Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01.

BACKGROUND: The MF07-01 trial is a multicenter, phase III, randomized, controlled study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone for treatment-naïve stage IV breast cancer (BC) patients. METHODS: At initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. RESULTS: The trial enrolled 274 patients: 138 in the LRT group and 136 in the ST group. Hazard of death was 34% lower in the LRT group than in the ST group (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.49-0.88; p = 0.005). Unplanned subgroup analyses showed that the risk of death was statistically lower in the LRT group than in the ST group with respect to estrogen receptor (ER)/progesterone receptor (PR)(+) (HR 0.64; 95% CI 0.46-0.91; p = 0.01), human epidermal growth factor 2 (HER2)/neu(-) (HR 0.64; 95% CI 0.45-0.91; p = 0.01), patients younger than 55 years (HR 0.57; 95% CI 0.38-0.86; p = 0.007), and patients with solitary bone-only metastases (HR 0.47; 95% CI 0.23-0.98; p = 0.04). CONCLUSION: In the current trial, improvement in 36-month survival was not observed with upfront surgery for stage IV breast cancer patients. However, a longer follow-up study (median, 40 months) showed statistically significant improvement in median survival. When locoregional treatment in de novo stage IV BC is discussed with the patient as an option, practitioners must consider age, performance status, comorbidities, tumor type, and metastatic disease burden.

Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism.

BACKGROUND: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. AIMS: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. STUDY DESIGN: Retrospective, clinical-based multi-centric study of 694 patients with pHPT. METHODS: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease. RESULTS: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria. CONCLUSION: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.

The impact of weight gain during adjuvant chemotherapy on survival in breast cancer.

OBJECTIVE: Weight gain can be detected during adjuvant chemotherapy in breast cancer patients, leading to administration of lower drug doses than planned and a decrease in long-term survival. In this study, the effect of weight gain on survival in breast cancer patients was investigated. MATERIAL AND METHODS: Breast cancer patients treated with adjuvant chemotherapy between May 2002 and May 2003 were prospectively included in the study. Patients treated with neoadjuvant chemotherapy or with chemotherapy for metastatic disease were excluded from the study. Data regarding patients' demographic, clinical and pathologic characteristics and chemotherapy protocols were recorded. Patients were grouped as those with weight gain less than or more than 3 kg, and those with a body mass index of less than or more than 30. The impact of weight gain on patients' disease-free and overall survival was investigated. Log-rank test and Cox regression analyses were utilized for survival analyses. P<0.05 value was accepted as statistically significant. RESULTS: Eighty-eight consecutive female patients with a median age of 46 (29-71) were included in the study. Patients received anthracycline based chemotherapy protocols. Weight gain was detected in 79 patients (89.8%), with more than 3 kg weight gain detected in 38 patients (43.2%). In a median follow-up time of 98 months (62-120), distant metastases were detected in 21 patients (23.9%), and 11 patients (12.5%) died. Mean disease-free survival of patients with a weight gain less than and more than 3 kg during chemotherapy was 89.1±3.9 and 84.7±4.2 months (p=0.007), whereas mean overall survival was 95.6±2.2 and 92.5±2.1 months (p=0.01), respectively. Mean disease-free survival of patients with a body mass index less than and more than 30 was 87.3±2.3 and 85.1±3.6 months (p=0.4), whereas mean overall survival was 94.2±2.3 and 92.1±1.1 months (p=0.35), respectively. CONCLUSION: Weight gain during adjuvant chemotherapy has a negative effect on both disease-free and overall survival in patients with breast cancer.

Adjuvant chemoradiation versus chemotherapy for stage III gastric cancer after surgery with curative intent.

OBJECTIVE: Gastric cancer is often diagnosed at an advanced stage and surgery alone cannot guarantee satisfactory results. Both chemoradiotherapy (CRT) and chemotherapy (CT) are used in postoperative therapy. However, it is controversial whether CRT or CT is better after D2 lymphadenectomy. In this study we investigated the efficacy of adjuvant CRT versus CT in stage III gastric cancer patients treated with R0 gastrectomy and D2 lymph node dissection. PATIENTS AND METHODS: Data from 92 patients diagnosed with gastric adenocarcinoma and treated with surgery followed by adjuvant treatment were retrospectively analyzed. Patients were classified into two groups depending on type of adjuvant treatment such as CT (Arm A) and CRT (Arm B). RESULTS: Twenty-one patients in Arm A and 71 patients in Arm B were included. Median age at diagnosis was 60 years. The median follow-up time was 30 months. No difference in local recurrence (14.3 vs 15.7%, P = 0.89), peritoneal recurrence (29.4 vs 23.5%, P = 0.62), and distant metastases rates (57.1 vs 45.1%, P = 0.42) were observed between the arms. Disease-free survival (DFS) rates did not differ between Arms A and B (26 and 22 months, P = 0.80) respectively. Median overall survival (OS) in Arm A was 29 months and it was 32 months for Arm B. There was no difference in 5-year OS and DFS between Arms A and B (23.8 vs 34.4%, P = 0.74; and 24.1 vs 32.9%, P = 0.80). CONCLUSIONS: Adjuvant CRT does not appear to improve clinical outcomes compared to adjuvant CT in this study and prospective studies are required to confirm these results.

New concepts in axillary management of breast cancer.

In the last decades, surgical treatment of breast cancer has evolved from more extensive procedures like radical mastectomy to less invasive breast conserving surgery. Similarly, surgical management of axilla has enormously changed from routine axillary dissection to sentinel lymph node biopsy. Traditional surgical approach to the axilla in case of sentinel lymph node negativity is to avoid completion axillary dissection. However, surgeons even avoid performing axillary dissection in selected patients with positive sentinel lymph node in clinical practice depending on the recent randomized controlled studies supporting this concept. All of the recent changes in the management of positive axilla necessitate surgeons to refresh their knowledge on this challenging topic.

Analysis of patients with phyllodes tumor of the breast.

OBJECTIVE: The diagnosis and management of phyllodes tumors is challenging due to its low incidence. The treatment of these tumors is surgery, however the extent of surgery, the application of adjuvant chemotherapy and radiotherapy are still controversial. Therefore, we aimed to evaluate patients who were treated with a diagnosis of phyllodes tumor of the breast in our clinic. MATERIAL AND METHODS: Patients who were treated with a diagnosis of phyllodes tumor of the breast between June 2011 and June 2013 were reviewed retrospectively. Patient demographic characteristics (age, gender), menopausal status, symptoms, radiologic and surgical methods used for diagnosis and treatment, histopathologic features of the tumor and type of adjuvant therapy were evaluated. Patients were grouped as benign or borderline/malignant according to histopathological diagnosis. Patients in these groups were compared in terms of age, menopausal status, tumor size and the number of mitosis within the tumor. RESULTS: The median age was 26 years (17-59), and 30 patients were female. The surgical treatment of choice was wide local excision with tumor-free surgical margins in 29 patients and mastectomy in one patient. Histopathological diagnosis after surgery was benign in 21 patients (70%), borderline in 6 patients (20%) and malignant phyllodes tumor in 3 patients (10%). Patients with borderline and malignant phyllodes tumors were significantly older (p=0.002) and had higher mitotic counts (p<0.0001). There was no significant relationship between histopathologic subtypes of phyllodes tumors and menopausal status (p=0.06) or tumor size (p=0.1). CONCLUSION: Surgery is the treatment of choice for phyllodes tumors, and obtaining tumor-free margins is important. Since phyllodes tumors might recur as borderline/malignant tumors, local control with surgery and adjuvant radiotherapy should be provided when required. In this way, distant metastases and death that may arise due to possible malignant recurrences might be avoided.

A prospective evaluation of the risk factors for development of wound dehiscence and incisional hernia.

OBJECTIVE: Post-laparotomy wound dehiscence, evantration and evisceration are important complications leading to an increase in both morbidity and mortality. Incisional hernias are frequently observed following abdominal surgeries and their occurrence is related to various local and systemic factors. This study aims to analyze the factors affecting wound healing by investigating the parameters that may cause wound dehiscence, incisional hernia, sinus formation and chronic incisional pain. MATERIAL AND METHODS: The records of 265 patients who underwent major abdominal surgery were analyzed. The data on patient characteristics, medication, surgical procedure type, type of suture and surgical instruments used and complications were recorded. The patients were followed up with respect to sinus formation, incisional hernia occurrence and presence of chronic incision pain. Statistical analysis was performed using SPSS 10.00 program. The groups were compared via chi-square tests. Significance was determined as p<0.05. Multi-variate analysis was done by forward logistic regression analysis. RESULTS: 115 (43.4%) patients were female and 150 (56.6%) were male. Ninety-four (35.5%) patients were under 50 years old and 171 (64.5%) were older than 50 years. The median follow-up period was 28 months (0-48). Factors affecting wound dehiscence were found to be; creation of an ostomy (p=0.002), postoperative pulmonary problems (p=0.001) and wound infection (p=0.001). Factors leading to incisional hernia were; incision type (p=0.002), formation of an ostomy (p=0.002), postoperative bowel obstruction (p=0.027), postoperative pulmonary problems (p=0.017) and wound infection (p=0.011). CONCLUSION: Awareness of the factors causing wound dehiscence and incisional hernia in abdominal surgery, means of intervention to the risk factors and taking relevant measures may prevent complications. Surgical complications that occur in the postoperative period are especially related to wound healing problems.

Bilateral breast metastasis as the first sign of recurrence of a cutaneous melanoma: A case report.

Breast skin and parenchyma are metastatic sites for various tumours. Metastasis to the breast is rare, but it must be considered in the differential diagnosis of a breast mass. Melanoma is among the most commonly reported metastatic tumours of the breast. With the increasing incidence of melanoma, this complication is being encountered with greater frequency. Melanoma has different manifestations in the breast. All these manifestations are important not only as initial presentations of the disease, but also as indicators of the progression period of the disease. Along with a brief review of the literature, we report the case of a woman who presented with breast metastasis after 17 years as the first sign of recurrence of a melanoma. The aim of this study was to report the clinico-pathological features of a patient with metastatic melanoma to the breast. Metastasis can mimic either benign disease or primary malignancy and is often an unexpected diagnosis in a patient presenting with a breast mass. These masses generally indicate disseminated disease with very short survival. Metastasis should be suspected in patients with a breast mass and a prior history of melanoma even if the primary was removed a long time ago (17 years in our case). Fine needle aspiration cytology combined with immunohistochemistry is essential for the diagnosis of metastasis.

Predictive factors for residual disease in re-excision specimens after breast-conserving surgery.

Local recurrence is an issue of concern after breast-conserving therapy and removing the primary tumor with negative surgical margins is the most important determinant of local recurrence. However, some patients with positive margins after initial surgery will have no residual tumor in the re-excision specimen. To avoid unnecessary re-excisions, factors predicting residual disease in re-excision material should be determined. This study aimed to determine the predictive factors for residual disease in the re-excision material in a homogeneous group of patients with positive margins and only invasive ductal carcinoma. Breast cancer patients treated between 2005 and 2008 with breast-conserving surgery and subsequent re-excisions due to positive surgical margins after initial surgery were included in the study. Patients were divided into two groups as those with and without residual disease in the re-excision material. One hundred and four breast cancer patients were included in the study. Forty-seven patients (45.2%) had residual tumor in re-excision specimen. Patient characteristics such as age (p = 0.42) and physical findings (p = 1.0) and specimen volume (p = 0.24), tumor grade (p = 0.33), estrogen (p = 1.0), and progesterone (p = 0.37) receptor status, axillary lymph node metastases (p = 0.16), extensive intraductal component (p = 0.8), and lymphovascular invasion (p = 0.064) were found as insignificant factors for predicting residual tumor. Large tumor size (>3 cm) (p = 0.026), human epidermal growth factor receptor2 (HER2) positivity (p = 0.013), and tumor to specimen volume ratio of >70% (p = 0.002) significantly increased the probability of finding residual disease after re-excision. In multivariate analysis, HER2 positivity (p = 0.046) and tumor to specimen volume ratio of >70% (p = 0.006) independently predicted the presence of residual disease. As a result, in patients with HER2 positive tumors larger than 3 cm, larger volume of breast tissue around the tumor should be removed to decrease the number of re-excisions due to positive surgical margins.

Value of sentinel lymph node biopsy in breast cancer patients with previous excisional biopsy.

PURPOSE: Sentinel lymph node biopsy (SLNB) in breast cancer patients with clinically negative axilla will ensure axillary dissection only for cases with lymph node metastasis and provide information about pathologic staging as accurate as the axillary dissection. It was shown that SLNB could be successfully performed regardless of the type of biopsy. The aim of this study was to investigate the feasibility of SLNB after excisional biopsy. METHODS: One hundred patients diagnosed with excisional biopsy or guide wire-localization and operated on with SLNB between February 2007 and March 2009 were retrospectively analyzed. SLNB was performed with 10 cc of 1% methylene blue alone or both methylene blue and 1 mCi of Tc-99m nanocolloid combination. Age, tumor localization and size, length of the biopsy incision, size of the biopsy specimen, multifocality, lymphovascular invasion, tumor grade, staining with methylene blue, localization, number and metastatic status of the lymph nodes stained, and success rate with a gamma probe were evaluated. RESULTS: Sentinel lymph node (SLN) could not be identified in 9 (16.9%) of patients in the methylene blue group (n=53). In the combination group (n=47), SLN could not be identified in one patient. Of 32 patients with negative SLNB, metastatic involvement was found to be present in 5 patients after axillary lymph node dissection (false negatives). The average numbers of SLNs found in the methylene blue group and combination group were 1.4 and 1.6, respectively. SLN detection and false negative rates in the methylene blue group were 83% and 15.7%, respectively. The rates for the combination group were 98% and 6.4%, respectively. None of the parameters related to patient, tumor or process were found to affect detection rates of SLN. CONCLUSION: Only SLNB using a combination method is a safe and reliable technique for breast cancer patients diagnosed with excisional biopsy.

The Relationship between Surgery and Phase of the Menstrual Cycle Affects Survival in Breast Cancer.

PURPOSE: The impact of time of surgery based on the menstrual cycle is a controversial issue. Two decades after the first interest in this topic, a number of studies with conflicting results have not helped to resolve this problem. This study aimed to prospectively evaluate the impact of timing of surgery based on the menstrual cycle on survival rates of breast cancer patients, and various clinical and hormonal classifications of the menstrual cycle were compared in order to determine the phase of the menstrual cycle which showed the highest degree of surgical survival. METHODS: Premenopausal breast cancer patients treated with curative surgery between 1998 and 2002 were prospectively included in this study. Patients were divided into different groups according to the first day of their last menstrual cycle using three different classifications (clinical, Hrushesky, Badwe), and were also grouped according to their serum hormone levels. Serum levels of follicle stimulating hormone, luteinizing hormone, estrogen, and progesterone were measured on the day of surgery. RESULTS: Ninety patients were included in the study. Median follow-up time was 90 months. Nineteen patients (21.1%) had loco-regional recurrence and/or distant metastases while 12 patients (13.3%) died during follow-up. Five-year (78.6% vs. 90.6%) and 10-year (66.7% vs. 90.6%) disease-free survival (DFS) rates of patients in the clinically defined follicular phase were significantly decreased compared to luteal phase. On the other hand, hormonally determined phases of the menstrual cycle and grouping of patients according to clinical classifications did not show an impact on prognosis. CONCLUSION: In the current study performing surgery in the follicular phase of the menstrual cycle decreased DFS in premenopausal patients. According to these results, performing surgery during the luteal phase of the menstrual cycle might have a beneficial effect on survival.

Total thyroidectomy for the surgical treatment of multinodular goiter.

PURPOSE: The indications for surgical treatment of multinodular goiter (MNG) are pressure symptoms, suspicion of malignancy, and cosmetic concerns. We report our clinical experience of performing total thyroidectomy (TT) for MNG, focusing on outcome and complications, to evaluate its effectiveness. METHODS: The medical records of 154 patients who underwent TT for MNG between 2005 and 2007 were reviewed retrospectively. We examined the ratio of thyroid nodules to the thyroid gland, pathological fine-needle aspiration biopsy findings, and the ultrasonographic characteristics of the nodules, and recorded the early and late postoperative complications. RESULTS: The most frequent indications for surgery were large nodules with or without radiological suspicion of malignancy (65%), hyperthyroidism (20%), and cosmetic problems or compression symptoms (15%). Seventeen (11%) patients had symptomatic, transient hypocalcemia, and 1 (0.6%) had permanent hypocalcemia. Other complications included hematoma in 1 (0.6%) patient, temporary unilateral recurrent laryngeal nerve palsy in 10 (6.4%), permanent unilateral recurrent laryngeal nerve palsy in 3 (1.9%), and seroma in 2 (1.3%). There was no significant relationship between complications and histopathology, nodule size, thyroid size, hyperthyroidism, age, or gender. CONCLUSION: Total thyroidectomy is the right surgical decision for MNG since it achieves complete remission of symptoms and eliminates malignancy, with low morbidity and mortality rates.

Drug resistant MCF-7 cells exhibit epithelial-mesenchymal transition gene expression pattern.

PURPOSE: Multidrug resistance is resistance to structurally unrelated anticancer agents. Large-scale expression analysis by using high-density oligonucleotide microarrays may provide information about new candidate genes contributing to MDR. This study demonstrates alterations in expression levels of several genes related to epithelial-mesenchymal transition (EMT) in paclitaxel, docetaxel, and doxorubicin resistant MCF-7 cells. METHODS: Resistant sublines were developed from sensitive cells by selective paclitaxel, docetaxel, and doxorubicin applications in dose increments. cDNA microarray analysis was performed for sensitive and resistant cells. Genes having statistically significantly altered expression levels more than two-folds compared to the sensitive MCF-7 cells were considered. Genes encoding the determinants of the EMT were evaluated. Immunostaining was performed for relevant protein expressions. RESULTS: Key elements of EMT were transcriptionally activated in paclitaxel, docetaxel and doxorubicin resistant sublines. One of the upregulated genes was Slug, a transcription factor of E-cadherin, occludin repression, and N-cadherin, vimentin activation. Decreased estrogen receptor-α (ER) levels in cells might have stimulated Slug expression. Increased expression levels of TGF-beta receptor2 (TGFBR2) together with SMAD3 might have stimulated EMT in resistant cells. Immunocytochemistry results confirmed loss of ER and E-cadherin, together with high vimentin levels. CONCLUSIONS: EMT was induced in multidrug resistant MCF-7 cells indicating a relationship of this process and drug resistance. However, the relationship of each specific component of EMT with drug resistance requires further analysis.

Relationships between epidemiological features and tumor characteristics of breast cancer.

OBJECTIVES: Breast cancer is a histological, morphological and molecular heterogenous disease. Like clinical outcomes and prognoses of different subtypes, etiologies might also be different. Therefore, epidemiologic risk factors like sociologic, demographic, antropometric, reproductive, and menstrual factors can be considered as an entity reflected in tumor features. This study was planned to explore the relation between well known risk factors of breast cancer and histological and molecular features of the tumor. MATERIALS AND METHODS: Epidemiologic data for 250 breast cancer patients followed-up by our clinic and 250 healthy individuals without any diagnosis of malignancy were obtained. The data displaying a relation to breast cancer are age, height, weight, body mass index (BMI), place of birth and province, educational level, menstrual status, age of menarche and menopause, number of births, age at first childbirth, family history of breast cancer, history of smoking and hormone treatment, mammographic screening, and presence of benign lesions. The tumor characteristics of patients in the breast cancer group were recorded. RESULTS: Advanced age, nulliparity, low educational level, irregular mammographic screening, early menarche and late menopause, and high BMI in postmenopausal period were found to be related to increased breast cancer risk. Striking results in terms of the relation between epidemiological factors and tumor features were the early diagnosis of breast cancer in patients with regular mammographic screening. Tumor size was decreased with increased age and increased with increased BMI. Advanced age, prolonged lactation, increased number of births, and high education level were found to decrease axillary involvement. CONCLUSIONS: Multiparity still continues to be the strongest protective factor against breast cancer in our society. The decrease in menarche age may be an early sign of the increased breast cancer incidence. Women should be informed about the relation between postmenopausal obesity and breast cancer and encouraged to attend physical activity and exercise programmes. Regular physical examination and mammographic screening are protective against breast cancer.

First report of a case with needle track sinus after aspiration biopsy of a benign thyroid nodule resulted in an unexpected postoperative complication.

Fine needle aspiration biopsy is the most feasible, safe, and accurate diagnostic tool for thyroid nodule diagnosis. The development of a sinus tract between thyroid gland and the skin through needle tract after fine needle aspiration biopsy is an extremely uncommon phenomenon. In this paper, a 71-year-old man presenting with a swelling and discharge on the anterior neck wall was reported. Similar complaints were present 15 to 20 days after fine needle aspiration biopsy of thyroid gland four years ago. Bilateral total thyroidectomy was performed considering a thyroid malignancy infiltrating the skin. Histopathologic examination confirmed a sinus tract between the thyroid gland and skin and thyroid nodule was benign in nature. It must be kept in mind that inflammatory reactions might also occur after fine needle aspiration biopsy of benign thyroid nodules. In patients with needle biopsy-related inflammation, surgery may be delayed until the inflammation subsides.

Anti-CENP-B antibodies are associated with prolonged survival in breast cancer.

AIMS: Presence of a relationship between autoimmunity and malignant diseases has been investigated for a long time. Anti-SS-B and anti-centromere protein (CENP)-B antibodies are used as serologic markers for autoimmune diseases. In this study, these autoantibodies were studied in breast cancer patients, and their effect on survival was evaluated. PATIENTS & METHODS: Breast cancer patients treated between January and June 2003 were prospectively included in this study. Antibodies were studied by ELISA, and serum values of greater than 10 U/ml were accepted as positive. RESULTS: In total, 55 patients with breast cancer were prospectively included in the study. Median follow-up time was 62 months. In univariate analysis, estrogen receptor status, anti-CENP-B antibody status and tumor size significantly affected disease-free survival, whereas overall survival was significantly dependent on tumor size and anti-CENP-B antibody status. In multivariate analysis, anti-CENP-B status was the independent prognostic factor for disease-free survival, whereas tumor size and anti-CENP-B status were independent prognostic factors for overall survival. CONCLUSION: Anti-CENP-B autoantibodies in breast cancer patients prolong disease-free and overall survival.

Central venous catheter-associated thrombosis in the perioperative period: a frequent complication in cancer patients that can be detected early with doppler examination.

AIMS AND BACKGROUND: The aim of the study was to determine the incidence of venous thrombosis in cancer patients with central venous catheters inserted perioperatively. METHODS AND STUDY DESIGN: A prospective analysis was performed with 68 patients in whom central venous catheters were placed perioperatively. Cancer patients with planned central venous catheters had prophylaxis with low-molecular-weight heparin. Patient characteristics, procedure-related complications and venous thrombosis related to central venous catheters were recorded. In order to detect the venous thrombosis, color Doppler sonography was used after removal of the central venous catheter. RESULTS: The median age of the 68 patients was 55 years (range, 24-83). The median duration of catheter placement in patients was 9 days (range, 1-24). Venous thrombosis was detected in 45 (66.2%) patients: at the superficial veins (jugular and subclavian veins) in 27 patients, stretching from superficial veins into the vena cava in 8 cases, in the vena cava in 2 cases, in the right atrium in 2 cases, and at more then one place in 6 patients. Total thrombosis was detected only in 3 patients. CONCLUSIONS: Cancer patients have a high central venous catheter-related thrombosis risk perioperatively despite prophylactic anticoagulation. Color Doppler sonography is a rapid and noninvasive technique and it is accurate in the diagnosis of venous thrombosis. Early detection of venous thrombosis is important to prevent the systemic and fatal complication of the thrombosis.