Mehmet Velidedeoglu

Ex Vivo Assessment of Sentinel Lymph Nodes in Breast Cancer Using Shear Wave Elastography.

Axillary lymph node status is one of the important prognostic factors in early‐stage breast cancer. Despite the combined use of sonography, fine‐needle aspiration, and sentinel lymph node (SLN) dissection, there is a gap between the potential effectiveness of those techniques and current success to determine the axillary lymph node status. The main aim of this study was to evaluate the baseline accuracy of shear wave elastography for differentiation of benign versus malignant SLNs in an ex vivo artifact‐free environment.

Radio-guided localization of clinically occult breast lesions: current modalities and future directions

The extensive availability of breast cancer screening programs and improvement in diagnostic imaging have led to more frequent detection of suspicious and clinically occult breast lesions. Early detection of tumor is important for breast-conserving treatment. Incomplete excision is a major risk factor for local recurrence. Following precise localization and removing the entire lesion while achieving adequate clear margins is the key factor for successful management of non-palpable breast lesions. For this purpose, several techniques such as wire-guided localization, intra-operative ultrasound guided resection, radio-guided occult lesion localization and radioactive seed localization have been described and applied. In this article, we overview the two commonly used localization techniques, radio-guided occult lesion localization and wire-guided localization, particularly describing their advantages and drawbacks.

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.

Changes in the elasticity of fibroadenoma during the menstrual cycle determined by real-time sonoelastography

OBJECTIVE Shear-wave elastography (SWE) presents quantitative data that thought to represent intrinsic features of the target tissue. Factors affecting the metabolism of the breast parenchyma as well as age, menstrual cycle, hormone levels, pregnancy and lactation, pre-compression artifact during the examination could affect these elastic intrinsic features. Aim of our study is to determine variation of fibroadenoma elasticity during the menstrual cycle (MC) by means of real-time shear-wave elastography (SWE) and identify the optimal time for SWE evaluation. METHODS Thirty volunteers (aged 20-40 years) who had biopsy-proven fibroadenoma greater than 1cm in diameter, with regular menstrual cycle and without contraceptive medication underwent SWE (ShearWave on Aixplorer, France) once weekly during MC. Statistical data were processed by using the software Statistical Package for the Social Sciences (SPSS) 19.0. A repeated measures analysis of variance was used for each lesion where the repeated factor was the elastographic measurements (premenstrual, menstrual and postmenstrual). Pillais trace test was used. Pairwise correlation was calculated using Bonferroni correction. Values of p<0.05 were considered statistically significant. RESULTS The mean elasticity value of fibroadenomas in mid-cycle was 28.49 ± 12.92 kPa, with the highest value obtained in the third week corresponding to the premenstrual stage (32.98 ± 13.35 kPa) and the lowest value obtained in the first week corresponding to the postmenstrual stage (25.39 ± 10.21 kPa). Differences between the elasticity values of fibroadenomas in premenstrual and postmenstrual periods were statistically significant (p<0.001). There were no significant differences in lesion size between the different phases of the menstrual cycle (p>0.05). CONCLUSION In this study, we found that there is significant difference between the elasticity values of fibroadenomas on premenstrual and postmenstrual period. We propose that one week after menstruation would be appropriate time to perform breast SWE.

A case report of primary breast angiosarcoma causing hemorrhagic shock in pregnancy.

Angiosarcoma is a rare breast tumor. In contrary to other breast tumors, primary breast angiosarcomas are seen in the third and fourth decades. Clinically, they present as rapidly growing masses. They can also be seen during pregnancy. The aim of this article is to report on a primary breast angiosarcoma case that occured during pregnancy and resulted in hemorrhagic shock.

Ductal Carcinoma In Situ Detected by Shear Wave Elastography within a Fibroadenoma.

Fibroadenoma is the most common breast tumor in women. Malignant transformation occurs rarely within fibroadenoma at older ages. Clinicians, radiologists, and pathologists need to be aware of malignant transformation within fibroadenomas. Radiologic studies play an important role in the diagnosis of fibroadenoma; however, radiologic findings are often nonspecific for malignancy and may appear completely benign. We detected an occult ductal carcinoma in situ that originated inside a fibroadenoma by using shear wave elastography. We report shear wave elastography findings of ductal carcinoma in situ within fibroadenoma and discuss the diagnostic role of this modality.

Is it necessary to perform prophylactic cholecystectomy for all symptomatic gallbladder polyps diagnosed with ultrasound

OBJECTIVE The main aim of this study is to determine the necessity of cholecystectomy in patients with ultrasound diagnosed symptomatic polypoid lesions of the gallbladder. MATERIAL AND METHODS The data of 82 patients with polypoid lesions of the gallbladder who had cholecystectomy between 2000 and 2012 were analyzed retrospectively with preoperative ultrasound and histopathology results. RESULTS The mean age was 48.05±11.18 years (range 25-74 years). All patients underwent preoperative ultrasound examination. Eighteen (22%) of the 82 patients were asymptomatic; their polypoid lesions of the gallbladder were detected with ultrasound during a check-up or other reasons. In 45 (55%) of cases pathology reported no polypoid lesions of the gallbladder. Right upper quadrant or epigastric pain was the most common symptom (41.46%) that led to hepatobiliary ultrasound, the other symptom was dyspepsia (36.59%). On preoperative ultrasound evaluation, 22 patients had multiple polyps, and 9 of these 22 patients had at least 3 polyps. CONCLUSION There is an inaccuracy of ultrasound to detect polypoid lesions of the gallbladder. After diagnosing polypoid lesions of the gallbladder by using standard ultrasound, further pre-operative diagnostic tests are needed to help discriminating benign lesions from malignant ones, which may prevent unnecessary surgery regardless of symptoms.

Sentinel lymph node biopsy under fluorescent indocyanin green guidance: Initial experience

Amac: Meme kanserinde sentinel lenf nodu biyopsisi, mavi boya, radyoizotop yontemi veya her iki yontem kom- bine edilerek yapilabilmektedir. Indosiyanin yesili kullanilarak yapilan floresan goruntuleme ise yeni tanimlanan bir metottur. Bu calisma floresan isikla goruntulenen indosiyanin yesili rehberliginde yapilan sentinel lenf nodu biyopsisinin uygulanabilirligini degerlendirmektedir. Gerec ve Yontemler: Goruntuler icin kizil otesini gosteren IC-VIEW sistemi (Pulsion Medical Systems AG, Munih, Almanya) kullanildi. Sentinel lenf nodlarinin goruntulenmesi icin 2 mL indosiyanin yesili enjeksiyonu yapildi. Enjek- siyon sonrasi es zamanli goruntu ile subkutan lenfatikler takip edilerek sentinel lenf nodlarina ulasildi. Floresan isik rehberliginde sentinel lenf nodlari eksize edilerek histopatolojik inceleme yapildi. Sentinel lenf nodunda metastaz saptanan hastalara aksiller diseksiyon yapildi. Bulgular: Calismada meme kanseri nedeniyle sentinel lenf nodu biyopsisi yapilan dort hasta yer aldi. Indosiyanin yesili ile tum hastalarda sentinel lenf nodlari goruntulendi. Indosiyanin yesili ile eksize edilen ortanca sentinel lenf nodu sayisi 2 (2-3) olarak bulundu. Lenf nodu metastazi saptanan iki hastaya aksiller diseksiyon yapildi. Aksiller di- seksiyon yapilan hastalarin sentinel disindaki lenf nodlarinda metastaz gorulmedi. Ameliyat sirasinda ve sonrasinda metoda bagli komplikasyon gorulmedi. Sonuc: Sinirli tecrubemize gore es zamanli goruntuleme avantajina sahip olan indosiyanin yesili rehberliginde yapi- lan sentinel lenf nodu biyopsisi teknik olarak uygulanabilir gorulmektedir. Anahtar Kelimeler: Floresan isik, indosiyanin yesili, sentinel lenf nodu biyopsisi Objective: Sentinel lymph node biopsy can be applied by using either blue dye or radionuclide method or both in breast cancer. Fluorescent imaging with indocyanine green is a new defined method. This study evaluates the applicability of sentinel lymph node biopsy via fluorescent indocyanine green. Material and Methods: IC-VIEW (Pulsion Medical Systems AG, Munich, Germany) infrared visualization system was used for imaging. Two mL of indocyanine green was injected to visualize sentinel lymph nodes. After injection, subcutaneous lymphatics were traced and sentinel lymph nodes were found with simultaneous imaging. Sentinel lymph nodes were excised under fluorescent light guidance, and excised lymph nodes were examined histopatholo- gically. Patients with sentinel lymph node metastases underwent axillary dissection. Results: Four patients with sentinel lymph node biopsy due to breast cancer were included in the study. Sentinel lymph nodes were visualized with indocyanine green in all patients. The median number of excised sentinel lymph node was 2 (2-3). Two patients with lymph node metastasis underwent axillary dissection. No metastasis was detec- ted in lymph nodes other than the sentinel nodes in patients with axillary dissection. There was no complication during and after the operation related to the method. ABSTRACT Ulus Cerrahi Derg 2016; 32: 50-53OBJECTIVE Sentinel lymph node biopsy can be applied by using either blue dye or radionuclide method or both in breast cancer. Fluorescent imaging with indocyanine green is a new defined method. This study evaluates the applicability of sentinel lymph node biopsy via fluorescent indocyanine green. MATERIAL AND METHODS IC-VIEW (Pulsion Medical Systems AG, Munich, Germany) infrared visualization system was used for imaging. Two mL of indocyanine green was injected to visualize sentinel lymph nodes. After injection, subcutaneous lymphatics were traced and sentinel lymph nodes were found with simultaneous imaging. Sentinel lymph nodes were excised under fluorescent light guidance, and excised lymph nodes were examined histopathologically. Patients with sentinel lymph node metastases underwent axillary dissection. RESULTS Four patients with sentinel lymph node biopsy due to breast cancer were included in the study. Sentinel lymph nodes were visualized with indocyanine green in all patients. The median number of excised sentinel lymph node was 2 (2-3). Two patients with lymph node metastasis underwent axillary dissection. No metastasis was detected in lymph nodes other than the sentinel nodes in patients with axillary dissection. There was no complication during and after the operation related to the method. CONCLUSION According to our limited experience, sentinel lymph node biopsy under fluorescent indocyanine green guidance, which has an advantage of simultaneous visualization, is technically feasible.

Floresan işikla görüntülenen indosiyanin yeşili rehberliğinde sentinel lenf nodu biyopsisi: İlk deneyimimiz

Amac: Meme kanserinde sentinel lenf nodu biyopsisi, mavi boya, radyoizotop yontemi veya her iki yontem kom- bine edilerek yapilabilmektedir. Indosiyanin yesili kullanilarak yapilan floresan goruntuleme ise yeni tanimlanan bir metottur. Bu calisma floresan isikla goruntulenen indosiyanin yesili rehberliginde yapilan sentinel lenf nodu biyopsisinin uygulanabilirligini degerlendirmektedir. Gerec ve Yontemler: Goruntuler icin kizil otesini gosteren IC-VIEW sistemi (Pulsion Medical Systems AG, Munih, Almanya) kullanildi. Sentinel lenf nodlarinin goruntulenmesi icin 2 mL indosiyanin yesili enjeksiyonu yapildi. Enjek- siyon sonrasi es zamanli goruntu ile subkutan lenfatikler takip edilerek sentinel lenf nodlarina ulasildi. Floresan isik rehberliginde sentinel lenf nodlari eksize edilerek histopatolojik inceleme yapildi. Sentinel lenf nodunda metastaz saptanan hastalara aksiller diseksiyon yapildi. Bulgular: Calismada meme kanseri nedeniyle sentinel lenf nodu biyopsisi yapilan dort hasta yer aldi. Indosiyanin yesili ile tum hastalarda sentinel lenf nodlari goruntulendi. Indosiyanin yesili ile eksize edilen ortanca sentinel lenf nodu sayisi 2 (2-3) olarak bulundu. Lenf nodu metastazi saptanan iki hastaya aksiller diseksiyon yapildi. Aksiller di- seksiyon yapilan hastalarin sentinel disindaki lenf nodlarinda metastaz gorulmedi. Ameliyat sirasinda ve sonrasinda metoda bagli komplikasyon gorulmedi. Sonuc: Sinirli tecrubemize gore es zamanli goruntuleme avantajina sahip olan indosiyanin yesili rehberliginde yapi- lan sentinel lenf nodu biyopsisi teknik olarak uygulanabilir gorulmektedir. Anahtar Kelimeler: Floresan isik, indosiyanin yesili, sentinel lenf nodu biyopsisi Objective: Sentinel lymph node biopsy can be applied by using either blue dye or radionuclide method or both in breast cancer. Fluorescent imaging with indocyanine green is a new defined method. This study evaluates the applicability of sentinel lymph node biopsy via fluorescent indocyanine green. Material and Methods: IC-VIEW (Pulsion Medical Systems AG, Munich, Germany) infrared visualization system was used for imaging. Two mL of indocyanine green was injected to visualize sentinel lymph nodes. After injection, subcutaneous lymphatics were traced and sentinel lymph nodes were found with simultaneous imaging. Sentinel lymph nodes were excised under fluorescent light guidance, and excised lymph nodes were examined histopatholo- gically. Patients with sentinel lymph node metastases underwent axillary dissection. Results: Four patients with sentinel lymph node biopsy due to breast cancer were included in the study. Sentinel lymph nodes were visualized with indocyanine green in all patients. The median number of excised sentinel lymph node was 2 (2-3). Two patients with lymph node metastasis underwent axillary dissection. No metastasis was detec- ted in lymph nodes other than the sentinel nodes in patients with axillary dissection. There was no complication during and after the operation related to the method. ABSTRACT Ulus Cerrahi Derg 2016; 32: 50-53OBJECTIVE Sentinel lymph node biopsy can be applied by using either blue dye or radionuclide method or both in breast cancer. Fluorescent imaging with indocyanine green is a new defined method. This study evaluates the applicability of sentinel lymph node biopsy via fluorescent indocyanine green. MATERIAL AND METHODS IC-VIEW (Pulsion Medical Systems AG, Munich, Germany) infrared visualization system was used for imaging. Two mL of indocyanine green was injected to visualize sentinel lymph nodes. After injection, subcutaneous lymphatics were traced and sentinel lymph nodes were found with simultaneous imaging. Sentinel lymph nodes were excised under fluorescent light guidance, and excised lymph nodes were examined histopathologically. Patients with sentinel lymph node metastases underwent axillary dissection. RESULTS Four patients with sentinel lymph node biopsy due to breast cancer were included in the study. Sentinel lymph nodes were visualized with indocyanine green in all patients. The median number of excised sentinel lymph node was 2 (2-3). Two patients with lymph node metastasis underwent axillary dissection. No metastasis was detected in lymph nodes other than the sentinel nodes in patients with axillary dissection. There was no complication during and after the operation related to the method. CONCLUSION According to our limited experience, sentinel lymph node biopsy under fluorescent indocyanine green guidance, which has an advantage of simultaneous visualization, is technically feasible.

Magnetic Resonance Imaging Guided Vacuum Assisted and Core Needle Biopsies

OBJECTIVE The purpose of this study to present the results of Magnetic resonance imaging (MRI) guided cutting needle biopsy procedures of suspicious breast lesions that can be solely detected on Magnetic resonance (MR) examination. MATERIALS AND METHODS The study included 48 patients with 48 lesions which were solely be observed in breast MRI, indistinguishable in ultrasonography and mammography, for MR guided vacuum-assisted cutting needle biopsy and 42 patients with 42 lesions for MR guided cutting needle biopsy for the lesions of the same nature. MR imaging was performed using a 1.5-Tesla MRI device. Acquired MR images were determined and biopsy protocol was performed using computer-aided diagnosis system on the workstation. Vacuum biopsies were performed using 10 G or 12 G automatic biopsy systems, cutting needle biopsy procedures were performed using fully automated 12 G biopsy needle. RESULTS All biopsy procedures were finalized successfully without major complications. The lesions were 54 mass (60%), 28 were non-mass contrast enhancement (31%) and 8 were foci (9%) in the MR examination. Histopathological evaluation revealed 18 malignant (invasive, in-situ ductal carcinoma and lobular carcinoma), 66 benign (apocrine metaplasia, fibrosis, fibroadenomatoid lesion, sclerosing adenosis, fibrocystic disease and mild-to-severe epithelial proliferation) and 6 high-risk (atypical ductal hyperplasia, intraductal papilloma, radial scar) lesions. CONCLUSION Magnetic resonance guided vacuum and cutting needle biopsy methods are successful methods fort he evaluation of solely MRI detected suspicious breast lesions. There are several advantages relative to each other in both methods.