Bekir Kuru

The false-negative rate of fine-needle aspiration cytology for diagnosing thyroid carcinoma in thyroid nodules.

PurposeOur aim was to define the false-negative rate of fine-needle aspiration cytology (FNAC) for diagnosing thyroid carcinoma in thyroid nodules <4xa0cm versus ≥4xa0cm.Materials and methodsSix hundred sixty-two patients with thyroid nodules who underwent FNAC and surgery at our institution were analyzed. The association of predictive factors with thyroid carcinoma was evaluated. The sensitivity, specificity, and the false-negative rate of FNAC were calculated.ResultsThe incidence of thyroid carcinoma was significantly higher in nodules ≥4xa0cm (24%) compared with nodules <4xa0cm (12%). The false-negative rates of FNAC were 2% in all nodules and 1.3% and 4.3% in nodules <4xa0cm and ≥4xa0cm (pu2009=u20090.9), respectively. Sensitivity and specificity of FNAC were 90% and 79%, respectively.ConclusionsThe false-negative rate of FNAC is low for thyroid nodules <4xa0cm and for nodules ≥4xa0cm.

PREDICTIVE INDEX FOR CARCINOMA OF THYROID NODULES AND ITS INTEGRATION WITH FINE-NEEDLE ASPIRATION CYTOLOGY

The objective of this study was to select patients for resection of thyroid malignity among patients with thyroid nodules by integration of predictive indices with fine‐needle aspiration cytology (FNAC).

Single-incision laparoscopic cholecystectomy in a 6-month pregnant woman: a report of a case.

Aim We aimed to present a case of single-incision laparoscopic cholecystectomy (SILC) in a pregnant woman. Case A 27-year-old, 24-week pregnant woman was referred to our clinic with abdominal pain, nausea, and vomiting. Physical examination and laboratory tests showed that she had acute biliary pancreatitis. An obstetric consultation showed that the patient and the fetus were healthy. After medical treatment the patient was discharged. However, she was again referred to our clinic with a second pancreatitis attack. We examined the patient and recommended cholecystectomy. Preoperative tests were completed and a new obstetric consultation was requested. After the receipt of informed consent for cholecystectomy, SILC was performed. Conclusions SILC is a feasible surgical method in pregnant women as well.

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 Mayıs 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, 60xa0% were male and the median age was 61xa0years (18–92xa0years). The most frequent indication was admittance to the intensive care unit, accounting for 46xa0% of the total, followed by neurological disease, with 41xa0%. The success rate of the procedure was 98xa0%, and the overall rate of complications was 22xa0%. No mortalities were reported as resulting from the procedure. The most common complication was the development of granulomas around the tube (8xa0%). 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.

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.

Non-operative treatment approach for blunt splenic injury: is grade the unique criterion?

BACKGROUNDnWe aimed to investigate the results of a non-operative approach to blunt spleen injury to re-evaluate the importance of injury grade.nnnMETHODSnThirty-one blunt splenic trauma cases subjected to non-operative treatment were evaluated retrospectively. The patients were classified into two groups as isolated spleen trauma (ST) group and multi-trauma (MT) group. The hospitalization and blood replacement needs, success of non-operative follow-up, and post-traumatic complications were compared between the two groups. The patients were evaluated via follow-up abdominal ultrasonography (US) and computerized tomography (CT). The results were evaluated with regard to post-splenic trauma complications.nnnRESULTSnAccording to the organ injury scale of the American Association for the Surgery of Trauma, 25.8% were grade-1, 32.2% grade-2, 29% grade-3, and 12.9% grade-4 injuries. It was observed that the transfusion amount was directly proportional to the injury grade. All patients with grade-4 injury and 14 patients with MT were treated successfully with the non-operative method. Splenic pseudoaneurysm developed in one patient in the MT group. One patient was diagnosed with late splenic rupture.nnnCONCLUSIONnHemodynamic stability is the most important criterion for the indication of non-operative treatment. However, in well-selected cases, patients with grade 4 splenic traumas and those with extra-splenic injuries could also be treated successfully with the non-operative method.

Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category IV (FN/SFN)

Thyroid nodules diagnosed as Bethesda category IV [follicular neoplasm/suspicious for follicular neoplasm (FN/SFN)] are recommended for surgery. However, only 10%‐40% of these nodules turn out to be malignant on histopathological examination. Therefore, selection for surgery of nodules diagnosed as Bethesda category IV is important. We aimed to define predictive factors for malignancy and factors associated with triage to surgery.

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

ABSTRACT 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.

Factors Influencing the Decision on Surgery or Observation for Patients with Bethesda Category 3 (AUS/FLUS)

The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) proposes a repeated fine-needle aspiration (FNA) for nodules with atypia of undetermined significance or a follicular lesion of undetermined significance (AUS/FLUS) on the initial FNA. Cibas and Ali reported that to increase the diagnostic accuracy of the AUS/FLUS FNA category and to prevent unnecessary surgery, two approaches have been proposed. The recommended management is clinical correlation and a repeated FNA at an appropriate interval. In some cases, the physician may choose not to repeat the FNA but to observe the nodule clinically or, alternatively, to refer the patient for surgery because of concerning clinical and/or sonographic features. Thus, determination of sonographic features associated for surgery or observation is important. In their published article in the Annals of Surgical Oncology, Nagarkatti et al. reported that younger and male patients with Bethesda criteria for AUS/FLUS were more likely to go directly to surgery. They reported that ultrasound features such as micro-calcifications, irregular margins, and marked hypoechogenicity did not appear to influence the decision to observe the patients or refer them for surgery. The choice of surgery versus observation was primarily based on the patient’s gender, the clinical judgment of the endocrinologist and/or surgeon, and the patient’s preference. However, Nagarkatti et al. did not report the predictor factors for malignancy, which are important in differentiation for surgery or observation. In our series, among all the thyroid FNAs performed during the study period between 2011 and 2015 at our institution, 11.3% (370 of 3270) resulted in AUS/FLUS. Of the 370 patients classified as AUS/FLUS on the initial FNA, 137 underwent surgery and 233 did not undergo surgery. The percentage of patients who were young ( 45 years) and had a nodule size of 2 cm or larger was significantly higher among those who underwent surgery than among those who did not. Among the 137 patients who underwent surgery, the predictor factors for malignancy were microcalcifications, nodule smaller than 2 cm, solid structure, hypoechogenicity, irregular margin, and increased vascularity of the nodules. We found that sonographic features did not influence the choice for surgery. The causes for selection of older patients for observation could be comorbidity, patient preference, physician life expectancy or other reasons. However, nodule size smaller than 2 cm should not be a criterion for observation of patients with AUS//FLUS FNA. We support the findings of Nagarkatti et al. who reported that sonographic features of nodules did not influence the choice for surgery or observation, but that age significantly influenced the choice. We suggest that worrisome sonographic predictors of malignancy in patients with AUS/ FLUS FNA should be considered for surgery.The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) proposes a repeated fine-needle aspiration (FNA) for nodules with atypia of undetermined significance or a follicular lesion of undetermined significance (AUS/FLUS) on the initial FNA. Cibas and Ali reported that to increase the diagnostic accuracy of the AUS/FLUS FNA category and to prevent unnecessary surgery, two approaches have been proposed. The recommended management is clinical correlation and a repeated FNA at an appropriate interval. In some cases, the physician may choose not to repeat the FNA but to observe the nodule clinically or, alternatively, to refer the patient for surgery because of concerning clinical and/or sonographic features. Thus, determination of sonographic features associated for surgery or observation is important. In their published article in the Annals of Surgical Oncology, Nagarkatti et al. reported that younger and male patients with Bethesda criteria for AUS/FLUS were more likely to go directly to surgery. They reported that ultrasound features such as micro-calcifications, irregular margins, and marked hypoechogenicity did not appear to influence the decision to observe the patients or refer them for surgery. The choice of surgery versus observation was primarily based on the patient’s gender, the clinical judgment of the endocrinologist and/or surgeon, and the patient’s preference. However, Nagarkatti et al. did not report the predictor factors for malignancy, which are important in differentiation for surgery or observation. In our series, among all the thyroid FNAs performed during the study period between 2011 and 2015 at our institution, 11.3% (370 of 3270) resulted in AUS/FLUS. Of the 370 patients classified as AUS/FLUS on the initial FNA, 137 underwent surgery and 233 did not undergo surgery. The percentage of patients who were young ( 45 years) and had a nodule size of 2 cm or larger was significantly higher among those who underwent surgery than among those who did not. Among the 137 patients who underwent surgery, the predictor factors for malignancy were microcalcifications, nodule smaller than 2 cm, solid structure, hypoechogenicity, irregular margin, and increased vascularity of the nodules. We found that sonographic features did not influence the choice for surgery. The causes for selection of older patients for observation could be comorbidity, patient preference, physician life expectancy or other reasons. However, nodule size smaller than 2 cm should not be a criterion for observation of patients with AUS//FLUS FNA. We support the findings of Nagarkatti et al. who reported that sonographic features of nodules did not influence the choice for surgery or observation, but that age significantly influenced the choice. We suggest that worrisome sonographic predictors of malignancy in patients with AUS/ FLUS FNA should be considered for surgery.

A breast cancer nomogram for prediction of non–sentinel-node metastasis in patients with sentinel node metastasis and validations of the 14 models.

93 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 of the axillary non-SLNs 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.nnnMETHODSnTwo hundred and thirty seven invasive breast cancer patients with SLN metastases who underwent ALND were included in the present study. Based on the 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.nnnRESULTSnIn a multivariate analysis, tumor size, presence of lymphovascular invasion, extranodal extension of SLN, large size of metastatic SLN in mm, the number of negative SLNs, and the multifocality were found to be independent predictive factors for non-SLN metastasis. The AUC was found to be 0.87 which is the highest value reported to date for previous models, 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 9 Eylul models yielded excellent AUC values of > 0.80.nnnCONCLUSIONSnWe present a new model (the Ondokuz Mayis nomogram) 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. [Table: see text].