
Nous rapportons un cas de goitre foetal decouvert a 31 semaines d'amenorrhee (SA) par echogra... more Nous rapportons un cas de goitre foetal decouvert a 31 semaines d'amenorrhee (SA) par echographie. La ponction de sang foetal pratiquee a 33 SA permet le diagnostic d'une hypothyroidie foetale. Le bilan maternel est negatif. Avant qu'une decision de traitement in utero soit prise, l'enfant nait prematurement a 35 SA par cesarienne avec des signes cliniques d'hypothyroidie et un volumineux goitre non compressif homogene. La biologie confirme l'hypothyroidie. La scintigraphie thyroidienne a l'iode 123, couplee a un test au thyocyanate, est evocatrice de trouble de l'organification de l'iode. Les progres de l'echographie et des moyens d'abords du foetus permettent d'etudier la fonction thyroidienne foetale et d'envisager un traitement in utero. Les troubles congenitaux de l'hormonogenese representent 10 a 15 % des hypothyroidies neonatales; la presence d'un goitre neonatal, quoique inconstante, en est un element d'orientat...
Revue française de gynécologie et d'obstétrique, 1997
L'hysteroscopie operatoire est une technique bien codifiee aux avantages connus ; cependant, ... more L'hysteroscopie operatoire est une technique bien codifiee aux avantages connus ; cependant, il s'agit d'une chirurgie a part entiere qui comporte des risques que tout gynecologue et anesthesiste doit connaitre. Ces complications ne font l'objet que de quelques publications. Nous avons coordonne une enquete nationale multicentrique, prospective, dont le but etait d'evaluer sur une periode de 6 mois, l'incidence des complications de l'hysteroscopie, en s'adressant, non pas aux seuls centres de reference, mais a un eventail plus large de gynecologues francais. 120 medecins nous ont rapporte un total de 2757 hysteroscopies, parmi lesquelles 1759 (63,8 %) hysteroscopies operatoires et 998 (36,2 %) hysteroscopies diagnostiques. 27 complications nous ont ete adressees : une (0,1 %) dans le groupe des hysteroscopies diagnostiques : il s'agissait d'une perforation aux suites simples. 26 (1,48 %) dans le groupe des hysteroscopies operatoires dont 16 pe...
L'hysterosalpingographie conserve la premiere place parmi les explorations de l'appareil ... more L'hysterosalpingographie conserve la premiere place parmi les explorations de l'appareil genital feminin en cas de sterilite car elle permet a la fois l'evaluation de la permeabilite tubaire et l'exploration intra-uterine. L'echographie, non invasive, permet une orientation diagnostique mais reste peu performante dans le bilan d'une sterilite. L'hysteroscopie est indispensable lorsqu'une pathologie intra-uterine est suspectee et en presence d'antecedents de manoeuvres intra-uterines. Elle peut egalement permettre une approche therapeutique de certaines sterilites tubaires proximales
Revue française de gynécologie et d'obstétrique, 1992
: Between October 1986 and March 1990, 220 patients underwent surgical treatment for ovarian cyst... more : Between October 1986 and March 1990, 220 patients underwent surgical treatment for ovarian cysts. 156 of these patients underwent an initial celioscopy and could potentially benefit from celiosciopic treatment. The group mean age was 33.3 years. The circumstances under which the cysts were discovered usually consisted of pelvic pain or diagnosis during a routine examination. Twenty-four patients underwent laparotomy immediately after coelioscopy either due to a suspect macroscopic diagnosis either due to technical difficulties. 84.6 percent of the patients in the group were able to undergo celioscopic treatment only, essentially consisting of intraperitoneal cystectomy. The main advantages were the reduction in adherent sequelae in these women of a sexually active age, but also some financial savings related to the reduced duration of hospitalization and of sick leave. The theoretical reservations consist of the risk of malignancy and macroscopic diagnosis following coelioscopic exploration must be very restricted, with laparotomy whenever there is any doubt. No malignant tumor was escaped detection in this group.
L'HDD est une cause majeure de morbidite et de mortalite maternelle. Elle reste souvent impre... more L'HDD est une cause majeure de morbidite et de mortalite maternelle. Elle reste souvent imprevisible et brutale malgre l'existence de facteurs de risques. L'etiologie la plus frequente est l'atonie uterine. Une prise en charge rapide et adapte, menee conjointement avec l'anesthesiste, permet de reduire les complications. Chaque service doit disposer d'un protocole accessible rapidement et connu de tous. Le traitement comporte une reanimation et l'administration d'uterotoniques en cas d'atonie. L'echec du traitement medical doit conduire rapidement a une embolisation ou a une ligature des afferences vasculaires uterines.
Background Substantial evidence in the scientific literature supports the use of simulation for s... more Background Substantial evidence in the scientific literature supports the use of simulation for surgical education. However, curricula lack for complex laparoscopic procedures in gynecology. The objective was to evaluate the validity of a program that reproduces key specific components of a laparoscopic hysterectomy (LH) procedure until colpotomy on a virtual reality (VR) simulator and to develop an evidence-based and stepwise training curriculum. Methods This prospective cohort study was conducted in a Marseille teaching hospital. Forty participants were enrolled and were divided into experienced (senior surgeons who had performed more than 100 LH; n = 8), intermediate (surgical trainees who had performed 2-10 LH; n = 8) and inexperienced (n = 24) groups. Baselines were assessed on a validated basic task. Participants were tested for the LH procedure on a high-fidelity VR simulator. Validity evidence was proposed as the ability to differentiate between the three levels of experience. Inexperienced subjects performed ten repetitions for learning curve analysis. Proficiency measures were based on experienced surgeons' performances. Outcome measures were simulator-derived metrics and Objective Structured Assessment of Technical Skills (OSATS) scores. Results Quantitative analysis found significant inter-group differences between experienced intermediate and inexperienced groups for time (1369, 2385 and 3370 s; p \ 0.001), number of movements (2033, 3195 and 4056; p = 0.001), path length (3390, 4526 and 5749 cm; p = 0.002), idle time (357, 654 and 747 s; p = 0.001), respect for tissue (24, 40 and 84; p = 0.01) and number of bladder injuries (0.13, 0 and 4.27; p \ 0.001). Learning curves plateaued at the 2nd to 6th repetition. Further qualitative analysis found significant inter-group OSATS score differences at first repetition (22, 15 and 8, respectively; p \ 0.001) and second repetition (25.5, 19.5 and 14; p \ 0.001). Conclusions The VR program for LH accrued validity evidence and allowed the development of a training curriculum using a structured scientific methodology.
ABSTRACT Le lesioni intraepiteliali del collo dell’utero possono essere gestite mediante trattame... more ABSTRACT Le lesioni intraepiteliali del collo dell’utero possono essere gestite mediante trattamenti di exeresi, la conizzazione chirurgica e laser e la resezione con ansa, o mediante dei trattamenti destruenti, la vaporizzazione laser e la crioterapia. Qualunque sia la tecnica scelta, i principi di base da applicare sono gli stessi: la lesione e anche la totalità della zona di trasformazione devono essere distrutte o resecate e la distruzione o escissione deve essere sufficientemente profonda (superiore a 5 mm), per assicurare la distruzione o l’exeresi della totalità delle cripte ghiandolari, potenzialmente penetrate dal processo neoplastico. Questi trattamenti devono essere realizzati sotto controllo colposcopico diretto da un operatore esperto e ciò per guidare il gesto e realizzare un trattamento «su misura» allo stesso tempo completo, che si adatti alla topografia della lesione, ai limiti della zona di trasformazione e alla morfologia cervicale, restando, contemporaneamente, quanto più conservativi possibile. Dato che questi trattamenti hanno un’efficacia terapeutica equivalente, la scelta di un trattamento non è dettata da questo criterio, ma dalla conoscenza di vantaggi, inconvenienti e limiti di ogni tecnica e dalla loro messa in bilancio con l’età della paziente e il suo desiderio di gravidanza, nonché con la gravità della lesione cervicale, la sua sede e la sua superficie, che possono influenzare il potenziale evolutivo naturale della lesione con il rischio di averne inizialmente sottovalutato la gravità. L’utilizzo di tre criteri colposcopici, l’impressione colposcopica, il tipo di giunzione squamocolonnare e l’estensione della lesione, e di due criteri complementari, l’età della paziente e la concordanza dei risultati citologici (striscio) e istologici (biopsia cervicale), permetterebbe così di valutare il rischio di misconoscere una lesione cervicale invasiva allo stadio iniziale e di guidare il medico nella sua decisione terapeutica.
Archives of gynecology and obstetrics, Jan 24, 2015
To assess whether the use of direct colposcopic vision during excision therapy of cervical intrae... more To assess whether the use of direct colposcopic vision during excision therapy of cervical intraepithelial neoplasia (CIN) has an impact on the risk of treatment failure. Data from 285 patients who had had excision therapy with proven CIN at specimen histological analysis were reviewed. Primary endpoint was the occurrence of post-treatment failure defined by the histological diagnosis of CIN 2-3 during follow-up. Data were analysed according to the use of colposcopy at the time of initial therapy of CIN. The use of direct colposcopic vision (DCV) resulted in a significant reduction in the mean height (p = 0.008) and diameter (p < 0.001) of the excised specimen. Patients' median follow-up was 28.4 (±1.3) months. A total of 43 (15.2 %) patients were diagnosed with treatment failure. Compared to excisions performed without any use of colposcopy, DCV was not found to have any significant impact on the risk of treatment failure (HR: 0.58; 95 % CI 0.16-2.13, p = 0.412), neither whe...
The objective of this study was to evaluate the endometrial response to sexual steroids in organ ... more The objective of this study was to evaluate the endometrial response to sexual steroids in organ culture using two means: prostaglandin (PG) F2α output in medium culture and steroid receptor immunoexpression in tissue. Human endometrium samples were classified in homogeneous and heterogeneous proliferative or secretory subsets. In proliferative endometrium explant culture, progesterone (10–7 M) induced a significant decrease in PGF2α output, but this was not the case in secretory endometrium, whereas no significant effect of estradiol (10–8 M) was observed. Before culture, homogeneous and heterogeneous proliferative endometrium presented the same pattern of estradiol receptor (ER) and progesterone receptor (PR) expression evaluated by quantitative immunocytochemistry. After culture, immunoreactive ER and PR were detected on the explant. PR immunoexpression rates after culture were lower than before culture in glands on homogeneous proliferative and in stroma on heterogeneous prolife...
A new lethal case of nemaline myopathy is reported. The diagnosis was made by postmortem muscle b... more A new lethal case of nemaline myopathy is reported. The diagnosis was made by postmortem muscle biopsy. The child died before his first day of life. This is one of the very rare cases of nemaline myopathy with severe antenatal ultrasonographic signs: fetal hydrops and arthrogryposis. In a review of the literature other cases of the congenital rapidly fatal form are found, some of them with clinical decrease of fetal movements but only few authors report ultrasonographic signs. The diagnostic, histopathogenic, genetic and evolutive aspects of this heterogeneous disorder are analyzed. This congenital nonprogressive myopathy is not as benign as previously thought and may be an etiology of the lethal form of arthrogryposis multiplex congenita. The existence of ultrasonographic antenatal signs seems to be a factor of poor prognosis. In spite of recent genetic discoveries, there is at present no specific antenatal diagnosis. Consequently, muscle biopsy in lethal cases is very important to...
CK2α is a signalling molecule that participates in major events in solid tumour progression. The ... more CK2α is a signalling molecule that participates in major events in solid tumour progression. The aim of this study was to evaluate the prognostic significance of the immunohistochemical expression of CK2α in breast carcinomas. Quantitative measurements of immunohistochemical expression of 33 biomarkers using high-throughput densitometry, assessed on digitised microscopic tissue micro-array images were correlated with clinical outcome in 1000 breast carcinomas using univariate and multivariate analyses. In univariate analysis, CK2α was a significant prognostic indicator (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Moreover, a multivariable model allowed the selection of the best combination of the 33 biomarkers to predict patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; outcome through logistic regression. A nine-marker signature highly predictive of metastatic risk, associating SHARP-2, STAT1, eIF4E, pmapKAPk-2, pAKT, caveolin, VEGF, FGF-1 and CK2α permitted to classify well 82.32% of patients (specificity 81.59%, sensitivity 92.55%, area under ROC curve 0.939). Importantly, in a node negative subset of patients an even more (86%) clinically relevant association of eleven markers was found predictive of poor outcome. A strong quantitative CK2α immunohistochemical expression in breast carcinomas is individually a significant indicator of poor prognosis. Moreover, an immunohistochemical signature of 11 markers including CK2α accurately (86%) well classifies node negative patients in good and poor outcome subsets. Our results suggest that CK2α evaluation together with key downstream CK2 targets might be a useful tool to identify patients at high risk of distant metastases and that CK2 can be considered as a relevant target for potential specific therapy.
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