The maximum standardized uptake value of metastatic site in 18 F-FDG PET/CT predicts molecular subtypes and survival in metastatic breast cancer: An Izmir Oncology Group study.

PURPOSE: The purpose of this study was to analyse the association between the 18F-2-deoxy-2-fluorodeoxyglucose maximum standardized uptake value (SUVmax) of metastatic sites and molecular subtypes and survival in metastatic breast cancer (MBC) patients. METHODS: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) was performed in 176 MBC patients before any therapeutic intervention. The FDG uptakes of metastatic sites were evaluated using the SUVmax. Histopathological prognostic parameters, such as the tumor size, grade, lymph node involvement, lymphovascular invasion, estrogen (ER), progesterone receptors (PR), HER2 status and Ki67 were determined from the primary breast tumor tissue. The SUVmax of the metastatic sites was assessed in relation to the molecular subtypes and survival in univariate and multivariate analyses. Cox regression analysis was used to evaluate the associations between SUVmax measurements and overall survival (OS). RESULTS: The mean SUVmax of 176 tumors was 8.0. Among the subtypes 49 (28.8%) were luminal A, 51 (28.9%) luminal B, 35 (19.8%) HER2-overexpressing, and 41 (23.2%) triple- negative, and the corresponding means of SUVmax were 5.6, 7.4, 11.4, 11.0, respectively. A cut-off value of ≤8.4 yielded 80% sensitivity and 57.1% specificity with an area under the receiver operating characteristics curve (AUC) of 0.731 for predicting that a tumor was of the luminal A subtype. A cut-off value of SUVmax ≥10.05 yielded 62.9% sensitivity and 67.4% specificity with an AUC of 0.648 for predicting a HER2 overexpressing subtype. A cut-off value of SUVmax ≥9.25 yielded 61% sensitivity and 64.4% specificity with an AUC of 0.660 for predicting a triple-negative subtype. The SUVmax could not effectively differentiate patients with luminal B subtype. Cox regression analysis showed that in patients with MBC, a SUVmax ≤7.55 acted as an independent negative prognostic factor for OS (hazard ratio/HR = 1.552). CONCLUSION: The SUVmax of metastatic sites on pretreatment 18F-FDG PET/CT may be an independent prognostic factor for the diagnosis of molecular phenotypes and survival in MBC patients.

The impact of cell proliferation markers and p53 mutation status on prognosis of non-metastatic colon cancer.

BACKGROUND AND OBJECTIVES: We aimed to evaluate the prognostic value of cell cycle proteins and p53 together with clinicopathologic features in non-metastatic resected colon cancer. METHODS: One hundred nine patients who were diagnosed with resected colon cancer between 2006 and 2011 were analyzed retrospectively. Immunohistochemical staining analyses were used to evaluate the expression of cyclins D1 and A, p53 and Ki-67 in tumor tissue. RESULTS: High cyclin D1 and cyclin A expression was more common in stage II than stage III tumors. Disease recurrence was more frequent in tumors with low cyclin D1 expression (P = 0.05). No significant association was observed between p53, Ki-67 or cyclin A expression and the risk of relapse and/or death. Multivariate analysis showed that the strongest predictor for a shorter disease-free survival period was extracapsular nodal invasion (ECNI). CONCLUSIONS: We were not able to establish a strong association between patient prognosis and cyclins D1 and A, p53 or Ki-67 expression. However, a negative correlation between cyclin D1 and cyclin A expression and disease stage as well as more frequent relapses in patients with low expression of cyclin D1 suggested that cyclins may be predictive for early relapse in non-metastatic colon cancer.

Prognostic evaluation of breast cancer patients with evident bone marrow metastasis.

In this study, we aimed to evaluate the clinicopathologic characteristics and prognosis of breast cancer (BC) patients with symptomatic bone marrow metastasis (BMM). Fifty-four BC patients, including patients with and without BMM, were evaluated retrospectively. In particular, the clinicopathologic features and survival of the patients with BMM (n = 27) were assessed and compared with the patients without BMM. All of the patients with BMM also had osseous metastases, and bone was the first site for distant recurrence in the majority of patients in the study group. Anemia was the most frequent symptom at presentation. The median time to BMM was 36.1 months (range 1.6-70.5 months, 95% CI). HER2(+) patients developed BMM earlier than HER2(-) patients (3.2 versus 38.3 months, 95% CI; p = 0.05). Patients with advanced disease at the time of initial BC diagnosis developed BMM earlier than patients with early disease (p = 0.04). Time to development of BMM was significantly shorter in tumors with perinodal infiltration (p = 0.001) and multicentric focus (p = 0.025). Median survival time after the diagnosis of apparent BMM was 6.43 months. Survival after BMM diagnosis in patients with grade III tumors was significantly shorter than in patients with grade I-II tumors (1.43 versus 5.36 months, 95% CI; p < 0.001). Systemic therapy after BMM diagnosis significantly prolonged survival (17.3 versus 0.93 months, 95% CI; p < 0.001). Hormone receptor-positive, high-grade, advanced-stage tumors at the time of initial BC diagnosis were more common in patients with BMM. Invasive lobular histology was also more frequent in patients with BMM. In conclusion, the presence of hormone receptor-positive, multicentric, grade III, advanced-stage tumors may be important risk factors for the development of evident BMM in BC patients. Systemic single-agent chemotherapy can prolong survival in these patients. However, multicenter analyses are required to verify these findings.

Capecitabine-related increased mean corpuscular volume of red blood cell may be a predictive marker of treatment response and survival in patients with metastatic colorectal cancer.

PURPOSE: Erythrocyte mean corpuscular volume (MCV) increase has been described in patients treated with capecitabine. In this study, we sought to evaluate the potential association of the erythrocyte MCV increase with tumor response and survival in patients with metastatic colorectal cancer (mCRC) treated with capecitabine. METHODS: A retrospective review of 131 patients with mCRC who were treated with capecitabine for at least 3 months at the Izmir Training and Research Hospital was undertaken. Complete blood count (CBC) including red blood cell indices were recorded at baseline and after 9 weeks from capecitabine treatment. RESULTS: The mean patient age was 57.9 years (range 28- 82). In patients treated with capecitabine, MCV increased significantly at 9 weeks compared with baseline (p=0.000). Median ΔMCV [(post-treatment MCV values) - (baseline MCV values)] level was 9.3 fL. Patients were grouped according to ΔMCV into two groups (> 9.3 or ≥ 9.3) in order to carry out survival analysis and correlation with tumor response. ΔMCV was >9.3 in 65 patients and ≤9.3 in 66 patients. Fifty-six of the 65 patients with ΔMCV levels >9.3 and 37 of the 66 patients with ΔMCV levels ≤9.3 had a clinical benefit (complete response + partial response + stable disease) from capecitabine treatment (p=0.000). The difference between progression-free survival (PFS) and overall survival (OS) of the patients who had ΔMCV>9.3 and those who had ≤9.3 was statistically significant (9.48 and 6.94 months, p=0.001 respectively; and 17.5 and 13.6 months respectively, p=0.018). Univariate analysis suggested that a favorable prognosis for OS and PFS was associated with MCV increase (p=0.000). In multivariate analysis, MCV increase was independently associated with favorable survival outcomes. CONCLUSIONS: Erythrocyte MCV increase may be used as a predictive marker for treatment response, PFS and OS in patients with mCRC treated with capecitabine.

Tonsillar leiomyosarcoma.

UNLABELLED: Leiomyosarcomas of the head and neck is an extremely rare entity that because of its infrequency has been associated with both delayed diagnosis and misdiagnosis. Sinonasal tract is the most common site in this region. The overall prognosis is poor. It is necessary for appropriate immunohistochemical investigation for accurate diagnosis. Tonsillar leiomyosarcoma presented only 1 case in the English-language literature (PubMed, Ovid, and Proquest databases). We report a second case of leiomyosarcoma arising in the tonsil in a 38-year-old woman. LEVEL OF EVIDENCE: Level IV therapeutic study.

Intramammary lymph node metastasis in a patient with ovarian carcinoma and a brief review of the literature.

Metastasis from serous carcinoma of the ovary usually occurs in the subdiaphragmatic region. Metastasis to the breast and/or axillary-intramammary lymph node is very rare. It usually occurs in advanced disease, and it is important to distinguish a primary breast cancer from an ovarian cancer metastasis since the management of these two entities is totally different. Here we present a patient with metastasis to the breast and intramammary lymph nodes from ovarian serous carcinoma 25 months after diagnosis.

Cutaneous and subcutaneous metastases from bladder carcinoma.

Cutaneous metastases of bladder carcinoma are very rare. The rate of cutaneous metastasis in urologic malignancies is 1.3% and this rate was found to be 0.84% for bladder carcinomas. Cutaneous metastasis of bladder carcinoma can be confused with cellulitis. This case report presents a 60-year-old patient operated on for bladder carcinoma and undergoing treatment for cellulitis because of erythematous lesions appearing in the suprapubic region in the early postoperative period. As there was no response to antibiotic treatment, skin biopsy was performed and cutaneous metastasis was diagnosed. Subsequently, chemotherapy with carboplatin and gemcitabine was started. The prognosis of bladder carcinoma with cutaneous metastasis has been reported to be poor.

The real-life efficacy and safety of osimertinib in pretreated advanced non-small cell lung cancer patients with T790M mutation: a Turkish Oncology Group Study.

INTRODUCTION: Osimertinib, an irreversible third-generation EGFR-TKI, is the standard of care for second-line treatment of T790M-mutant advanced NSCLC patients whose disease progressed after first-line EGFR-TKI therapy. In this multicenter study, we aimed to determine the real-life efficacy and safety of Osimertinib in pretreated advanced NSCLC patients with T790M mutation. MATERIALS AND METHODS: This retrospective trial included advanced T790M-mutant pretreated NSCLC patients who received Osimertinib from 24 different centers in Turkey. Primary endpoint was time-to-treatment discontinuation (TTD). Secondary endpoints were objective response rate (ORR), overall survival (OS), and safety. RESULTS: Of 163 patients, 68.7% had EGFR exon 19 deletion and 22.7% had exon 21 L858R mutation. Osimertinib was given as second-line treatment in 96 patients (58.9%) and third-line in 48 patients (29.4%). After median of 13-month follow-up, median TTD was 21.6 months with an 82.2% ORR. Estimated median OS was 32.1 months. Grade 3-4 adverse events were seen in 11.7% of the patients. CONCLUSION: Osimertinib is a highly effective option in second- or third-line treatment of NSCLC patients with T790M mutation, with a favorable safety profile.

Appropriate interslice gap for screening coronal paranasal sinus tomography for mucosal thickening.

The objective of this study was to establish the appropriate interslice gap for screening coronal paranasal sinus tomography to identify sinus mucosal thickening. We reviewed 100 coronal paranasal sinus tomographic scans (interslice gap, 2 mm) that had been performed at our institution between January 2004 and November 2004 to evaluate rhinosinusitis. Digital photographs of all slices from each tomographic scan were taken. The intervening slices were eliminated to form six different sets of interslice gaps of 4, 6, 8, 10, 16, and 20 mm. The remaining slices for each set were moved to corresponding folders created on a computer to catalog each interslice gap. The same specialist evaluated each folder of interslice gap. The paranasal sinuses, the ethmoid infundibulum, and the frontal recess were evaluated for mucosal thickening. The sensitivity, specificity, and accuracy of each interslice gap in detecting mucosal thickening were calculated by accepting the results of 2-mm-thick slices as the gold standard. The interslice gap of 2 mm was compared with that of other interslice gaps using the chi-square test for dependent groups (the McNemar test). The value of 20 mm interslice gap in detecting sinus mucosal thickening was found to be significantly low when compared with the interslice gap of 2 mm (P = 0.022). Using coronal paranasal sinus tomography, an interslice gap up to 16 mm may be used to detect sinus mucosal thickening.

Evaluation of postoperative patient satisfaction after covering the nasal dorsum with upper lateral cartilage: "upper lateral closing".

INTRODUCTION: Following nasal hump removal during septorhinoplasty, the middle vault should be reconstructed to avoid functional and esthetic problems. Middle vault reconstruction, however, may result in widening of the middle vault and may need a camouflage graft to cover dorsal irregularities. OBJECTIVE: To present the results of reconstructing the middle vault with a technique that covers the nasal dorsum with upper lateral cartilage, from the viewpoint of patient satisfaction. METHODS: Retrospective study of patients who underwent septorhinoplasty that included nasal dorsum closure with upper lateral cartilage from December 1, 2014 to January 31, 2016. Those with postoperative follow-up of less than 3 months were excluded. The final study group included 39 patients. The same surgeon performed all septorhinoplasties. The dorsum was closed using an "upper lateral closing" technique that approximated upper lateral cartilages to each other over the septum. Postoperative patient satisfaction was determined using a visual analog scale and the rhinoplasty outcomes evaluation questionnaire. The questionnaire evaluates patient esthetic and functional satisfaction with the operated nose. High scores indicate improved esthetic results. RESULTS: No dorsal irregularities were seen at postoperative follow-up evaluation of the patients. For esthetic nasal appearance, the median visual analogue scale scores was 86%, and the mean for the questionnaire was 77.03%. CONCLUSION: The natural dome-shaped anatomy of the nasal dorsum was achieved by approximating the upper lateral cartilages to each other. Closing the dorsum with this technique also covers any dorsal irregularities and results in a smooth dorsum. Patients expressed satisfaction with the esthetic and functional aspects of the smooth, attractive nasal dorsum.

Effects of different suture materials on cartilage reshaping.

OBJECTIVE: To examine the effects of different suture materials and suturation techniques on cartilage reshaping in a rabbit model. METHODS: Twenty-two rabbits were used. Posterior skin flaps were elevated, and 4 cartilage struts were prepared on each auricula. Each strut was bent at its midpoint, and the skin under the bent area was elevated only in 1 side. The strut was sutured either with catgut, polyglactin 910, polydioxanone, or polypropylene sutures. Anteriorly, the suture was passed subcutaneously on 1 side, while transcutaneously on the other. Animals were killed at the first and fourth months. The shape of the struts was macroscopically evaluated. Inflammation and foreign body reaction around the suture were examined under light microscopy. RESULTS: Maintenance of shape with all suture materials was significantly lower in the transcutaneously sutured group than in the subcutaneously sutured group. Because of high rates of suture loss in the transcutaneously sutured group, further evaluations on cartilage tissue were made only in subcutaneously sutured group. Success rate in maintenance of shape was similarly high in the polydioxanone, polyglactin 910, and polypropylene suture groups; however, it was significantly lower in the catgut suture group. CONCLUSION: Long-lasting absorbable suture materials are as effective as nonabsorbable ones, and the subcutaneous technique is more effective than the transcutaneous technique.

[Utility of fine-needle aspiration biopsy in head and neck masses]. / Bas-boyun kitlelerinde ince igne aspirasyon biyopsisinin yeri.

OBJECTIVES: We investigated the utility of fine-needle aspiration biopsy (FNAB) for head and neck masses, and compared FNAB results with histopathologic diagnoses. PATIENTS AND METHODS: In a group of 352 patients (168 males, 184 females; mean age 44+/-19 years; range 2 to 94 years) who were operated on for head and neck masses, FNAB was performed in 167 patients (47.4%). The results of FNAB were compared with histopathologic diagnoses in four groups of localization: parotid, thyroid, submandibular gland, and cervical levels. Sensitivity, specificity, positive predictive and negative predictive rates of FNAB were calculated for each group. RESULTS: There were 64 parotid (38.3%), 29 thyroid (17.4%), 19 level V (11.4%), 18 level II (10.8%), 14 level III (8.4%), 9 level I (5.4%), and 7 submandibular gland (4.2%) masses. The overall correlation of FNAB with histopathologic diagnoses was 71.9%, being 76.6% in parotid, 75.9% in thyroid, 57.1% in submandibular gland, and 67.2% in neck (levels I-VI) masses. The highest sensitivity, specificity, positive predictive and negative predictive rates were determined for parotid masses (98%, 93.3%, 98%, 93.3%, respectively), whereas the lowest rates were obtained in submandibular gland masses (50%, 66.7%, 66.7%, 50%, respectively). CONCLUSION: The use of FNAB for head and neck masses, in particular parotid masses, provides considerable contribution to treatment planning.

[Pseudoaneurysm of the internal carotid artery following a tonsil biopsy: endovascular repair with covered stent]. / Tonsil biyopsisine bagli gelisen internal karotis arter psödoanevrizmasi: endovasküler kapli stent ile onarim.

Evaluation and management of peritonsillar masses require specific attention because of their relationship to vital neighboring anatomical structures. A 57-year-old woman developed pseudoaneurysm of the internal carotid artery following a biopsy taken at another center from a mass in the left tonsillar region. She was treated by a multidisciplinary approach and an endovascular covered stent was implanted under local anesthesia in the left internal carotid artery. No recurrence was detected in the neck and the patient was asymptomatic in the postoperative second year.