Trang 12 Chxaspzivteree 1Ipnvterogdhu3cvtziopn1.1 Ipnvterogdhu3cvtziopn1.1.1 IPAL & PxaervteepnxaziereelsFZICGHUEREE 1.1: Ilmxacgee & Peeerivxalsziivee A3c3ceelsls Lxa@b IPAL ylocgo.L’IP
Trang 3Jee vtzieepnls `xa ereelmeeer3czieeer gdxapnls hupn spereelmzieeer vteelmspls, lmopn eepn3cxagderxapnvt gdee lsvtxacgee, kMopnlszieehuerTholmxals Bohugdzieeer, spohuer lm’xaivozier xa3c3chueeziylylzi xahu lseezipn gdee yl’´eeqhuzispee, spohuer lsopn lsohuvtzieepn
Trang 4Txa@bylee gdeels lmxavtzi`eeereels
Co p n v t e e p n v t l s z i z i z i
L z i l s v t of F z i c g h u e r e e l s i v
1 I p n v t e ro g d h u 3 c v t z i o p n 1
1.1 Ipnvterogdhu3cvtziopn 1
1.1.1 IPAL & Pxaervteepnxaziereels 1
1.2 O@bjee3cvtzif gdhu lsvtxacgee 2
1.2.1 Copnvteepxvtee gdhu vterxaivxaziyl 2
1.2.2 O@bjee3cvtzif gdhulsvtxacgee 3
2 E´ v t x a v t g d e e y l’ x a e r v t 5 2.1 Rxaspspeeyl gdee @bzioylocgziee 5
2.1.1 Svterhu3cvthueree gdee ylxa 3ceeylylhuylee 5
2.1.2 Cxapn3ceeer gdhu lseezipn 6
2.1.3 Dzixa@b`eevtee eevt zipnlshuylzipnee 9
2.2 Apnxaylmylsee gdee yl’oercgxapnzilsxavtziopn lsspxavtzixaylee 10
2.2.1 Terxaivxahupx lszilmziylxaziereels 10
2.2.2 Apnxaylmylsee `xa yl’´ee3cheeylylee ylo3cxaylee 11
2.2.3 Apnxaylmylsee `xa yl’´ee3cheeylylee cgylo@bxaylee 13
2.2.3.1 Svtxavtzilsvtziqhuee lsspxavtzixaylee 13
2.2.3.2 Fopn3cvtziopnls gd’eelsvtzilmxavtziopn gdee ylxa gdzilsvterzi@bhuvtziopn 15
2.3 Elsvtzilmxavtziopn gdee ylxa gdzilsvtxapn3cee 18
2.3.1 Dzilsvtxapn3cee eehu3cylzigdzieepnpnee 18
2.3.2 Dzilsvtxapn3ceels cg´eeogd´eelsziqhueels 20
2.4 Epnivzieropnpneelmeepnvt ylocgzi3czieeyl huvtziylzils´ee 22
3 I l m s p y l´ e e l m e e p n v t x a v t z i o p n 24 3.1.1 kMogd´eeylzilsxavtziopn gdee ylxa lsvterhu3cvthueree gd’hupnee 3ceeylylhuylee 24
3.1.2 kMogd´eeylzilsxavtziopn `xa yl’´ee3cheeylylee ylo3cxaylee 25
3.1.2.1 Foerlmee xapnxaylmyvtziqhuee gdee ylxa 3ceeylylhuylee 25
3.1.2.2 Foerlmeels 3colmspyleepxeels gdee ylxa 3ceeylylhuylee 29
3.1.3 kMogd´eeylzilsxavtziopn `xa yl’´ee3cheeylylee cgylo@bxaylee 34
3.1.4 kMogd´eeylzilsxavtziopn `xa lmhuylvtzi-´ee3cheeylyleels 38
3.1.5 Lxapncgxacgee gdee gdeels3cerzispvtziopn gdee yl’oercgxapnzilsxavtziopn lsspxavtzixaylee 42
4 R´ e e l s h u y l v t x a v t & D z i l s 3 c h u l s l s z i o p n 46 4.1 R´esultat 46
Trang 6hupnzifoerlmee) (gd’xasper`eels [4]) .15
v
Trang 8n n
Trang 11Lzilsvt of Aylcgoerzivthlmls
1 Aylcgoerzivthlmee gdee kMopnvtee Cxaerylo spohuer vtziereeer hupn o@bjeevt xayl´eexavtozieree qhuzi lsxavtzilsfxazivt
yleels er`eecgyleels gdee ereeylxavtziopn R gdxapnls ylee gdolmxazipnee gdee eree3cheeer3chee P 27
2 G´P eepn´eeereeer gdee pnolm@bereehupx o@bjeevtls `xa yl’zipnvt´eeerzieehuer gdhu gdolmxazipnee gdee eree3cheeer3chee eevt lsxavtzilsfxazieree yleels er`eecgyleels gdee ereeylxavtziopnls RCC eepn huvtziylzilsxapnvt ylxa lm´eevthogdee gdee kMopnvtee-Cxaerylo28 3 Fopn3cvtziopn TPPzi : vtziereeer ylee gdolmxazipnee gdhu3ceepnvteree gd’hupn o@bjeevt S z i qhuzi eelsvt `xa yl’zipnvt´eeerzieehuer g d h u g d l m x a z i p n e e g d e e e r e e 3 c h e e e r 3 c h e e P e e v t x a e r x a g d z i h u l s e r e e v t y l x a e r e e y l x a v t z i o p n S z i TPP z i P 30
4 Fopn3cvtziopn DC : vtziereeer ylee gdolmxazipnee gdhu 3ceepnvteree gd’hupn o@bjeevt S z i qhuzi eelsvt `xa yl’zipnvt´eeerzieehuer gdhu gdolmxazipnee gdee eree3cheeer3chee P , `xa yl’eepxvt´eeerzieehupx gdeels o@bjeevtls eepxzilsvteels S eevt xa erxagdzihuls e r e e v t y l x a e r e e y l x a v t z i o p n S z i DC P 32
5 Alm´eeylzioerxavtziopn gdee yl’xaylcgoerzivthlmee1gdee kMopnvtee Cxaerylo :cg´eepn´eeerxavtziopn gdee pnolm@bereehupx o@bjeevtls S1, S2, , S p n `xa yl’zipnvt´eeerzieehuer gdhu gdolmxazipnee gdee eree3cheeer3chee P eepn huvtziylzilsxapnvt ylxa 3cxaervtee gdee gdzilsvtxapn3cee 32
6 FoP pn3cvtziopn gdee gdzilsvterzi@bhuvtziopn eepn xaspspylziqhuxapnvt ylxa 3cxaervtee gdee gdzilsvtxapn3cee xaerxalm`eevteree gdee gdzilsvterzi@bhuvtziopn α ∈ [0, 1] 35
7 G´eepn´eeerxavtziopn gdee pnolm@bereehupx o@bjeevtls S1, S2, ., S p n `xa yl’zipnvt´eeerzieehuer gdhu gdolmxazipnee gdee eree3cheeer3chee P , eevt lsopnvt gdzilsvterzi@bhu´ee (xayl´eexavtozieree, xacger´eecg´ee, hupnzifoerlmee) eepn huvtziylzilsxapnvt ylxa 3cxaervtee gdee gdzilsvtxapn3cee 37
8 Aylcgoerzivthlmee spohuer er´eexaylzilseeer ylee ls3c´eepnxaerzio 10 : gdeels 3cylhulsvteeerls eepn lmeelm@berxapnee 41
- Fhupn3cvtziopn cgeepneeereeerCeepnvterozigdVeelszi3chuyleels (3ceeylylhuylee P , pn@bCeepnvterozigd o k) 41
- Fhupn3cvtziopn cgeepneeereeerEyleelmeepnvtPeeerCylhulsvteeer (ylzilsvteeCeepnvterozigd C, p n) 42
p
x
Trang 12Chxaspzivteree 1
1.1 Ipnvterogdhu3cvtziopn
1.1.1 IPAL & Pxaervteepnxaziereels
FZ I C G H U E R E E 1.1: Ilmxacgee & Peeerivxalsziivee A3c3ceelsls Lxa@b (IPAL) ylocgo
L’IPAL, `xa yl’oerzicgzipnee I l m x a c g e e P e ro 3 c e e l s l s z i p n c g & A s p s p y l z i 3 c x a v t z io p n L x a @ bo e r x a v to e r m y, eelsvt 3cer´ee´ee eepn
Ahujohuergd’hhuzi I l m x a c g e e & P e e e r i v x a l s z i i v e e A 3 c 3 c e e l s l s L x a @ b (IPAL), ziyl eelsvt 3cogdzierzicg´ee gdeesphuzils 2008
spxaer ylee sperofeelslseehuer Dxapnzieeyl RACOCEAlNU, spohuer ylxa spxaervtziee ferxapn¸3cxazilsee, eevt spxaer ylee Der.Joo Hweeee LIkM spohuer ylxa spxaervtziee lszipncgxaspohuerzieepnpnee
1
Trang 13ylhuzi offerzier hupn ohuvtziyl gd’xalslszilsvtxapn3cee eevt gdee ivxaylzigdxavtziopn, speeerlmeevtvtxapnvt `xa ylxa fozils hupn cgxazipn eepn
vteelmspls eevt eepn jhulsvteelslsee gdee speropnolsvtzi3c Dxapnls hupn gdeehupxzi`eelmee vteelmspls, ylee sperojeevt ivzilsee `xaofferzier xahupx lm´eegdee3czipnls hupnee zipnvteeerfxa3cee speeervtzipneepnvtee eevt xagdxaspvt´eeee `xa yleehuerls @beelsozipnls.L’IPAL xa gd´eeiveeylospsp´ee spohuer 3ceeylxa hupnee opnvtoylocgziee gdeels- vtzipn´eeee `xa ereesper´eelseepnvteeer yleels
Trang 14Cee lsvtxacgee eelsvt 3co-eepn3cxagder´ee spxaer Tholmxals BOUDIER, kMxaˆıvteree gdee 3copnf´eeereepn3ceels `xa
yl’Upnziiveeerlszivt´ee Pzieeereree eevt kMxaerziee Chuerziee, Lhugdoivzi3c ROUX, zipncg´eepnzieehuer gdee eree3cheeer3cheels `xaIPAL, xazipnlszi qhuee spxaer Shzijzixapn LU gdxapnls ylee 3cxagderee gd’hupnee 3coylylxa@boerxavtziopn eepnvteree IPAL eevtI2R lNovteree lsvtxacgee lsee gd´eeerohuylee xahu ylxa@boerxavtozieree IPAL, UkMI ClNRS 2955, Szipncgxaspohuer
Trang 19FZ I C G H U E R E E 2.2: E´vtxaspeels gdhu 3cxapn3ceeer gdhu lseezipn : l No e r l m x a y l 3 c e e y l y l l s, D h u 3 c v t x a y l h m y s p e e e r s p y l x a l s z i x a
-vterosp gdee 3ceeylylhuyleels A v t m y s p z i 3 c x a y l g d h u 3 c v t x a y l h m y s p e e e r s p y l x a l s z i x a - vterosp gdee 3ceeylylhuyleels qhuzi
3
colmlmeepn3ceepnvt `xa xaspspxaerxaˆıvteree xapnoerlmxaylee (´eecgxayleelmeepnvt 3copnpnhu lsohuls ylee pnolm ADH).D h u 3 c v t x a y l 3 c x a e r 3 c z i p no l m x a z i p n l s z i v t h u - vterosp gdee 3ceeylylhuyleels qhuzi lsee gd´eeiveeylospspeepnvt 3colmlmee hupn
3cxapn3ceeer lmxazils lsopnvt eepn3coeree 3copnfzipn´eels `xa yl’zipnvt´eeerzieehuer gdhu 3copngdhuzivt (DCIS) DCIS- k MI
(DCIS xaivee3c lmzi3cero-zipnivxalsziopn) - spylhulszieehuerls lsohuls-vtmyspeels gdee DCIS, 3ceeervtxazipnls spylhuls cgerxaiveels
qhuee gd’xahuvtereels I p n i v x a l s z i i v e e g d h u 3 c v t x a y l 3 c x a p n 3 c e e e r - L’´eevtxavt zipn3copnvterˆoyl´ee gdeels 3ceeylylhuyleels qhuzi opnvt
pass´e `a travers des barri`eres tissulaires normales
Trang 23´eelmeepnvt´ee hupn xaylcgoerzivthlmee eeffzi3cxa3cee spohuer 3cxayl3chuyleeer yleels ereeylxavtziopnls
Trang 30Trang 43
gdolmxazipneeTPPzi = vtziereeerDolmxazipneePolslszi@byleeTPPzi (DolmxazipneeRee3cheeer3chee P ) ;
gdolmxazipneeDC = vtziereeerDolmxazipnPolslszi@byleeDC (erxagdzihulslNohuiveexahuO@bjeevt,
Trang 47(a) Dolmxazipnee gdee eree3cheeer3chee P
(b) Dolmxazipnee spolslszi@bylee(gdeels spozipnvtls o@bvteepnhuls eepn
Trang 52gdolmxazipneeTPPzi = vtziereeerDolmxazipneeTPPzi (3ceeylylhuylee P , erxagdzihulslNohuiveexahuCeepnvterozigd) ;
gdolmxazipneeDC = vtziereeerDolmxazipneeDC (erxagdzihulslNohuiveexahuCeepnvterozigd,
Trang 53gdolmxazipneeTPPzi = vtziereeerDolmxazipneeTPPzi (3ceeylylhuylee P ,
erxagdzihulslNohuiveexahuVeelszi3chuylee) ; gdolmxazipneeDC = vtziereeerDolmxazipneeDC
Trang 55FZ I C G H U E R E E 3.21: Lxa 3copn3ceespvtziopn cgylo@bxaylee gdeels o@bjeevtls eevt gdeels ereeylxavtziopnls eepnvteree yleels o@bjeevtls.
Ceevtvtee 3copn3ceespvtziopn fxazivt ylee ylzieepn eepnvteree yleels o@bjeevtls, lsvterhuvthuereels eevt er´eespopngderee `xa ylxa
qhueelsvtziopn 3colmlmeepnvt 3ceevtvtee 3copnpnxazilslsxapn3cee lsvterhu3cvthuereeylylee eevt lsspxavtzixaylee speehuvt ˆeevteree huvtziylzils
´eeee spohuer cghuzigdeeer yl’zipnvteeersper´eevtxavtziopn gd’zilmxacgeels
Trang 60(a) Lxa vtxa@bylee gdee ereeylxavtziopn eepnvteree yleels 3ceeylylhuyleels pnoerlmxayleels (ivozier ylxa lsee3cvtziopn2.1.2eevt ylee ls3c´eepnxaerzio3.0.4), 3chxaqhuee
Trang 62szivthu´ee eepnvteree gdeehupx cgerxaspheels qhuzi opnvt
yleels ivxayleehuerls gdee 3copnfzixapn3cee 5% eevt 95%,, 3c’eelsvt-`xa-gdzieree 3cee lmogd`eeylee lsspxa- vtzixayl xa
´eevt´ee sperogdhuzivt 3coereree3cvteelmeepnvt
(d) R´eelshuylvtxavt gdhu H-fhupn3cvtziopn (ylee
ivxayleehuer gdee 3copnfzixapn3cee gdee F-fhupn3cvtziopnSDI = 0.03 ohu 3% eevt 3cee cgerxasphee eelsvt
Trang 66[1]Keepnmyopn lNS Rzi3coergdzi C Beeercgcgereepn PO Cxazi3ceegdo A Cxa@bereeerxa O, Beeerlmxapn DkM Theeh