The effect of preoperative 18F-FDG PET on the surgical decision in early breast cancer: 5-Year follow-up.

OBJECTIVE: The diagnosis, treatment, and management of the breast cancer (BC) require a multidisciplinary approach. In newly diagnosed BC, fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) can detect extra-axillary regional nodal and distant lesions. SUBJECTS AND METHODS: Between 2010 and 2015, this study included 101 patients with early-stage BC who were examined with 18F-FDG PET before surgery. Patients were divided into two groups: Group 1 consisted of patients with suspected 18F-FDG uptake and Group 2 with the remaining 18F-FDG-negative patients. Differences between these groups were tested using the Pearson chi-square test, Fisher's exact test, Mann Whitney-U test, independent t-test and ROC analysis. They could be followed-up after 2015 for 5 years. All patients were then rediscussed either neoadjuvant therapy or surgery in the oncology board in 2020 with changing neoadjuvant criteria and oncoplastic surgery techniques. RESULTS: Fluorine-18-FDG PET was found to have a sensitivity of 77.8% and a specificity of 90.8% in detecting axillary lymph node metastasis. During the minimum 5-year follow-up, one patient had bone metastasis, 2 patients had a local recurrence, and 3 patients had metastatic lymph nodes in the axilla. In the re-evaluation of the same patients over 5 years, the decrease in mastectomy decision was remarkable (P-value 0.01). CONCLUSION: We observed that we could not achieve a significant difference in 5-year metastasis/recurrence between the groups. Moreover, due to 18F-FDG-PET high false positivity, it significantly extended the time to surgery (P-value 0.01). In early-stage BC, 18F-FDG PET demonstrated better performance in axillary lymph nodes metastases detection in comparison with other diagnostic imaging methods, even if SLNB remains the gold standard technique.

Bilateral idiopathic granulomatous mastitis.

OBJECTIVES: Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory pseudotumor. Bilateral involvement of IGM has been reported in a few cases. To our knowledge, this study is the largest series of bilateral cases to date. The goals of this study were to present clinical features of bilateral IGM and to evaluate the results of treatments. MATERIALS AND METHODS: We performed a retrospective review of the idiopathic granulomatous mastitis database from 2010 to 2013. Ten female patients who met required histologic and clinical criteria of IGM in both breasts were included in study. Demographic data, clinical findings, medication history, and radiologic findings are presented. RESULTS: The mean age at onset of the disease was 38.4 ± 8.3 years (range: 29-52 years). Nine patients had no recurrence during a mean follow-up period of 21 months (range: 11-26 months). Additionally, the median time to second breast involvement was 15.6 months. CONCLUSION: Bilateral IGMs have a higher rate of more relapse and greater resistance to medical therapies than do unilateral IGMs. Surgical management should be avoided unless all medical treatment options have been exhausted. Nevertheless, expectant management seems a rational option for the treatment of bilateral IGM.

Simultaneous excision of ipsilateral nonpalpable multiple breast lesions using radioguided occult lesion localization.

The purpose of this study was to determine the feasibility and effectiveness of ROLL technique for the identification and excision of ipsilateral nonpalpable multiple breast lesions. Between August 2005 and August 2010, eight women, aged 40-61 years, with a radiographic evidence of two separate nonpalpable lesions within the same breast underwent ROLL, as we termed it, double-ROLL. Each lesion was localized with Tc-99m-labeled human serum albumin macroaggregate under ultrasonography or mamography control. A gamma probe was used to guide surgical excisions. There was no radiotracer overlapping or extravasation in any case. Out of the 16 resected specimens, histopathologic examination revealed benign findings in 13 lesions and malignancy in 3. There was no lesion involvement at the surgical margins, and no residuals were detected in any of the benign cases during follow-up. Double-ROLL technique is feasible and safe for the identification and excision of such multiple ipsilateral breast lesions.

Radio-guided lymph node biopsy for the diagnosis of axillary lymphadenopathy.

Ultrasonography-guided needle biopsy techniques have limitations and conventional excisional biopsy may pose challenges in the diagnosis of ultrasonography-demonstrable axillary lymphadenopathy. In this study, we report an alternative technique, radio-guided lymph node biopsy, and describe its technical aspects and diagnostic role. Between January 2006 and December 2009, six patients were included in this study (five women and one man, aged 23-65 years). After a complete clinical evaluation, all the patients were referred to our general surgery clinic for excisional lymph node biopsy from the axilla. The indications of biopsy were either the new onset of an axillary lympadenopathy on post-therapeutic screening or the presence of a persistent axillary lymphadenopathy. In all of the cases, ultrasonography confirmed the clinical suspicion of axillary lymphadenopathy and the radio-guided lymph node biopsy technique was used for the diagnosis. Tc-99m-labelled human serum albumin macroagregate in saline was injected under ultrasonographic guidance for the localization of the lymph nodes. A γ-probe was used to guide the excisions.The lymph nodes that were involved were successfully localized and excised surgically. The postoperative course was uneventful and no complications occurred in all cases. Pathological examination of the excised lymph nodes showed reactive hyperplasia in three patients, tuberculous lymphadenitis in one patient, Hodgkin's lymphoma in another and, non-Hodgkin's lymphoma in one patient. Radio-guided lymph node biopsy has proved to be an accurate and a safe technique for the diagnosis of axillary lymphadenopathies in the indicated subset of patients.

CCND1 and CDKN1B polymorphisms and risk of breast cancer.

BACKGROUND AND OBJECTIVES: Previous studies have shown alterations in the cell cycle regulatory proteins in breast carcinomas. However, the results of these studies remain controversial. Cyclin D1 (CCND1) and p27(KIP1) (CDKN1B) are two essential regulators of cell cycle progression. This study aimed to investigate the associations of CCND1 A870G and CDKN1B C79T polymorphisms with breast cancer risk. PATIENTS AND METHODS: Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the genotype and allelic frequencies of polymorphisms. Seventy-eight breast cancer patients and 84 age-matched healthy controls were included in the study. RESULTS: Frequencies of CT genotype and T allele of CDKN1B were found to be higher in breast cancer patients than in controls (p=0.013, OR: 1.514 95% CI: 1.086-2.114.15; p=0.007, OR=1.496; 95% CI: 1.111-2.014, respectively). The frequency of AA genotype of CCND1 was decreased in hormone receptor- (estrogen and progesterone receptors) negative patients with breast cancer (p<0.049, OR=0.286; 95% CI: 0.071-1.142) CONCLUSIONS: Even though CDKN1B polymorphism appears to be an important predictive factor for breast cancer risk and CCND1 polymorphism may be a prognostic biomarker for breast cancer, further investigations with larger study groups are needed to fully elucidate the role of CCND1 and CDKN1B polymorphisms in the development and prognosis of breast cancer.

Radioguided occult lesion localization (ROLL) for non-palpable breast cancer: a comparison between day-before and same-day protocols.

BACKGROUND: Although radioguided occult lesion localization (ROLL) has become a widely accepted technique, the optimal time interval between the radioisotope injection and surgery has not yet been determined. AIM: To delineate the effects of time from the injection of the radionuclide until surgery on the ROLL success rate in a patient population diagnosed as having non-palpable breast cancer. METHODS: Between December 2004 and May 2009, 75 patients underwent ROLL procedure. The day-before protocol and same-day protocols included 50 and 25 breast cancer patients respectively. RESULTS: The two study groups were comparable in terms of age, localization technique, radiological findings and the type of surgical procedures (P > 0.05). No statistically significant difference was noticed in the pathological diagnosis, cancer size and the surgical margin clearance between the two groups (P > 0.05). CONCLUSIONS: Same-day injection of the radiotracer was not superior to the day-before injection in ROLL. The day-before protocol can be scheduled for the convenience of both patients and hospital staff.

Effects of hyperbaric oxygen and Pgg-glucan on ischemic colon anastomosis.

AIM: In colorectal surgery, anastomotic failure is still a problem in ischemia. Here,we analyzed the effects of hyperbaric oxygen and beta-glucan on colon anastomoses in ischemic condition. METHODS: Colonic resection and anastomosis in rectosigmoid region were done in forty Wistar-Albino rats of four groups of equal number. Colon mesentery was ligated to induce ischemia. The first group was the control group. The subjects of second group were treated with hyperbaric oxygen;the third group with glucan and the forth group were treated with both. At the forth day, rats were sacrificed,anastomotic segment was resected and burst pressures and hydroxyproline levels of anastomotic line were measured. RESULTS: The burst pressure difference of second and third groups from the control group were meaningful (P<0.01); the forth group differed significantly from the control (P<0.001). There was no difference between the treated groups on burst pressure level (P>0.05). The hydroxyproline levels in all treated groups were different from the control group significantly (P<0.001). Hydroxyproline levels in the forth group were higher than those of the second and the third groups (P<0.001). There were no significant differences between the second and the fourth groups in burst pressure and hydroxyproline levels (P>0.05). CONCLUSION: Hyperbaric oxygen and glucan improve healing in ischemic colon anastomoses by anti-microbic,immune stimulating properties and seem to act synergistically when combined together.

Zinc and copper status in acute pancreatitis: an experimental study.

Metal ions are required as active components of several proteins, including pancreatic enzymes, and they can play important roles in the etiopathogenesis of acute pancreatitis. In the present study, we measured the concentrations of zinc (Zn) and copper (Cu) in both serum and pancreatic tissue, as markers of trace element status in an experimental acute pancreatitis model. Twenty-four male Wistar rats were divided into two groups: the experimental group (N=24) and the control group (N=10). Acute pancreatitis was induced by injection of 48% ethyl alcohol into the common biliary duct. The animals were sacrificed 24 h later to detect the concentrations of Zn and Cu. There was no significant difference in tissue Zn and Cu concentrations between control and experimental groups (p<0.05). However, in the acute pancreatitis group, serum Zn and Culevels were very significantly lower (p<0.001 and p<0.0001, respectively). In conclusuion, these findings suggested that altered mineral metabolism in serum and pancreatic tissue may have contributed to the pathophysiology of acute pancreatitis.