OBJECTIVE We aimed at to compare the thyroid ultrasound risk stratification systems (RSSs) of the... more OBJECTIVE We aimed at to compare the thyroid ultrasound risk stratification systems (RSSs) of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS), European (EU) TI-RADS, Korean (K) TI-RADS, and American Thyroid association (ATA) guidelines and American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME) guidelines to differentiate benign from malignant thyroid nodules and to avoid unnecessary FNA. METHODS The records of 1143 nodules ≥1 cm which underwent fine needle aspiration biopsy (FNA) and thyroidectomy between 2012 and 2020 at our institution were reviewed. Ultrasound categories and FNA recommendation indications of five international RSSs were compared with histopathological finding as benign or malignant. The ultrasound categories and recommended FNA indications and the proportion of the avoidable FNA procedures, and false negative rates (FNR) by different systems were compared with each other. RESULTS Of the 1143 nodules, 45% had thyroid malignancy. FNA recommendation and ultrasound risk classification of ATA guidelines had the highest area under curves (AUCs) of 0.619, and 0.715, respectively. ACR TI-RADS, AACE/ACE/AME guidelines, EU TI-RADS, ATA guidelines and K TI-RADS would have avoided 34.7%, 31%, 25.7%, 20%, 6% nodules from FNA with a FNR of 24%, 28.5%, 22%, 7.2%, and 1.9%, respectively. CONCLUSION Our findings showed that all RSSs classified the nodules appropriately for malignancy. ATA guidelines had the highest AUC and a low FNR, whereas ACR TI-RADS would have spared more patients from FNA with a high FNR.
Purpose The COVID-19 pandemic brought unprecedented conditions for overall health care systems by... more Purpose The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole ± β-blocker combination for Graves' disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3-4 cytological results and papillary microcarcinoma. Conclusion This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible.
PURPOSE Breast cancer is the most frequent cancer in women, and there is a great variability in s... more PURPOSE Breast cancer is the most frequent cancer in women, and there is a great variability in surgical practice for treating that cancer in different countries. The aims of this study were to analyze the effect of guidelines from the Turkish Federation of Breast Diseases Societies on academic institutions that have breast centers and to evaluate surgical practice in Turkey in 2018. PATIENTS AND METHODS Between January and March 2019, a survey was sent to breast surgeons who were working in breast centers in academic institutions. The sampling frame included 24 academic institutions with breast centers in 18 cities in Turkey to evaluate interdisciplinary differences among breast centers and seven regions in Turkey regarding patients’ choices, surgical approaches, and academic institutions. RESULTS All surgeons responded to the survey, and all 4,381 patients were included. Most of the surgeons (73.9%) were working in a breast center. Multidisciplinary tumor boards were performed in ...
Morrow reported that changing treatment landscape had raised new questions on axillary management... more Morrow reported that changing treatment landscape had raised new questions on axillary management, on initial sentinel lymph node (SN) biopsy and repeat lumpectomy. The important remarks that I selected from her lecture are as follows: Metastatic work up is essential prior to any local therapy for locoregional recurrence (LRR); because, historically ~50% of LRR was accompanied by distant metastases. Axillary dissection is an appropriate approach for axillary recurrence after SN biopsy. Reoperative SN biopsy after local recurrence is feasible, accurate and provides useful information. A SN can be identified in the majority of the patients who had initial SN biopsy (81%), and in about 50% of those with axillary dissection. Aberrant drainage is common after SN or axillary dissection and has implications for mapping. Extra-axillary or aberrant lymphatic drainage is uncommon in untreated axilla. However, in patients with ipsilateral breast recurrence (IBTR) after a breast conserving surgery (BCS) and SN biopsy or axillary dissection, aberrant drainage is likely in one third of patients. Because prior axillary surgery increases drainage to contralateral axilla, this is not necessarily a metastatic disease. In patients who had contralateral axillary metastases identified with ipsilateral local recurrence, Morrow suggested to do metastatic work-up and to exclude contralateral breast primarily with mammography and magnetic resonance imaging, and if local recurrence was operable and non-locally advanced, to perform axillary dissection. Combined radioactive colloid and blue dye is recommended for reoperative SN biopsy, because identification of extra-axillary SN is uncommon with intradermal or subareolar injection. She suggests peritumoral injection is optimal in reoperative setting. Under the heading of 'Management of IBTR after BCS: Is lumpectomy alone appropriate?', the indications for repeat lumpectomy alone were suggested as follows: disease meeting criteria for no radiotherapy after primary surgery (that is, low risk group); age >70 years, T1N0 ER+ Her2-, Grade 1, 2 DCIS ≤1.5 cm, disease suggestive of second primary tumor with long disease-free interval, in separate quadrant, and patients with severe morbidity. Morrow concluded that better data were needed to define optimal management of LRR. Tari King reported that the quest for optimal regional treatment is continuing, and the goal of balancing the risks and benefits of treatment options is to minimize morbidity of local regional treatment without compromising the outcome. Here are the remarks from her lecture: SN after neoadjuvant chemotherapy (NAK) in T1, 2, cN0-cN1 patients decreases axillary dissection significantly due to the decrease in % of node positive axilla. Benefits of avoiding axillary dissection were manifested with lower rates of lymphedema (11-14% for axillary dissection vs. 3-8% with SN). Rationale for NAK in cN+ patients was that nodal pCR rates were 38-49%. Nodal pCR rates were 21% for ER+/Her2-, 47% for ER-/Her2-, 70% for ER+/Her2+, and 97% for ER-/Her2-, respectively. There is no role for nomograms to predict the likelihood of additional axillary metastases or PET scans to look for additional metastases. In response to "When can nodal staging be omitted?", from 'CALGB randomized trial of the omission of radiotherapy', patients with age ≥70 years, T1N0, ER+, patients who had BCS and tamoxifen treatment were suggested as candidates for omission of axillary staging. Ten-year rate of axillary failure for these patients (no: 392) was 1.5%. Tari King concluded under the title of "Where will we go from here" that "there was no improvement on survival with axillary dissection", "Increasing role of biology vs. anatomy in decision making for systemic therapy", and "Growing interest to omit axillary staging".
Purpose: Our aim was to determine if a close surgical margin (<2 mm, but no ink on tumor) for duc... more Purpose: Our aim was to determine if a close surgical margin (<2 mm, but no ink on tumor) for ductal carcinoma in situ (DCIS) associated with invasive breast cancer (IBC) leads to an increased rate of ipsilateral breast tumor recurrence (IBTR). Patients and Methods: Six hundred and twenty-eight patients with T1-2 IBC who underwent breast conserving therapy (BCT) and had no ink on tumor between 2009 and 2017 in our institution were included in the study. Age, tumor size, axillary lymph node status, resection margin status of DCIS as closer than 2 mm or !2 mm, DCIS as present or absent, extensive intraductal component as yes or no were investigated. All patients were followed-up for IBTR. Results: The median age was 50 years (range, 29-82), and median tumor size was 25 mm (range, 5-50). Median follow-up time was 56 months (range, 12-114). Of the 628 IBC patients, 440 (70%) were found to be associated with DCIS. Of the 440 patients with DCIS, 119 (27%) had a close margin (<2 mm) and 321 (73%) had a margin !2 mm for DCIS. Among 440 IBC patients associated with DCIS, there were three local recurrences. One developed in a patient who had a close surgical margin for DCIS, and in the other two patients, surgical margins were !2 mm. Conclusions: No ink on tumor is an adequate margin for IBC associated with DCIS in patients who undergo BCT and it is not associated with increased IBTR.
93 Background: To avoid performing axillary lymph node dissection (ALND) for non-sentinel lymph n... more 93 Background: To avoid performing axillary lymph node dissection (ALND) for non-sentinel lymph node (SLN)-negative patients with SLN-positive axilla, nomograms for predicting the status of the axillary non-SLNs have been developed in many centers. We created a new nomogram predicting non-SLN metastasis in SLN positive patients with invasive breast cancer and evaluated 14 existing breast cancer models in our patient group. Methods: Two hundred and thirty seven invasive breast cancer patients with SLN metastases who underwent ALND were included in the present study. Based on the independent predictive factors for non-SLN metastasis identified by logistic regression analysis, we developed a new nomogram. Receiver operating characteristics (ROC) curves for the models were created, and the areas under the curves (AUC) were computed. Results: In a multivariate analysis, tumor size, presence of lymphovascular invasion, extranodal extension of SLN, large size of metastatic SLN in mm, the n...
In these 21 cases, median age at first operation was 51 (range 34-80), and disease free survival ... more In these 21 cases, median age at first operation was 51 (range 34-80), and disease free survival was 35.4 ± 6.3 months. Histopathological study revealed the presence of invasive ductal carcinoma in all cases. Average tumor size was 2.55 ± 0.43 cm, and the average numbers of removed sentinel lymph node were 3.4 ± 0.5. The numbers of nuclear grade 3 were 9 (42.9%). Vein invasion was seen in 3 cases (14.3%), and lymph vascular invasion was seen in 9 cases (42.9%). All 21 patients were performed ALND after ALN recurrence. The average numbers of dissected lymph node were 13.9 ± 1.5, and of metastatic lymph node were 3.0 ± 0.5. During the median follow up period of 62.7 months from additional ALND, distant metastases were observed in 5 cases (23.9%) and 1 case (4.8%) died. In the group with distant metastases after ALND, the rate of lymph vascular invasion was significantly higher than the group without distant metastases (60.0% vs. 37.5%, p = 0.048), whereas there were no significant differences of clinical or pathological backgrounds between the group with and without distant metastases. But patients who received chemotherapy after ALND had a trend to a lower distant metastases compared with patients who received no chemotherapy (13.3% vs. 50.0%, p = 0.115). Conclusion: In this study, the risk factor for the ALN recurrence is nuclear grade and presence of lymph vascular invasion, and lymph vascular invasion is also the risk of distant metastases. Chemotherapy may probably affect to prevent distant metastases after additional ALND, but still need further investigation.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
To evaluate the predicting factors for non-sentinel lymph node (SLN) metastases in T1-2 invasive ... more To evaluate the predicting factors for non-sentinel lymph node (SLN) metastases in T1-2 invasive breast cancer with 1-2 metastatic SLN that fully matched the ACOSOG Z0011 criteria. Also, to develop a scoring system to predict the risk of non-SLN metastasis and to discriminate the low-risk patients for omission of the axillary lymph node dissection (ALND) in this population. Two hundred and seven T1-2 invasive breast cancer patients with 1-2 metastatic SLN who underwent ALND at our Institution were included in the study. Independent factors predicting the non-SLN metastasis were found using logistic regression analysis, and a scoring system to predict the non-SLN metastasis was created. Seventy (34%) out of 207 patients had non- SLN metastasis. Multivariate logistic regression analysis demonstrated that tumor size, presence of lymphovascular invasion (LVI), number of negative SLNs, and size of SLN metastasis were independent factors predicting non-SLN metastasis. There were 68 (33%) ...
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
In this article published in Volume 21, issue 5, the Results section of the Pubmed abstract appea... more In this article published in Volume 21, issue 5, the Results section of the Pubmed abstract appeared as: "There were 68 (33%) and 108 (52%) patients with a the score of ? 4 (predicted probability of ?10%) with a false negative rate (FNR% of 4.4%, and ?5 (predicted probability of ?15%) with a FNR of 7.4%, respectively. The area under the curve (AUC) value for the Ondokuz Mayis scoring system was 0.88 (95% CI 0.83-0.93%)." The correct Results section of the abstract is: "There were 68 (33%) and 108 (52%) patients with a the score of ≤4 (predicted probability of ≤10%) with a false negative rate (FNR) of 4.4%, and ≤5 (predicted probability of ≤15%) with a FNR of 7.4%, respectively. The area under the curve (AUC) value for the Ondokuz Mayis scoring system was 0.88 (95% CI 0.83-0.93)." This error appeared only in the PubMed database and not in the print form of the Journal.
The Oncoplastic and Reconstructive Breast Surgery course was held in Izmir by the Izmir Breast Di... more The Oncoplastic and Reconstructive Breast Surgery course was held in Izmir by the Izmir Breast Diseases Federation in collaboration with the Breast Diseases Federation of Turkey. The techniques of oncoplasty, the application details and experience in this subject were shared. In this text, the main topics and outcomes are briefly summarised. These evaluations can be considered highly valuable on both local and regional scales.
Introduction : The objective of this study was to analyze the complication rates after completion... more Introduction : The objective of this study was to analyze the complication rates after completion thyroidectomy and compare them with primary total benign and malign thyroidectomy causes in total of 647 patients. Patients and Methods: Among 647 patients, there were 159 receiving completion thyroidectomy for differentiated thyroiud cancer (DTC) (Group 1); 217 patients receiving total thyroidectomy for DTC (Group 2) and 271 given total thyroidectomy for benign diseases (Group 3). Results: When groups were compared for complications, there were no significant difference except temporary hypocalcemia between completion thyroidectomy and total thyroidectomy for DTC. When the total thyroidectomies were compared (Group 2 and 3), there were no significant difference observed except unilateral temporary RLN palsy. Conclusion: With improvements in surgical technique and experience, complication rates of thyroidectomy performed for benign or malign diseases are reduced. In spite of the improvement in surgical experience, temporary RLN palsy and hypoparathyroidism are the main complications in completion thyroidectomies which need special attention. To evaluate the patients more carefully in preoperative period and performing adequate thyroidectomy appears more logical.
Background: Selection of nodules for surgery diagnosed as Bethesda category III [atypia of undete... more Background: Selection of nodules for surgery diagnosed as Bethesda category III [atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category] is important. It was aimed to define the malignancy rates associated with and without repeat fine needle aspiration biopsy (FNAB) and to define the contribution of repeat FNAB to triage to surgery or observation in nodules with AUS/FLUS FNAB. Methods: The records of all patients with nodules who underwent FNAB and classified by Bethesda reporting system as AUS/FLUS at their institution were reviewed. Malignancy rates for patients with AUS/FLUS FNAB with and without repeat FNAB were calculated. Results: Of the 582 patients who were classified as AUS/FLUS on initial FNAB, 179 underwent surgery with an associated malignancy rate of 22.9% (upper boundary). Risk of malignancy among all patients with AUS/FLUS nodules was 7% (lower boundary). The upper and lower boundaries of the malignancy rates with and without repeat FNAB were 38.6% and 15.6% for resected patients, and 13% and 4.6% for all patients, respectively. Reclassification rate with repeat FNAB was 56%. Conclusion: The findings showed that repeat FNAB for initial AUS/FLUS category was associated with a significantly increased malignancy rate compared with those without repeat FNAB. Repeat FNAB could help selection of patients with AUS/FLUS to triage to surgery. Therefore, repeat FNAB for nodules with AUS/FLUS on initial FNAB was suggested.
Tiroid nodüllerinde hangi nodüllere ince iğne aspirasyon biyopsisi (İİAB) yapılacağı ve tiroid ka... more Tiroid nodüllerinde hangi nodüllere ince iğne aspirasyon biyopsisi (İİAB) yapılacağı ve tiroid kanser odaklarının dominant nodülle olan ilişkisi halen tartışılan konulardır. Birçok ana başvuru kaynağında nodüler guatrda genellikle sadece 1 cm den büyük dominant nodüller kanser için değerlendirmeye alınmalıdır (1, 2); çünkü bu nodüllerin klinik önemi olan kanser olma potansiyeli daha yüksektir denilmektedir (3). Nodüler guatrda dominant ve dominant olmayan nodüllerde kanser insidansı için bir çok çalışma yapılmıştır, ancak dominant nodül nedeniyle total tiroidektomi yapılan ve kanser saptanan hastalarda dominant ve dominant olmayan nodüllerdeki kanser insidansı konusunda çalışmalar çok azdır (4-6). Multinodüler guatrda (MNG) 1 cm'den büyük dominant nodülde ve dominant nodül dışındaki > (US) şüpheli nodüllerde İİAB yapılması da önerilmektedir (7, 8). Bu çalışma, nultinodüler guatrda 1 cm'den büyük ve dominant nodül olarak adlandırılabilecek bir nodüle yapılacak İİAB'nin sonuçlarını ve buna dayanarak lobektomi yapılması halinde elde edilecek sonuçları irdelemek için planlanmış; total tiroidektomi yapılmış ve patolojik incelemelerinde tiroid kanseri saptanmış olan hastaların retrospektif incelenmesiyle kanserin dominant nodül ile ilişkisi belirlenmeye çalışılmıştır.
ABSTRACT Aims: We aimed to provide information on world&amp;#39;s economic and academic citat... more ABSTRACT Aims: We aimed to provide information on world&amp;#39;s economic and academic citation and to find the characteristics of overall, medical and particularly general surgical scientific paper production. Material and Method: Data form SCI were used in order to determine the progress of scientific production in the world. Fourty countries with the highest H-index rank that constituted 90% of the world&amp;#39;s economic and scientific production were analyzed. An economic- scientific ranking (ESR) was developed in terms of average ranking of eleven criteria of these countries. Additionally, comparison of proportionate areas like USA versus eight European countries and Turkey vs Russia, Mexico, Egypt and Iran was done. Results: A tendency of decline in citations per paper was observed despite a constant increase in the number of articles. There was a considerably high correlation between ESR and H-index and total number of citations. While the proportion of USA in total world citations decreased, eight European countries filled this gap and became leader in medicine and overall in science. Turkey, which has a relatively high rank in the production of scientific articles, is inadequate in terms of the H-index, and new developments are needed. Although the number of publications from Turkey is considerably high, it is observed that H-index and the number of citations are inadequate. Conclusion: The H-index and total number of citations have been proved to be important in indicating social development, along with scientific productivity. It was concluded that the government and scientific institutions should aim to increase the number of publications that may provide high levels of citations in Turkey that needs innovation and patent formation, i.e. qualificational evolution.
OBJECTIVE We aimed at to compare the thyroid ultrasound risk stratification systems (RSSs) of the... more OBJECTIVE We aimed at to compare the thyroid ultrasound risk stratification systems (RSSs) of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS), European (EU) TI-RADS, Korean (K) TI-RADS, and American Thyroid association (ATA) guidelines and American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME) guidelines to differentiate benign from malignant thyroid nodules and to avoid unnecessary FNA. METHODS The records of 1143 nodules ≥1 cm which underwent fine needle aspiration biopsy (FNA) and thyroidectomy between 2012 and 2020 at our institution were reviewed. Ultrasound categories and FNA recommendation indications of five international RSSs were compared with histopathological finding as benign or malignant. The ultrasound categories and recommended FNA indications and the proportion of the avoidable FNA procedures, and false negative rates (FNR) by different systems were compared with each other. RESULTS Of the 1143 nodules, 45% had thyroid malignancy. FNA recommendation and ultrasound risk classification of ATA guidelines had the highest area under curves (AUCs) of 0.619, and 0.715, respectively. ACR TI-RADS, AACE/ACE/AME guidelines, EU TI-RADS, ATA guidelines and K TI-RADS would have avoided 34.7%, 31%, 25.7%, 20%, 6% nodules from FNA with a FNR of 24%, 28.5%, 22%, 7.2%, and 1.9%, respectively. CONCLUSION Our findings showed that all RSSs classified the nodules appropriately for malignancy. ATA guidelines had the highest AUC and a low FNR, whereas ACR TI-RADS would have spared more patients from FNA with a high FNR.
Purpose The COVID-19 pandemic brought unprecedented conditions for overall health care systems by... more Purpose The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole ± β-blocker combination for Graves' disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3-4 cytological results and papillary microcarcinoma. Conclusion This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible.
PURPOSE Breast cancer is the most frequent cancer in women, and there is a great variability in s... more PURPOSE Breast cancer is the most frequent cancer in women, and there is a great variability in surgical practice for treating that cancer in different countries. The aims of this study were to analyze the effect of guidelines from the Turkish Federation of Breast Diseases Societies on academic institutions that have breast centers and to evaluate surgical practice in Turkey in 2018. PATIENTS AND METHODS Between January and March 2019, a survey was sent to breast surgeons who were working in breast centers in academic institutions. The sampling frame included 24 academic institutions with breast centers in 18 cities in Turkey to evaluate interdisciplinary differences among breast centers and seven regions in Turkey regarding patients’ choices, surgical approaches, and academic institutions. RESULTS All surgeons responded to the survey, and all 4,381 patients were included. Most of the surgeons (73.9%) were working in a breast center. Multidisciplinary tumor boards were performed in ...
Morrow reported that changing treatment landscape had raised new questions on axillary management... more Morrow reported that changing treatment landscape had raised new questions on axillary management, on initial sentinel lymph node (SN) biopsy and repeat lumpectomy. The important remarks that I selected from her lecture are as follows: Metastatic work up is essential prior to any local therapy for locoregional recurrence (LRR); because, historically ~50% of LRR was accompanied by distant metastases. Axillary dissection is an appropriate approach for axillary recurrence after SN biopsy. Reoperative SN biopsy after local recurrence is feasible, accurate and provides useful information. A SN can be identified in the majority of the patients who had initial SN biopsy (81%), and in about 50% of those with axillary dissection. Aberrant drainage is common after SN or axillary dissection and has implications for mapping. Extra-axillary or aberrant lymphatic drainage is uncommon in untreated axilla. However, in patients with ipsilateral breast recurrence (IBTR) after a breast conserving surgery (BCS) and SN biopsy or axillary dissection, aberrant drainage is likely in one third of patients. Because prior axillary surgery increases drainage to contralateral axilla, this is not necessarily a metastatic disease. In patients who had contralateral axillary metastases identified with ipsilateral local recurrence, Morrow suggested to do metastatic work-up and to exclude contralateral breast primarily with mammography and magnetic resonance imaging, and if local recurrence was operable and non-locally advanced, to perform axillary dissection. Combined radioactive colloid and blue dye is recommended for reoperative SN biopsy, because identification of extra-axillary SN is uncommon with intradermal or subareolar injection. She suggests peritumoral injection is optimal in reoperative setting. Under the heading of 'Management of IBTR after BCS: Is lumpectomy alone appropriate?', the indications for repeat lumpectomy alone were suggested as follows: disease meeting criteria for no radiotherapy after primary surgery (that is, low risk group); age >70 years, T1N0 ER+ Her2-, Grade 1, 2 DCIS ≤1.5 cm, disease suggestive of second primary tumor with long disease-free interval, in separate quadrant, and patients with severe morbidity. Morrow concluded that better data were needed to define optimal management of LRR. Tari King reported that the quest for optimal regional treatment is continuing, and the goal of balancing the risks and benefits of treatment options is to minimize morbidity of local regional treatment without compromising the outcome. Here are the remarks from her lecture: SN after neoadjuvant chemotherapy (NAK) in T1, 2, cN0-cN1 patients decreases axillary dissection significantly due to the decrease in % of node positive axilla. Benefits of avoiding axillary dissection were manifested with lower rates of lymphedema (11-14% for axillary dissection vs. 3-8% with SN). Rationale for NAK in cN+ patients was that nodal pCR rates were 38-49%. Nodal pCR rates were 21% for ER+/Her2-, 47% for ER-/Her2-, 70% for ER+/Her2+, and 97% for ER-/Her2-, respectively. There is no role for nomograms to predict the likelihood of additional axillary metastases or PET scans to look for additional metastases. In response to "When can nodal staging be omitted?", from 'CALGB randomized trial of the omission of radiotherapy', patients with age ≥70 years, T1N0, ER+, patients who had BCS and tamoxifen treatment were suggested as candidates for omission of axillary staging. Ten-year rate of axillary failure for these patients (no: 392) was 1.5%. Tari King concluded under the title of "Where will we go from here" that "there was no improvement on survival with axillary dissection", "Increasing role of biology vs. anatomy in decision making for systemic therapy", and "Growing interest to omit axillary staging".
Purpose: Our aim was to determine if a close surgical margin (<2 mm, but no ink on tumor) for duc... more Purpose: Our aim was to determine if a close surgical margin (<2 mm, but no ink on tumor) for ductal carcinoma in situ (DCIS) associated with invasive breast cancer (IBC) leads to an increased rate of ipsilateral breast tumor recurrence (IBTR). Patients and Methods: Six hundred and twenty-eight patients with T1-2 IBC who underwent breast conserving therapy (BCT) and had no ink on tumor between 2009 and 2017 in our institution were included in the study. Age, tumor size, axillary lymph node status, resection margin status of DCIS as closer than 2 mm or !2 mm, DCIS as present or absent, extensive intraductal component as yes or no were investigated. All patients were followed-up for IBTR. Results: The median age was 50 years (range, 29-82), and median tumor size was 25 mm (range, 5-50). Median follow-up time was 56 months (range, 12-114). Of the 628 IBC patients, 440 (70%) were found to be associated with DCIS. Of the 440 patients with DCIS, 119 (27%) had a close margin (<2 mm) and 321 (73%) had a margin !2 mm for DCIS. Among 440 IBC patients associated with DCIS, there were three local recurrences. One developed in a patient who had a close surgical margin for DCIS, and in the other two patients, surgical margins were !2 mm. Conclusions: No ink on tumor is an adequate margin for IBC associated with DCIS in patients who undergo BCT and it is not associated with increased IBTR.
93 Background: To avoid performing axillary lymph node dissection (ALND) for non-sentinel lymph n... more 93 Background: To avoid performing axillary lymph node dissection (ALND) for non-sentinel lymph node (SLN)-negative patients with SLN-positive axilla, nomograms for predicting the status of the axillary non-SLNs have been developed in many centers. We created a new nomogram predicting non-SLN metastasis in SLN positive patients with invasive breast cancer and evaluated 14 existing breast cancer models in our patient group. Methods: Two hundred and thirty seven invasive breast cancer patients with SLN metastases who underwent ALND were included in the present study. Based on the independent predictive factors for non-SLN metastasis identified by logistic regression analysis, we developed a new nomogram. Receiver operating characteristics (ROC) curves for the models were created, and the areas under the curves (AUC) were computed. Results: In a multivariate analysis, tumor size, presence of lymphovascular invasion, extranodal extension of SLN, large size of metastatic SLN in mm, the n...
In these 21 cases, median age at first operation was 51 (range 34-80), and disease free survival ... more In these 21 cases, median age at first operation was 51 (range 34-80), and disease free survival was 35.4 ± 6.3 months. Histopathological study revealed the presence of invasive ductal carcinoma in all cases. Average tumor size was 2.55 ± 0.43 cm, and the average numbers of removed sentinel lymph node were 3.4 ± 0.5. The numbers of nuclear grade 3 were 9 (42.9%). Vein invasion was seen in 3 cases (14.3%), and lymph vascular invasion was seen in 9 cases (42.9%). All 21 patients were performed ALND after ALN recurrence. The average numbers of dissected lymph node were 13.9 ± 1.5, and of metastatic lymph node were 3.0 ± 0.5. During the median follow up period of 62.7 months from additional ALND, distant metastases were observed in 5 cases (23.9%) and 1 case (4.8%) died. In the group with distant metastases after ALND, the rate of lymph vascular invasion was significantly higher than the group without distant metastases (60.0% vs. 37.5%, p = 0.048), whereas there were no significant differences of clinical or pathological backgrounds between the group with and without distant metastases. But patients who received chemotherapy after ALND had a trend to a lower distant metastases compared with patients who received no chemotherapy (13.3% vs. 50.0%, p = 0.115). Conclusion: In this study, the risk factor for the ALN recurrence is nuclear grade and presence of lymph vascular invasion, and lymph vascular invasion is also the risk of distant metastases. Chemotherapy may probably affect to prevent distant metastases after additional ALND, but still need further investigation.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
To evaluate the predicting factors for non-sentinel lymph node (SLN) metastases in T1-2 invasive ... more To evaluate the predicting factors for non-sentinel lymph node (SLN) metastases in T1-2 invasive breast cancer with 1-2 metastatic SLN that fully matched the ACOSOG Z0011 criteria. Also, to develop a scoring system to predict the risk of non-SLN metastasis and to discriminate the low-risk patients for omission of the axillary lymph node dissection (ALND) in this population. Two hundred and seven T1-2 invasive breast cancer patients with 1-2 metastatic SLN who underwent ALND at our Institution were included in the study. Independent factors predicting the non-SLN metastasis were found using logistic regression analysis, and a scoring system to predict the non-SLN metastasis was created. Seventy (34%) out of 207 patients had non- SLN metastasis. Multivariate logistic regression analysis demonstrated that tumor size, presence of lymphovascular invasion (LVI), number of negative SLNs, and size of SLN metastasis were independent factors predicting non-SLN metastasis. There were 68 (33%) ...
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
In this article published in Volume 21, issue 5, the Results section of the Pubmed abstract appea... more In this article published in Volume 21, issue 5, the Results section of the Pubmed abstract appeared as: "There were 68 (33%) and 108 (52%) patients with a the score of ? 4 (predicted probability of ?10%) with a false negative rate (FNR% of 4.4%, and ?5 (predicted probability of ?15%) with a FNR of 7.4%, respectively. The area under the curve (AUC) value for the Ondokuz Mayis scoring system was 0.88 (95% CI 0.83-0.93%)." The correct Results section of the abstract is: "There were 68 (33%) and 108 (52%) patients with a the score of ≤4 (predicted probability of ≤10%) with a false negative rate (FNR) of 4.4%, and ≤5 (predicted probability of ≤15%) with a FNR of 7.4%, respectively. The area under the curve (AUC) value for the Ondokuz Mayis scoring system was 0.88 (95% CI 0.83-0.93)." This error appeared only in the PubMed database and not in the print form of the Journal.
The Oncoplastic and Reconstructive Breast Surgery course was held in Izmir by the Izmir Breast Di... more The Oncoplastic and Reconstructive Breast Surgery course was held in Izmir by the Izmir Breast Diseases Federation in collaboration with the Breast Diseases Federation of Turkey. The techniques of oncoplasty, the application details and experience in this subject were shared. In this text, the main topics and outcomes are briefly summarised. These evaluations can be considered highly valuable on both local and regional scales.
Introduction : The objective of this study was to analyze the complication rates after completion... more Introduction : The objective of this study was to analyze the complication rates after completion thyroidectomy and compare them with primary total benign and malign thyroidectomy causes in total of 647 patients. Patients and Methods: Among 647 patients, there were 159 receiving completion thyroidectomy for differentiated thyroiud cancer (DTC) (Group 1); 217 patients receiving total thyroidectomy for DTC (Group 2) and 271 given total thyroidectomy for benign diseases (Group 3). Results: When groups were compared for complications, there were no significant difference except temporary hypocalcemia between completion thyroidectomy and total thyroidectomy for DTC. When the total thyroidectomies were compared (Group 2 and 3), there were no significant difference observed except unilateral temporary RLN palsy. Conclusion: With improvements in surgical technique and experience, complication rates of thyroidectomy performed for benign or malign diseases are reduced. In spite of the improvement in surgical experience, temporary RLN palsy and hypoparathyroidism are the main complications in completion thyroidectomies which need special attention. To evaluate the patients more carefully in preoperative period and performing adequate thyroidectomy appears more logical.
Background: Selection of nodules for surgery diagnosed as Bethesda category III [atypia of undete... more Background: Selection of nodules for surgery diagnosed as Bethesda category III [atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category] is important. It was aimed to define the malignancy rates associated with and without repeat fine needle aspiration biopsy (FNAB) and to define the contribution of repeat FNAB to triage to surgery or observation in nodules with AUS/FLUS FNAB. Methods: The records of all patients with nodules who underwent FNAB and classified by Bethesda reporting system as AUS/FLUS at their institution were reviewed. Malignancy rates for patients with AUS/FLUS FNAB with and without repeat FNAB were calculated. Results: Of the 582 patients who were classified as AUS/FLUS on initial FNAB, 179 underwent surgery with an associated malignancy rate of 22.9% (upper boundary). Risk of malignancy among all patients with AUS/FLUS nodules was 7% (lower boundary). The upper and lower boundaries of the malignancy rates with and without repeat FNAB were 38.6% and 15.6% for resected patients, and 13% and 4.6% for all patients, respectively. Reclassification rate with repeat FNAB was 56%. Conclusion: The findings showed that repeat FNAB for initial AUS/FLUS category was associated with a significantly increased malignancy rate compared with those without repeat FNAB. Repeat FNAB could help selection of patients with AUS/FLUS to triage to surgery. Therefore, repeat FNAB for nodules with AUS/FLUS on initial FNAB was suggested.
Tiroid nodüllerinde hangi nodüllere ince iğne aspirasyon biyopsisi (İİAB) yapılacağı ve tiroid ka... more Tiroid nodüllerinde hangi nodüllere ince iğne aspirasyon biyopsisi (İİAB) yapılacağı ve tiroid kanser odaklarının dominant nodülle olan ilişkisi halen tartışılan konulardır. Birçok ana başvuru kaynağında nodüler guatrda genellikle sadece 1 cm den büyük dominant nodüller kanser için değerlendirmeye alınmalıdır (1, 2); çünkü bu nodüllerin klinik önemi olan kanser olma potansiyeli daha yüksektir denilmektedir (3). Nodüler guatrda dominant ve dominant olmayan nodüllerde kanser insidansı için bir çok çalışma yapılmıştır, ancak dominant nodül nedeniyle total tiroidektomi yapılan ve kanser saptanan hastalarda dominant ve dominant olmayan nodüllerdeki kanser insidansı konusunda çalışmalar çok azdır (4-6). Multinodüler guatrda (MNG) 1 cm'den büyük dominant nodülde ve dominant nodül dışındaki > (US) şüpheli nodüllerde İİAB yapılması da önerilmektedir (7, 8). Bu çalışma, nultinodüler guatrda 1 cm'den büyük ve dominant nodül olarak adlandırılabilecek bir nodüle yapılacak İİAB'nin sonuçlarını ve buna dayanarak lobektomi yapılması halinde elde edilecek sonuçları irdelemek için planlanmış; total tiroidektomi yapılmış ve patolojik incelemelerinde tiroid kanseri saptanmış olan hastaların retrospektif incelenmesiyle kanserin dominant nodül ile ilişkisi belirlenmeye çalışılmıştır.
ABSTRACT Aims: We aimed to provide information on world&amp;#39;s economic and academic citat... more ABSTRACT Aims: We aimed to provide information on world&amp;#39;s economic and academic citation and to find the characteristics of overall, medical and particularly general surgical scientific paper production. Material and Method: Data form SCI were used in order to determine the progress of scientific production in the world. Fourty countries with the highest H-index rank that constituted 90% of the world&amp;#39;s economic and scientific production were analyzed. An economic- scientific ranking (ESR) was developed in terms of average ranking of eleven criteria of these countries. Additionally, comparison of proportionate areas like USA versus eight European countries and Turkey vs Russia, Mexico, Egypt and Iran was done. Results: A tendency of decline in citations per paper was observed despite a constant increase in the number of articles. There was a considerably high correlation between ESR and H-index and total number of citations. While the proportion of USA in total world citations decreased, eight European countries filled this gap and became leader in medicine and overall in science. Turkey, which has a relatively high rank in the production of scientific articles, is inadequate in terms of the H-index, and new developments are needed. Although the number of publications from Turkey is considerably high, it is observed that H-index and the number of citations are inadequate. Conclusion: The H-index and total number of citations have been proved to be important in indicating social development, along with scientific productivity. It was concluded that the government and scientific institutions should aim to increase the number of publications that may provide high levels of citations in Turkey that needs innovation and patent formation, i.e. qualificational evolution.
Uploads
Papers by Bekir Kuru