Mehmet Ferahman

Radioguided occult lesion localization (ROLL) for non-palpable breast cancer: A comparison between day-before and same-day protocols

BACKGROUND Although radioguided occult lesion localization (ROLL) has become a widely accepted technique, the optimal time interval between the radioisotope injection and surgery has not yet been determined. AIM To delineate the effects of time from the injection of the radionuclide until surgery on the ROLL success rate in a patient population diagnosed as having non-palpable breast cancer. METHODS Between December 2004 and May 2009, 75 patients underwent ROLL procedure. The day-before protocol and same-day protocols included 50 and 25 breast cancer patients respectively. RESULTS The two study groups were comparable in terms of age, localization technique, radiological findings and the type of surgical procedures (P > 0.05). No statistically significant difference was noticed in the pathological diagnosis, cancer size and the surgical margin clearance between the two groups (P > 0.05). CONCLUSIONS Same-day injection of the radiotracer was not superior to the day-before injection in ROLL. The day-before protocol can be scheduled for the convenience of both patients and hospital staff.

Zinc and copper status in acute pancreatitis: an experimental study.

Metal ions are required as active components of several proteins, including pancreatic enzymes, and they can play important roles in the etiopathogenesis of acute pancreatitis. In the present study, we measured the concentrations of zinc (Zn) and copper (Cu) in both serum and pancreatic tissue, as markers of trace element status in an experiental acute pancreatitis model. Twenty-four male Wistar rats were divided into two groups: the experimental group (N=24) and the control group (N=10). Acute pancreatitis was induced by injection of 48% ethyl alcohol into the common biliary duct. The animals were sacrificed 24 h later to detect the concentrations of Zn and Cu. There was no significant difference in tissue Zn and Cu concentrations between control and experimental groups (p<0.05). However, in the acute pancreatitis group, serum Zn and Cu levels were very significantly lower (p<0.001 and p<0.0001, respectively). In conclusuion, these findings suggested that altered mineral metabolism in serum and pancreatic tissue may have contributed to the pathophysiology of acute pancreatitis.

Bilateral idiopathic granulomatous mastitis.

OBJECTIVES Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory pseudotumor. Bilateral involvement of IGM has been reported in a few cases. To our knowledge, this study is the largest series of bilateral cases to date. The goals of this study were to present clinical features of bilateral IGM and to evaluate the results of treatments. MATERIALS AND METHODS We performed a retrospective review of the idiopathic granulomatous mastitis database from 2010 to 2013. Ten female patients who met required histologic and clinical criteria of IGM in both breasts were included in study. Demographic data, clinical findings, medication history, and radiologic findings are presented. RESULTS The mean age at onset of the disease was 38.4 ± 8.3 years (range: 29-52 years). Nine patients had no recurrence during a mean follow-up period of 21 months (range: 11-26 months). Additionally, the median time to second breast involvement was 15.6 months. CONCLUSION Bilateral IGMs have a higher rate of more relapse and greater resistance to medical therapies than do unilateral IGMs. Surgical management should be avoided unless all medical treatment options have been exhausted. Nevertheless, expectant management seems a rational option for the treatment of bilateral IGM.

Simultaneous excision of ipsilateral nonpalpable multiple breast lesions using radioguided occult lesion localization

The purpose of this study was to determine the feasibility and effectiveness of ROLL technique for the identification and excision of ipsilateral nonpalpable multiple breast lesions. Between August 2005 and August 2010, eight women, aged 40-61 years, with a radiographic evidence of two separate nonpalpable lesions within the same breast underwent ROLL, as we termed it, double-ROLL. Each lesion was localized with Tc-99m-labeled human serum albumin macroaggregate under ultrasonography or mamography control. A gamma probe was used to guide surgical excisions. There was no radiotracer overlapping or extravasation in any case. Out of the 16 resected specimens, histopathologic examination revealed benign findings in 13 lesions and malignancy in 3. There was no lesion involvement at the surgical margins, and no residuals were detected in any of the benign cases during follow-up. Double-ROLL technique is feasible and safe for the identification and excision of such multiple ipsilateral breast lesions.

Does Working Specifically As A Breast Surgeon Alter the Type of Surgery in Treating Breast Cancer

INTRODUCTION: Breast surgery is a subspeciality of general surgery. Improvements in this specific field have implemented to prefer less invasive procedures such as breast sparing surgery and sentinel lymph node biopsy (SLNB) instead of radical or modified radical surgery. OBJECTIVES: Our aim is to investigate the differences of preferred surgery between breast surgeons (BS) and non-breast surgeons (NBS). MATERIAL AND METHODS: Two hundred and thirty two patients that underwent breast surgery between January 2011 and December 2011 in Cerrahpasa Faculty of Medicine were included in this retrospective study. Surgeons were divided into two groups as breast surgeons (Group 1) and non-breast surgeons (Group 2). Diagnostic approach to a primary lesion, the proportion of breast sparing surgery, treatment of the axilla, and the number of immediate reconstructions were compared between the two groups. RESULTS: One hundred eighty patients were present in Group 1, and 52 patients were present in Group 2. The median age was 53, 5 (26-86) for Group 1 and 52, 3 (23-81) for Group 2. Diagnosing the primary lesion with frozen examination was 0 in Group 1, and 10 in Group 2 (19, 2%). Breast sparing surgery proportions were 46, 6% for Group 1 and 26, 9% for Group 2. The proportions of sentinel lymph node identification were 98, 8% (121/123) in Group 1 and 73, 3% (11/15) in Group 2. In Group 1, axillary dissection was only performed in clinically or pathologically axilla positive patients; whereas in Group 2, axillary dissection was performed without sentinel lymph node biopsy in 10 patients who were clinically axilla negative. The number of immediate reconstructions were 6 (6, 2%) in Group 1, and 1 (2, 6%) in Group 2. CONCLUSION: This study shows that modern techniques such as breast sparing surgery, sentinel lymph node biopsy, and immediate reconstructions have been more preferred by breast surgeons than non-breast surgeons. Therefore, we presume that surgeons who are working specifically in the breast prefer less invasive and more cosmetic procedures.