Preoperative predictive factors affecting sentinel lymph node positivity in breast cancer and comparison of their effectiveness with existing nomograms.

This study aimed to establish a strong regression model by revealing the preoperative predictive factors for sentinel lymph node (SLN) positivity in patients with early stage breast cancer (ESBC). In total, 445 patients who underwent SLN dissection for ESBC were included. All data that may be potential predictors of SLN positivity were retrospectively analyzed. Tumor size >2 cm, human epidermal growth factor receptor 2 (HER2) + status, lymphovascular invasion (LVI), palpable tumor, microcalcifications, multifocality or multicentricity, and axillary ultrasonographic findings were defined as independent predictors of SLN involvement. The area under the receiver operating characteristic (ROC) curve (AUC) values were 0.797, 0.808, and 0.870 for the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram, MD Anderson Cancer Center (MDACC) nomogram, and our regression model, respectively (P < .001). The recent model for predicting SLN status in ESBC was found to be stronger than existing nomograms. Parameters not included in current nomograms, such as palpable tumors, microcalcifications, and axillary ultrasonographic findings, are likely to make this model more meaningful.

An Evaluation of the Factors Affecting Failure of the Procedure in Reoperated Thyroidectomies: A Retrospective Analysis.

BACKGROUND: The aim of this study was to determine the factors affecting procedure failure in revision thyroidectomy surgery. METHODS: A total of 148 patients applied with revision surgery were separated into 2 groups according to the surgical success status. Comparisons were made of the 2 groups of patients where residual tissue was totally excised (Group 1, n:132) and patients where residual tissue could not be completely excised (Group 2, n:16). The patients were examined in respect of factors affecting the success of the procedure. RESULTS: The patients comprised 133 (89.9%) females and 15 (10.1%) males with a mean age of 49.68±12.02 years. Surgical failure was observed in 7 patients as the lesion could not be determined despite the use of intraoperative USG, and in 9 patients because of weak signal or signal loss. The determination of residual tissue ≤25mm on preoperative USG examination was seen to have a significant negative effect on surgical success (r=-0.329, p0.001). The patient having undergone ≥3 previous operations was determined to have a negative effect on surgical success (r=-0.229, p=0.005), and nerve damage on the opposite side to the lesion in a previous surgical procedure was determined to be the most important factor with a negative effect on surgical success (r=-0.571, p<0.001). In multinomial logistic regression analysis of the factors affecting success, the preoperative presence of nerve damage in the contralateral lobe to the lesion (OR: 33.11, 95% CI: 4.22-192.28, p<0.001) and lesion size ≤25 mm (OR: 10.10, 95% CI: 3.54-75.01, p=0.001) were determined to contribute significantly to surgical failure. CONCLUSION: The results of this study clearly showed that as residual tissue size ≤25mm and contralateral nerve damage in the preoperative ultrasonographic evaluation are associated with surgical failure, alternative treatment methods such as radioactive iodine ablation may be preferred in these patients.

Can preoperative modified systemic inflammation score (mSIS) be used to predict malignancy in persistent nondiagnostic thyroid nodules?

Background/aim: Despite the use of ultrasound guidance, a significant part of thyroid biopsies are nondiagnostic (ND). We aimed to investigate the utility of the preoperative modified systemic inflammation score (mSIS) to predict malignancies in patients with persistent ND thyroid nodules (TNs). Materials and methods: Records of 924 patients underwent thyroidectomy between September 2016 and May 2019 were retrospectively reviewed. The calculation of mSIS was as follows: mSIS 0 [patients with albumin (ALB) ≥ 4.0 g/dL and lymphocyte to monocyte ratio (LMR) ≥ 3.4], mSIS 1 [ALB < 4.0 g/dL or LMR < 3.4], and mSIS 2 [ALB < 4.0 g/dL and LMR < 3.4]. Results: One hundred and thirty-six patients were included in the study. Of the patients with a median age of 49 (21­81) years, 26 (19.1%) were male, and 110 (80.9%) were female. Besides low lymphocyte count (P = 0.03), and ALB levels (P < 0.01), higher BMI (P = 0.02) were also associated with malignancy. In patients classified as mSIS 2, 1 and 0; malignancy rates were 100%, 25.8%, and 16.1%, respectively. The association between preoperative mSIS and thyroid malignancies was statistically significant (P < 0.01). Conclusion: We recommend that when patients with persistent ND TNs are assigned to mSIS 2 or 1, surgery should not be delayed due to the risk of malignancy.

Diagnostic value of modified systemic inflammation score for prediction of malignancy in patients with indeterminate thyroid nodules.

BACKGROUND: Approximately 20% of the thyroid biopsies render an indeterminate (ID) cytology. We evaluated the diagnostic value of preoperative modified systemic inflammation score (mSIS) in predicting the malignancy of ID thyroid nodules (TNs). METHODS: Data of 162 patients with indeterminate TNs were examined retrospectively. The mSIS was calculated as follows: mSIS 0 [patients with albumin (ALB) ≥ 4.0 g/dL and lymphocyte-to-monocyte ratio (LMR) ≥ 3.4], mSIS 1 [ALB < 4.0 g/dL or LMR < 3.4], and mSIS 2 [ALB < 4.0 g/dL and LMR < 3.4]. RESULTS: Patients were classified into mSIS 0 (n = 105), mSIS 1 (n = 34) and mSIS 2 (n = 23) groups. The malignancy rates for the mSIS 0, 1 and 2 groups were 34.3%, 64.7% and 100% respectively. Preoperative mSIS was significantly associated with the presence of thyroid malignancy (p < 0.001). CONCLUSIONS: If the mSIS of patients with ID cytology is 1 or 2, appropriate surgical treatment should be performed without delay, due to the increased risk of malignancy.

Central neck dissection is an independent risk factor for incidental parathyroidectomy.

OBJECTIVE: This study aims to determine the frequency of incidental parathyroidectomy (IP), to reveal the risk factors and to present the clinical importance of IP through the experiences of our clinic. MATERIALS AND METHODS: Patients undergoing thyroid surgery between June 2016 and May 2019 were reviewed retrospectively. Along with demographic data, surgery reports, pathology results and postoperative follow-up data were examined. Factors assumed to be associated with IP and postoperative hypocalcemia were compared between the IP group and the non-IP group. RESULTS: A total of 633 patients with a mean age of 48 ± 13 years were included in this study. IP was detected in 138 (21.8%) patients and parathyroid glands were localized 29.72% intrathyroidal. Postoperative hypocalcemia in the IP group was approximately 2-fold higher than the no-IP group (%15.94 to %7.27), (p < .001). Gender (p = .014), body mass index (p = .021), both preoperative and postoperative diagnosis of malignancy (p < .001) and performing central neck dissection (CND) (p < .001) were significantly associated with IP in univariate analysis. However, multivariate analysis demonstrated that CND was independently associated with IP (OR = 0.301, 95% Cl: 0.161-0.562, p < .001). CONCLUSION: This study reveals that IP increases the frequency of postoperative temporary and permanent hypocalcemia in patients undergoing thyroid surgery, and CND is the only independent risk factor for IP. Highlights of the study This study reveals that central neck dissection is the most important and only independent risk factor for incidental parathyroidectomy in patients undergoing thyroid surgery. According to our analysis, both temporary and permanent hypocalcemia, which occurs in the postoperative period, are associated with incidental parathyroidectomy.

Associated Features with Non-Sentinel Lymph Node Involvement in Early Stage Breast Cancer Patients who Have Positive Macrometastatic Sentinel Lymph Node.

OBJECTIVE: The main goal of this study is to determine the clinico-pathological factors that correlate non-sentinel lymph nodes (LNs) involvement in clinically node negative breast cancer (BC) patients with positive macrometastatic sentinel lymph node (SLN) in order to derive future evidence to define a subgroup where completion axillary lymph node dissection (cALND) might not be recommended. MATERIALS AND METHODS: Total 289 SLN biopsies were performed in clinically node negative BC patients between March 2014 and April 2017. Seventy patients who performed cALND due to positive macrometastatic SLN were retrospectively selected and classified into two groups, according to non-SLN involvement (NSLNI). Clinico-pathological features of patients were examined computerized and documentary archives. RESULTS: Extracapsular extension (ECE) of SLN, number of harvested SLNs, metastatic rate of SLNs, absence of ductal carcinoma in situ (DCIS) and presence of multilocalization were significantly associated with the likelihood of non-SLN involvement after univariate analysis (p<0,05). Absence of DCIS and presence of multilocalization were found to be significant after multivariate analysis. CONCLUSION: Careful examination of clinico-pathological features can help to decide avoiding cALND if enough LNs are removed and the rate of SLN metastases is low, particularly in case DCIS accompanying invasive cancer in patients without multi localized tumour.

A Diagnostic Dilemma: Skip Metastasis in Papillary Thyroid Cancer.

The frequency, pattern, and predictive factors for skip LN metastasis in patients with papillary thyroid carcinoma (PTC) remain controversial. In this study, we evaluated predictive factors of skip LN metastasis in these patients. We reviewed the medical records of 68 PTC patients who underwent total thyroidectomy, central neck dissection, and lateral neck dissection at the initial operation. The relationships between skip LN metastasis and clinicopathologic factors were analyzed. After careful examination of electronic medical records of patients, 19 patients were excluded from the study. Of the remaining 49 patients, 9 (18.4%) had skip LN metastasis. Multivariate analysis showed that tumor size <1 cm was an independent risk factor for the presence of skip metastasis (P = 0.035, odds ratio: 3.78, 95% confidence interval: 1.09-13.15). The rate of positive LN was relatively higher in micro-PTC patients than PTC patients. This finding is clinically significant and should be considered in routine clinical practice.

Stratifying the risk factors for hypoparathyroidism after total thyroidectomy. A single Center study.

BACKGROUND: Post-operative hypoparathyroidism is a complication in patients who undergo thyroid surgery. Our study aimed to evaluate the incidence and causes of post-operative transient and permanent hypoparathyroidism in patients undergoing thyroid surgery. MATERIALS AND METHODS: The data of 933 consecutive patients who underwent total thyroidectomy in a single center were retrospectively evaluated. The rate of post-operative hypoparathyroidism, clinicopathological features, and laboratory parameters during the post-operative first day, first month, and first year of patients with and without hypoparathyroidism were analyzed. Patients with hypoparathyroidism were classified as transient or permanent cases. RESULTS: The incidence of post-operative hypoparathyroidism was 22.7%, including transient (20.6%) and permanent (2.1%). In multivariable analysis, independent predictors of permanent hypoparathyroidism were as follows: surgery due to malignant thyroid disease, tumor multifocality, and pre-operative vitamin-D deficiency (VDD) (p<0.001, 0.047, and 0.002, respectively). During the post-operative first month, the mean serum PTH levels were found to be 7.58 pg/mL, and they remained low on the post-operative first year in patients with permanent hypoparathyroidism. CONCLUSION: Surgery due to thyroid malignancy and VDD should be considered risk factors for permanent hypoparathyroidism in patients who undergo thyroid surgery. The post-operative first month is important in the prediction of permanent hypoparathyroidism. KEY WORDS: Hypoparathyroidism, Permanent, Transient.

Dynamic MRI Evaluation of the Gastric Fundus and Splenic Circulation to Assess the Gastric Breves Dissection during Laparoscopic Nissen Fundoplication.

AIM: We aimed to evaluate the possible effects of dissecting gastric breves (GB) during the Laparoscopic Nissen Fundoplication (LNF) on the gastric fundus and splenic circulation using dynamic Magnetic Resonance Imaging (MRI). METHODS: In total 14 patients with gastroesophageal reflux disease (GERD) that was diagnosed with esophagogastroduodenoscopy and 24 - hour PH monitorization and undergoing LNF surgery were included. All patients underwent LNF surgery between October 2006 and March 2010. All patients were evaluated regarding gastric fundus and splenic circulation one week before and 15 days after the surgery with dynamic MRI. Alteration of the signal intensity before and after surgery was used to assess gastric fundus and splenic circulation. RESULTS: We detected a significant decrease in DeMeester score before and after surgery (p < 0.001). There were no statistical differences between preoperative and postoperative dynamic MRI measurements of the spleen, anterior wall measurements, posterior wall measurements in different MRI phases (Bonferroni corrected p < 0.01). Postoperative measurements of anterior and posterior gastric wall measurements were comparable (Bonferroni corrected p < 0.0033). CONCLUSIONS: We did not detect any significant differences in the abovementioned tissues regarding perfusion.

Sclerosing Angiomatoid Nodular Transformation of the Spleen: An uncommon Cause of Abdominal Pain.

Sclerosing angiomatoid nodular transformation (SANT) is a rare and benign lesion arising from the red pulp of the spleen, with an unknown etiopathogenesis. These tumors are usually asymptomatic or cause nonspecific abdominal pain. Most SANTs are found incidentally on radiographic examination, or during surgery for an unrelated condition. Therefore, high clinical suspicion is of great importance for the diagnosis. Splenectomy provides complete cure, and no recurrence and/or malignant transformation was reported to date. In this study, a rare case of SANT was reported in a young adult male, and was discussed with the relevant literature. How to cite this article: Atas H, Bulus H, Akkurt G. Sclerosing Angiomatoid Nodular Transformation of the Spleen: An uncommon Cause of Abdominal Pain. Euroasian J Hepato-Gastroenterol 2017;7(1):89-91.

How to approach Incidentally detected Gastrointestinal Stromal Tumor during Laparoscopic Sleeve Gastrectomy: A Report of Two Cases.

Laparoscopic sleeve gastrectomy (LSG) is a frequently used bariatric surgery method. It is possible to incidentally detect gastrointestinal stromal tumors (GISTs) of stomach or other gastric tumors during this procedure. In the literature, there is limited data about cooccurrence of GIST in obesity, and treatment of such cases is still controversial. On the contrary, currently accepted treatment of local and nonmetastatic GIST cases is surgery alone, and of cases with systemic disease is surgery combined with imatinib mesylate therapy. Incidental detection of GIST during bariatric surgery may require a modification in the planned procedure, and an extensive exploration and picking a convenient surgical procedure will become necessary. Here, we present two cases - a gastric GIST and a GIST of small intestine - both of which were incidentally detected during LSG performed for obesity. HOW TO CITE THIS ARTICLE: Atas H, Bulus H, Akkurt G, Yavuz A, Tantoglu U, Alimogullari M, Aydin A. How to approach Incidentally detected Gastrointestinal Stromal Tumor during Laparoscopic Sleeve Gastrectomy: A Report of Two Cases. Euroasian J Hepato-Gastroenterol 2016;6(2):173-175.