Evaluation of the relationship between Ki67 expression level and neoadjuvant treatment response and prognosis in breast cancer based on the Neo-Bioscore staging system.

BACKGROUND: Neoadjuvant chemotherapy (NAC) is widely used in the treatment of primary breast cancer. Different staging systems have been developed to evaluate the residual tumor after NAC and classify patients into different prognostic groups. Ki67, a proliferation marker, has been shown to be useful in predicting treatment response and prognosis. We aimed to investigate the prognostic importance Neo-Bioscore stage and pretreatment and posttreatment Ki67 levels in breast cancer patients who received NAC and correlations between Neo-Bioscore stage and pretreatment and posttreatment Ki67 levels. METHODS: A total of 176 invasive breast carcinoma patients who underwent NAC were included in the study. Ki67 levels were evaluated by immunohistochemical methods in Trucut biopsy and surgical excision specimens. Patients were classified into prognostic groups using the Neo-Bioscore staging system. RESULTS: Patients with high pretreatment Ki67 score were more likely to be in the higher Neo-Bioscore risk group (p < 0.001). Patients with a high posttreatment Ki67 score were more likely to be in the higher Neo-Bioscore prognostic risk group (p < 0.001). Overall survival (OS) and disease-free survival (DFS) were shorter in patients with high posttreatment Ki67 scores and in patients in the higher Neo-Bioscore risk group. We also determined a cutoff 37% for pathological complete response. CONCLUSION: Neo-Bioscore staging system is found to be important in predicting survival. The posttreatment Ki67 level is more important than pretreatment Ki67 level in predicting survival.

Does a Close Surgical Margin for Ductal Carcinoma In Situ Associated with Invasive Breast Carcinoma Affect Breast Cancer Recurrence?

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.

Management of the Axilla in T1-2 Breast Cancer Patients with Macrometastatic Sentinel Node Involvement Who Underwent Breast-Conserving Therapy.

PURPOSE: The aims of our study were to determine the incidence of axillary recurrence and arm morbidity in T1-2 invasive breast cancer patients with macrometastases on the sentinel lymph node (SLN) who underwent breast-conserving therapy (BCT), with or without axillary lymph node dissection (ALND). METHODS: One hundred and nine T1-2 invasive breast cancer patients with macrometastases on the SLN who underwent BCT in our institution were included in the study. Patients with 1-2 positive SLN and without extra nodal extension (ENE) on the SLN did not undergo ALND (SLN-only group) and patients with ENE or patients who had >2 metastatic nodes underwent level I, II ALND (ALND group). The SLN-only group received radiotherapy to three axillary levels, the supraclavicular fossa, and ± mammaria interna. ALND group received radiotherapy to axillary level III, the supraclavicular fossa, and ± mammaria interna. The incidence of axillary recurrence and arm morbidity were investigated. RESULTS: Of the 109 patients, 18 patients with >2 metastatic SLNs and 10 with ENE on the SLN underwent ALND and 81 patients underwent SLN only. Median follow-up time was 37 months (3-77). There was no axillary recurrence in SLN-only group. However, in the ALND group 1 patient had developed axillary metastasis. There were 2 objective lymphoedema and 3 arm-shoulder restriction cases in the SLN-only group, and 2 and 3 in the ALND group, respectively. CONCLUSIONS: Axillary dissection could safely be omitted in patients with 1-2 macrometastatic SLN and without ENE who undergo BCT and axillary radiotherapy.

Single-Port Laparoscopic Liver Resection: Largest Turkish Experience.

Single-port laparoscopic surgery has the advantage of a hidden scar and reduced abdominal wall trauma. Although single-port laparoscopic surgery is widely performed for other organs, its application is very limited for liver resection. Here, we report our experience with nine patients who underwent single-port laparoscopic liver resection. Nine patients underwent single-port laparoscopic liver resection for the indications of hydatid cyst, hepatocellular carcinoma, and colorectal cancer liver metastasis. Nine patients were successfully treated with single-port laparoscopic surgery. The operative time was between 60 and 240 min. The only operative complication was bleeding up to 650 mL in a patient with cirrhosis. No postoperative complications occurred. All patients were discharged earlier than usual. Single-port laparoscopic liver surgery is a challenging surgery. Surgeon with the experience of laparoscopic liver surgery should perform the single-port laparoscopic liver surgery. It is technically feasible with a good outcome in well-selected patients. Initial cases must be benign lesions to avoid jeopardizing oncological safety.

A First Report of Synchronous Intracapsular and Extracapsular Hepatic Adenoma.

Although the gallbladder is the most common site of ectopic liver, it has been reported in many other organs, such as kidney, adrenal glands, pancreas, omentum, stomach, esophagus, mediastinum, lungs, and heart. Hepatocytes in an ectopic liver behave like normal hepatocytes; furthermore, they can be associated with the same pathological findings as those in the main liver. Ectopic liver in the gallbladder can undergo fatty change, hemosiderosis, cholestasis, cirrhosis, hemangioma, focal nodular hyperplasia, adenoma, and even carcinogenesis. The incidence of extracapsular hepatic adenoma is not known, but only two cases have been reported. Here, we provide the first case report of synchronous multiple intracapsular and extracapsular hepatic adenomas. A 60-year-old woman with multiple hepatic adenomas and one 7 × 5 × 5 cm ectopic hepatic adenoma attached to the gallbladder fundus complicated with abdominal pain is presented.

Factors predicting non-sentinel lymph node metastasis in T1-2 invasive breast cancer with 1-2 axillary sentinel lymph node metastases: Presentation of Ondokuz Mayis scoring system.

PURPOSE: 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. METHODS: 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. RESULTS: 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%) 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). CONCLUSIONS: The present Ondokuz Mayis model with an AUC of 0.88 showed excellent discrimination capacity to distinguish patients at low risk for positive non-SLN from high risk patients and could help spare ALND in an important portion of patients.

Effect of Neoadjuvant Chemotherapy on Axillary Lymph Node Positivity and Numbers in Breast Cancer Cases.

BACKGROUND: The aim of this study is to compare the numbers of axillary lymph nodes (ALN) taken out by dissection between patients with breast cancer operated on after having neoadjuvant chemotherapy (NAC) treatment and otherswithout having neoadjuvant chemotherapy, and to investigate factors affecting lymph node positivity. MATERIALS AND METHODS: A total of 49 patients operated due to advanced breast cancer after neoadjuvant chemotherapy and 144 patients with a similar stage of the cancer having primary surgical treatment without chemotherapy at the general surgery clinic of Ondokuz Mayis University Medicine Faculty between the dates 01.01.2006 and 31.10.2012 were included in the study. The total number of lymph nodes taken out by axillary dissection (ALND) was categorized as the number of positive lymph nodes and divided into <10 and ≥10. The variables to be compared were analysed using the program SPSS 15.0 with P<0.05 accepted as significant. RESULTS: Median number of dissected lymph nodes from the patient group having neoadjuvant chemotherapy was 16 (16-33) while it was 20 (5-55) without chemotherapy. The respective median numbers of positive lymph nodes were 5 ( 0-19) and 10 (0-51). In 8 out of 49 neoadjuvant chemotherapy patients (16.3%), the number of dissected lymph nodes was below 10, and it was below 10 in 17 out of 144 primary surgery patients. Differences in numbers of dissected total and positive lymph nodes between two groups were significant, but this was not the case for numbers of <10 lymph nodes. CONCLUSIONS: The number of dissected lymph nodes from the patients with breast cancer having neoadjuvant chemotherapy may be less than without chemotherapy. This may not always be attributed to an inadequate axillary dissection. More research to evaluate the numbers of positive lymph nodes are required in order to increase the reliability of staging in the patients with breast cancer undergoing neoadjuvant chemotherapy.

Giant Cutaneous Leiomyosarcoma Originating From the Abdominal Wall: A Case Report.

BACKGROUND: Leiomyosarcoma, a rare type of tumor, accounts for 5-10% of all soft tissue tumors. CASE REPORT: A 44-year-old male patient was admitted to the emergency service of our medical faculty with the complaints of fatigue and abdominal mass. CONCLUSIONS: The pathology result was leiomyosarcoma. Leiomyosarcoma of the skin is rare and our case is the largest such lesion reported in the literature.

Erratum: Factors predicting non-sentinel lymph node metastasis in T1-2 invasive breast cancer with 1-2 axillary sentinel lymph node metastases:Presentation of Ondokuz Mayis scoring system.

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.

Portomesenteric venous gas does not always mean intestinal necrosis: report of a case.

Portomesenteric venous gas is a rare condition most commonly caused by mesenteric ischaemia. Mesenteric ischemia, can be life-threatining and requires immediate surgical intervention with a poor prognosis. During the laparotomy, intestinal necrosis and perforation are most common findings although some patients reveal no surgical pathology. In this report we present a case of portomesenteric venous gas which is secondary to acute intramural intestinal haematoma.

Percutaneous Endoscopic Gastrostomy: Technical Problems, Complications, and Management.

Percutaneous endoscopic gastrostomy (PEG) is an important technique for the provision of nutrition. The present study presents data from our analysis of the PEG procedure. Patients administered with PEG at the endoscopy unit of the 19 Mayis University General Surgery Department between 2007 and 2013 were analyzed retrospectively, and technical problems, indications, and complications related to the PEG procedure in 221 patients were evaluated. Of the patients, 60 % were male and the median age was 61 years (18-92 years). The most frequent indication was admittance to the intensive care unit, accounting for 46 % of the total, followed by neurological disease, with 41 %. The success rate of the procedure was 98 %, and the overall rate of complications was 22 %. No mortalities were reported as resulting from the procedure. The most common complication was the development of granulomas around the tube (8 %). PEG is a safe method of long-term feeding but is associated with a high rate of morbidity that can be treated easily using conservative treatment methods.

Prognostic factors affecting disease-free survival in patients at age 35 or younger with invasive breast cancer.

AIM: Our aim is to determine the disease-free survival (DFS) rate, and to investigate the prognostic factors among patients with invasive breast cancer at age 35 or younger. PATIENTS AND METHOD: The medical records of the 67 patients who underwent surgery for invasive breast cancer were retrospectively reviewed. Potential prognostic factors that affect the DFS were investigated. DFS curves were obtained using the Kaplan-Meier method. The comparisons were made by the long-rank test. The prognostic factors affecting the DFS were determined by stepwise Cox proportional hazard regression test. The P value < 0.05 was accepted as significant. RESULTS: The median age was 32 (range, 23-35). The median follow-up interval was 55 months (range, 10-108). The 5-year DFS rate was 69.3%. In univariate analysis the number of pathologic axillary lymph nodes (p=0.035), triplenegative status (p=0.014) and tumor size (p= 0.004) were found to be the prognostic factors affecting the DFS. The 5-year DFS rate was 81% in non-triple negative patients, whereas this was 35% in triple-negative patients. In the multivariate analysis, triple-negative status was the only independent prognostic factor which affected the DFS adversely (HR: 1.48, CI: 0.66-082, p=0.027). CONCLUSION: Triple-negative status was found to be the only independent and adverse prognostic factor which affects the DFS in patients with invasive breast cancer at age 35 or younger. KEY WORDS: Breast cancer, Disease-free survival, Triple negative breast cancer, Young age.

A breast cancer nomogram for prediction of non-sentinel node metastasis - validation of fourteen existing models.

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 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. MATERIALS AND METHODS: Two hundred and thirty seven invasive breast cancer patients with SLN metastases who underwent ALND were included in the study. Based on 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, the number of negative SLNs, and multifocality were found to be independent predictive factors for non-SLN metastasis. The AUC was found to be 0.87, and calibration was good for the present Ondokuz Mayis nomogram. Among the 14 validated models, the MSKCC, Stanford, Turkish, MD Anderson, MOU (Masaryk), Ljubljana, and DEU models yielded excellent AUC values of > 0.80. CONCLUSIONS: We present a new model to predict the likelihood of non-SLN metastasis. Each clinic should determine and use the most suitable nomogram or should create their own nomograms for the prediction of non- SLN metastasis.

Factors affecting surgical margin positivity in invasive ductal breast cancer patients who underwent breast-conserving surgery after preoperative core biopsy diagnosis.

PURPOSE: The aim of our study is to evaluate the factors affecting surgical margin positivity among patients with invasive ductal breast cancer who underwent breast-conserving surgery (BCS) after preoperative diagnostic core biopsy. METHODS: Two hundred sixteen patients with stage I, II invasive ductal breast carcinoma who had histological diagnosis with preoperative tru-cut biopsy and underwent BCS were included in the present study. Potential factors that affect the positive surgical margin were analyzed. In univariate analysis, the comparisons of the factors affecting the surgical margin positivity were made by chi-square test. Logistic regression test was used to detect the independent factors affecting the surgical margin positivity. RESULTS: Positive axillary lymph node (odds ratio [OR], 8.2; 95% confidence interval [CI], 3.01 to 22.12), lymphovascular invasion (LVI; OR, 3.9; 95% CI, 1.62 to 9.24), extensive intraductal component (EIC; OR, 6.1; 95% CI, 2.30 to 16.00), presence of spiculation (OR, 5.1; 95% CI, 2.00 to 13.10) or presence of microcalcification in the mammography (OR, 13.7; 95% CI, 4.04 to 46.71) have been found to be the independent and adverse factors affecting surgical margin positivity. CONCLUSION: Considering decision making for the extent of the excision and for achieving negative surgical margin before BCS, positive axillary lymph node, LVI, EIC, spiculation or microcalcification in mammography are related as predictor factors for positive surgical margin.

Single incision laparoscopic surgery for hepatic hydatid disease. Report of a case.

A 76 year-old female patient with a long-time history of nonspecific abdominal pain admitted to our hospital. Imaging studies showed 5 cm liver hydatid cyst between segments 2 and 3. She was recommended surgery and was informed about the details of single incision laparoscopic surgery (SILS). We performed single-incision laparoscopic pericystectomy.This is the first reported case of single-incision laparoscopic surgery for liver hydatid disease according to searching of English literature at the PubMed. SILS is a feasible surgical method for liver hydatid disease in selected patients with good outcome.

The coexistence of invasive ductal carcinoma and malignant phyllodes tumor with liposarcomatous and chondrosarcomatous differentiation in the same breast in a post-osteosarcoma case.

Malignant phyllodes tumors of the breast are rare biphasic neoplasms, the stromal component of which may show homologous and heterologous sarcomatous elements. Malignant epithelial transformation is rare. It has been reported in a few cases of in situ and infiltrating ductal or lobular carcinoma. Rarely, breast carcinomas and phyllodes tumors may also develop in the same breast independent of each other. To our knowledge, this is the first case of two different types of tumor occurring in the same breast at the same time in a post-osteosarcoma case.