Publications by authors named "Fahrettin Kilic"

23 Publications

  • Page 1 of 1

Second Look Ultrasonography-Guided Breast Biopsy with Magnetic Resonance Imaging Confirmation by Intralesional Contrast Injection.

Eur J Breast Health 2021 Jan 24;17(1):1-9. Epub 2020 Dec 24.

Clinic of Radiology, Memorial Hospital, İstanbul, Turkey.

Objective: This study aimed to introduce an alternative pre-biopsy confirmation technique that combines sonography-guided intra-lesional contrast injections and single non-enhanced magnetic resonance imaging (MRI) pulse sequence in order to identify sonographic correlates of incidentally detected breast MRI lesions which were occult on primary ultrasonography (USG) and mammography examination.

Materials And Methods: From May 2014 through May 2015, a total of 37 incidental breast lesions of 37 patients, which were detected by breast MRI, were evaluated with targeted second look ultrasound (SLUS). The suspected lesion on USG was marked with a gadolinium-based contrast agent under USG guidance. After a single non-enhanced T1 weighted control MR sequence, positively correlated lesions with initial MRI were sampled by USG guided core biopsy.

Results: Of the 37 lesions evaluated, 32 (86%) lesions showed a correlation between MRI and SLUS findings. On SLUS core biopsy, there were eight (25%) malignant and 11 (34.4%) high-risk lesions among these 32 cases with correlated MRI findings; while the remaining 13 (40.6%) cases had benign histopathology. Eleven (34.4%) of the SLUS-discovered lesions were focus, 11 (34.4%) were non-mass enhancements, and the remaining 10 (31.2%) were mass lesions. Of the five lesions (13.5%) that showed no correlations on MRI and SLUS examinations, four were non-mass enhancements and one was focus.

Conclusion: SLUS represents a method for identifying MRI-detected lesions and provides a bridge to ultrasound-guided biopsy for histopathological diagnosis. There is a need for confirmation of biopsies to avoid false negative results. We describe a cheap, safe, and easy-to-apply USG-guided pre-biopsy lesions marking method in order to ensure definite correlation.
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http://dx.doi.org/10.5152/ejbh.2020.5663DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006787PMC
January 2021

In Vivo Evaluation of the Biomechanical Properties of Optic Nerve and Peripapillary Structures by Ultrasonic Shear Wave Elastography in Glaucoma.

Iran J Radiol 2016 Apr 31;13(2):e36849. Epub 2016 Mar 31.

Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

Background: Primary open-angle glaucoma is a multifactorial serious disease characterized by progressive retinal ganglion cell death and loss of visual field.

Objectives: The purposes of this study were to investigate shear wave elastography (SWE) use in the evaluation of the optic nerve (ON) and peripapillary structures, and to compare the findings between glaucomatous and control eyes.

Patients And Methods: A case-controlled study, including 21 patients with primary open-angle glaucoma and 21 age-matched control subjects, was carried out. All of the participants had comprehensive ophthalmological exams that included corneal biomechanical measurements with ocular response analyzer. In vivo evaluation of the biomechanical properties of the ON and peripapillary structures were performed with SWE in all participants. The Kolmogorov-Smirnov test was used to analyze the normal distribution of data. Differences of parameters in ophthalmologic data and stiffness values of patients with and without glaucoma were evaluated using the Mann-Whitney U test.

Results: There were no statistically significant differences between the glaucoma and control groups in terms of age (P > 0.05) and gender (P > 0.05). Corneal hysteresis was lower in the glaucoma group (P < 0.05). Corneal compensated intraocular pressure and Goldmann correlated intraocular pressure were higher in the glaucoma group (P < 0.0001 for both). The mean stiffness of the ON and peripapillary structures were significantly higher in glaucoma patients for each measured region (P < 0.05).

Conclusion: The study evaluated the biomechanical properties of the ON and peripapillary structures in vivo with SWE in glaucoma. We observed stiffer ON and peripapillary tissue in glaucomatous eyes, indicating that SWE claims new perspectives in the evaluation of ON and peripapillary structures in glaucoma disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039735PMC
http://dx.doi.org/10.5812/iranjradiol.36849DOI Listing
April 2016

Shear wave elastography of the placenta in patients with gestational diabetes mellitus.

J Obstet Gynaecol 2016 Jul 25;36(5):585-8. Epub 2016 Mar 25.

a Department of Obstetrics and Gynecology , Cerrahpasa School of Medicine, Istanbul University , Istanbul , Turkey and.

To evaluate placental elasticty in women with gestational diabetes mellitus (GDM) and non-diabetic controls. Thirty-three pregnant women with GDM according to the current criteria of the American Diabetes Association and 43 healthy pregnant women who were admitted to the antenatal clinic were recruited for this case-control study. Elasticity values of both the peripheral and the central parts of the placentas of the patients in both groups were determined by shear wave elastography (SWE) imaging. Mean elasticity values of both the central and the peripheral part of the placentas were significantly higher in GDM pregnancies (p < 0.001). No difference was observed in the mean elasticity values of the central and the peripheral part of the placentas in two groups (p > 0.05). SWE imaging technology might provide a quantitative assessment of the morphological pathologies of placentas in pregnant women with GDM.
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http://dx.doi.org/10.3109/01443615.2015.1110120DOI Listing
July 2016

Clinical Application of Six Current Classification Systems for Iatrogenic Bile Duct Injuries after Cholecystectomy.

Hepatogastroenterology 2015 May;62(139):577-84

Background/aims: Due to being a severe complication, iatrogenic bile duct injury is still a challenging issue for surgeons in gallbladder surgery. However, a commonly accepted classification describing the type of injury has not been available yet. This study aims to evaluate ability of six current classification systems to discriminate bile duct injury patterns.

Methodology: Twelve patients, who were referred to our clinic because of iatrogenic bile duct injury after laparoscopic cholecystectomy were reviewed retrospectively. We described type of injury for each patient according to current six different classifications.

Results: 9 patients underwent definitive biliary reconstruction. Bismuth, Strasberg-Bismuth, Stewart-Way and Neuhaus classifications do not consider vascular involvement, Siewert system does, but only for the tangential lesions without structural loss of duct and lesion with a structural defect of hepatic or common bile duct. Siewert, Neuhaus and Stewart-Way systems do not discriminate between lesions at or above bifurcation of the hepatic duct.

Conclusion: The Hannover classification may resolve the missing aspects of other systems by describing additional vascular involvement and location of the lesion at or above bifurcation.
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May 2015

Magnetic Resonance Imaging Guided Vacuum Assisted and Core Needle Biopsies.

J Breast Health 2016 Jan 1;12(1):25-30. Epub 2016 Jan 1.

Department of Radiology, İstanbul University Faculty of Medicine, İstanbul, Turkey.

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.
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http://dx.doi.org/10.5152/tjbh.2015.2769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351431PMC
January 2016

Magnetic Resonance Imaging of Non-Puerperal Complete Uterine Inversion.

Iran J Radiol 2015 Oct 5;12(4):e9878. Epub 2015 Aug 5.

Department of Obstetrics and Gynecology, Okmeydani Training and Research Hospital, Istanbul, Turkey.

Uterine inversion is shortly described as the indentation and depression of the fundic area extending downwards up to the different levels of the birth canal till vaginal opening. Clinical diagnosis of uterine inversion is difficult due to its non-specific symptoms and physical examination. Ultrasonography is the most practical modality for radiological evaluation, but it is inadequate to determine the exact nature of this condition and making the differential diagnosis. In this case, we present the main MRI findings of non-puerperal complete uterine inversion caused by a giant leiomyoma.
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http://dx.doi.org/10.5812/iranjradiol.9878v2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691525PMC
October 2015

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

J Ultrasound Med 2016 Feb 29;35(2):271-7. Epub 2015 Dec 29.

Departments of Radiology (F.K., S.G.K., A.S.D., M.E.E., F.K., M.H.Y.), General Surgery (M.V., F.A.), and Pathology (T.O.), Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

Objectives: 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.

Methods: Thirty patients with breast cancer scheduled for SLN dissection were enrolled prospectively after informed consent and Institutional Review Board approval were obtained. After dissection, lymph nodes were embedded in ultrasound gel and examined with grayscale sonography and shear wave elastography. Findings were compared to histopathologic results.

Results: A total of 64 SLNs obtained from the 30 patients were evaluated. Twelve of them (18.8%) were metastatic, and 52 (81.2%) were benign. The mean cortical thickness (benign versus metastatic, 1.6 versus 4.4 mm), short-axis length (4.63 versus 7.50 mm), cortical stiffness (10.7 versus 25.5 kPa), and hilar stiffness (7.5 versus 11.3 kPa) were statistically higher in metastatic lymph nodes (P ≤ .02). Area under the receiver operator characteristic curve values for these variables were 0.814, 0.768, 0.786, and 0.759, respectively. Cortical thickness was found to have the highest diagnostic performance, followed by cortical stiffness.

Conclusions: Shear wave elastography can be used with grayscale sonography for evaluation of cases to decide on needle biopsy sampling. However, it cannot be used as a replacement for fine-needle aspiration or SLN dissection.
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http://dx.doi.org/10.7863/ultra.15.03039DOI Listing
February 2016

Mobile Thoracolithiasis in a Patient With Lung Cancer.

Ann Thorac Surg 2015 Oct;100(4):1472

Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

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http://dx.doi.org/10.1016/j.athoracsur.2015.06.094DOI Listing
October 2015

A Rare Complication of the Thyroid Malignancies: Jugular Vein Invasion.

Pol J Radiol 2015 17;80:360-3. Epub 2015 Jul 17.

Department of Radiology, Cerrahpasa Medical Faculty, Istanbul, Turkey.

Background: Unilateral invasion of the internal jugular vein (IJV) after subtotal thyroidectomy caused by local recurrence of papillary thyroid carcinoma is extremely rare. We report a case of papillary thyroid carcinoma which invades IJV with hypervascular tumor thrombus.

Case Report: We report a case of a 52-year-old woman with a history of previous thyroid operation who presented with a 2-month history of a painless, growing, hard, solitary mass on the left side of the neck. Clinical examination revealed also ipsilateral cervical lymphadenopathy. Radiological examination showed a necrotic and cystic mass arising from the operated area extending and invading the left jugular vein wall with hypervascular tumor thrombus. Cytological examination of the mass confirmed a papillary thyroid carcinoma (PTC) and enlarged metastatic lymph nodes. Therefore, total thyroidectomy with left neck dissection and segmental resection of the left internal jugular vein were performed, and the tumor thrombus was cleared successfully.

Conclusions: Invasion of IJV with hypervascular tumor thrombosis is an extremely rare condition in papillary thyroid carcinoma. Thrombosis of IJV is probably underdiagnosed. Early-stage diagnosis is important for long-term survival rates.
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http://dx.doi.org/10.12659/PJR.894057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509426PMC
August 2015

Bilateral idiopathic granulomatous mastitis.

Asian J Surg 2016 Jan 2;39(1):12-20. Epub 2015 May 2.

Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. Electronic address:

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.
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http://dx.doi.org/10.1016/j.asjsur.2015.02.003DOI Listing
January 2016

Shear wave elastography of placenta: in vivo quantitation of placental elasticity in preeclampsia.

Diagn Interv Radiol 2015 May-Jun;21(3):202-7

Department of Radiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey.

Purpose: We aimed to evaluate the utility of shear wave elastography (SWE) for assessing the placenta in preeclampsia disease.

Methods: A total of 50 pregnant women in the second or third trimester (23 preeclampsia patients and 27 healthy control subjects) were enrolled in the study. Obstetrical grayscale and Doppler ultrasonography, SWE findings of placenta, and prenatal/postnatal clinical data were analyzed and the best SWE cutoff value which represents the diagnosis of preeclampsia was determined. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of preeclampsia were calculated based on SWE measurements.

Results: Mean stiffness values were much higher in preeclamptic placentas in all regions and layers than in normal controls. The most significant difference was observed in the central placental area facing the fetus where the umbilical cord inserts, with a median of 21 kPa (range, 3-71 kPa) for preeclampsia and 4 kPa (range, 1.5-14 kPa) for the control group (P < 0.01). The SWE data showed a moderate correlation with the uterine artery resistivity and pulsatility indices. The cutoff value maximizing the accuracy of diagnosis was 7.35 kPa (area under curve, 0.895; 95% confidence interval, 0.791-0.998); sensitivity, specificity, PPV, NPV, and accuracy were 90%, 86%, 82%, 92%, and 88%, respectively.

Conclusion: Stiffness of the placenta is significantly higher in patients with preeclampsia. SWE appears to be an assistive diagnostic technique for placenta evaluation in preeclampsia.
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http://dx.doi.org/10.5152/dir.2014.14338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463268PMC
February 2016

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

Eur J Radiol 2015 Jun 16;84(6):1044-8. Epub 2015 Mar 16.

Istanbul University Cerrahpasa Medical Faculty, Department of Radiology, Turkey.

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). Pillai's 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.
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http://dx.doi.org/10.1016/j.ejrad.2015.03.006DOI Listing
June 2015

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

J Breast Cancer 2014 Jun 27;17(2):180-3. Epub 2014 Jun 27.

Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

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.
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http://dx.doi.org/10.4048/jbc.2014.17.2.180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090322PMC
June 2014

The impact of share wave elastography in differentiation of hepatic hemangioma from malignant liver tumors in pediatric population.

Eur J Radiol 2014 Sep 13;83(9):1691-7. Epub 2014 Jun 13.

Department of Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University, 34300, Kocamustafapasa, Istanbul, Turkey. Electronic address:

Objective: In children it is crucial to differentiate malignant liver tumors from the most common benign tumor, hepatic hemangiomas since the treatment strategies are quite different. We aimed to evaluate the efficiency of shear wave elastography (SWE) technique in differentiation of malignant hepatic tumors and hepatic hemangiomas.

Methods: Twenty patients with hepatic tumor were included in our study. Two radiologists performed SWE for 13 patients with malignant hepatic tumors including hepatoblastoma (n=7), hepatocellular carcinoma (n=3), metastasis (n=2), embryonal sarcoma (n=1) and 7 patients with hepatic hemangioma. All of our patients were between the age of 1 and 192 months (mean age: 56.88 months). Receiver operating characteristic analysis was achieved to evaluate the diagnostic accuracy of SWE and to determine the optimal cut-off value in differentiation hepatic hemangioma from malignant hepatic tumors.

Results: The mean SWE values (in kPa) for the first observer were 46.94 (13.8-145) and 22.38 (6.6-49.6) and those for the second observer were 57.91 (11-237) and 23.87 (6.4-57.5), respectively for malignant hepatic tumors and hepatic hemangiomas. The SWE values of malignant hepatic tumors were significantly higher than those of hepatic hemangioma (p=0.02). The inter-observer agreement was almost perfect (0.81). The area under the receiver operating characteristic curve of SWE for differentiating the hepatic hemangioma from malignant hepatic tumors was 0.77 with a sensitivity of 72.7% and a specificity of 66.7% at a cutoff value of 23.62 with 95% confidence interval.

Conclusion: Shear wave elastography can be helpful in differentiation of malignant hepatic tumors and hepatic hemangioma.
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http://dx.doi.org/10.1016/j.ejrad.2014.06.002DOI Listing
September 2014

Corticosteroid treatment in the management of idiopathic granulomatous mastitis to avoid unnecessary surgery.

Surg Today 2015 Apr 4;45(4):457-65. Epub 2014 Jul 4.

Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Purpose: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It can mimic breast carcinoma clinically and radiologically, and usually affects females of childbearing age. There is no commonly accepted optimal treatment for IGM. In this study, we present the clinical and histopathological features and outcomes of the therapeutic management of IGM, as well as the clinical course of the disease when patients were treated with oral corticosteroids.

Methods: This retrospective study included 49 of 87 patients who met the required histological criteria for IGM who were followed up between January 2009 and December 2011. All patients had a disease-free follow-up period of at least 6 months. The data regarding the clinical features at presentation, laboratory values and the treatment modalities were obtained from the medical records of the patients.

Results: The mean age of the patients was 34.3 ± 4.37 years. Forty patients were treated with prednisolone, five were started on antituberculosis treatment, two received non-steroidal anti-inflammatory drugs, one received antibiotics and one underwent wide excision. All patients who received steroids responded well to the therapy.

Conclusion: Systemic therapy with corticosteroids is an effective and appropriate treatment option for IGM. It can provide complete disease resolution and prevent recurrence in the long term. A multidisciplinary approach including specialists in the fields of both general surgery and infectious diseases is essential for the diagnosis, treatment and follow-up of IGM.
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http://dx.doi.org/10.1007/s00595-014-0966-5DOI Listing
April 2015

Relative proportions of stromal to cellular components of pleomorphic adenomas: determination with shear wave elastography.

J Ultrasound Med 2014 Mar;33(3):503-8

Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Kocamustafapasa, 34300 Istanbul, Turkey.

Objectives: The purpose of this study was to evaluate whether the relative proportions of stromal to cellular components of pleomorphic adenomas have an effect on the shear elastic modulus determined by shear wave elastography (SWE).

Methods: This study was approved by the Ethics Committee of our institution and performed between September 2011 and December 2012. Thirty-five patients who underwent surgery for a parotid mass were included in the study. The maximum shear elastic modulus of the mass was measured by SWE. Pleomorphic adenomas were histopathologically subdivided into stroma-poor, intermediate-stroma, and stroma-rich tumors based on the relative proportion of stromal to cellular components.

Results: The maximum shear elastic modulus values of the pleomorphic adenomas ranged from 12.6 to 291.9 kPa (mean ± SD, 120.9 ± 92.8 kPa). The Friedman test revealed a statistically significant relationship between the stromal amount and maximum shear elastic modulus (P < .001). Stroma-poor adenomas (mean, 32.3 ± 27.7 kPa; range, 12.6-81.1 kPa) were softer on SWE than stroma-rich adenomas (mean, 174.1 ± 48.4 kPa; range, 92.7-217.2 kPa; P = .009). No such significant difference was detected between stroma-poor and intermediate-stroma tumors (mean, 146.3 ± 106.1 kPa; range, 19.1-291.9 kPa; P = .062) or between intermediate-stroma and stroma-rich tumors (P = .465).

Conclusions: Shear wave elastography depicts pleomorphic adenomas with a variable appearance, which is due to the relative proportions of stromal to cellular contents in the tumors.
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http://dx.doi.org/10.7863/ultra.33.3.503DOI Listing
March 2014

Use of shear wave elastography to differentiate benign and malignant breast lesions.

Diagn Interv Radiol 2014 May-Jun;20(3):239-44

From the Departments of Radiology İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.

Purpose: We aimed to determine the correlations between the elasticity values of solid breast masses and histopathological findings to define cutoff elasticity values differentiating malignant from benign lesions.

Materials And Methods: A total of 115 solid breast lesions of 109 consecutive patients were evaluated prospectively using shear wave elastography (SWE). Two orthogonal elastographic images of each lesion were obtained. Minimum, mean, and maximum elasticity values were calculated in regions of interest placed over the stiffest areas on the two images; we also calculated mass/fat elasticity ratios. Correlation of elastographic measurements with histopathological results were studied.

Results: Eighty-three benign and thirty-two malignant lesions were histopathologically diagnosed. The minimum, mean, and maximum elasticity values, and the mass/fat elasticity ratios of malignant lesions, were significantly higher than those of benign lesions. The cutoff value was 45.7 kPa for mean elasticity (sensitivity, 96%; specificity, 95%), 54.3 kPa for maximum elasticity (sensitivity, 95%; specificity, 94%), 37.1 kPa for minimum elasticity (sensitivity, 96%; specificity, 95%), and 4.6 for the mass/fat elasticity ratio (sensitivity, 97%; specificity, 95%).

Conclusion: SWE yields additional valuable quantitative data to ultrasonographic examination on solid breast lesions. SWE may serve as a complementary tool for diagnosis of breast lesions. Long-term clinical studies are required to accurately select lesions requiring biopsy.
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http://dx.doi.org/10.5152/dir.2014.13306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463348PMC
July 2015

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

Ulus Cerrahi Derg 2014 1;30(1):54-6. Epub 2014 Mar 1.

Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.

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.
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http://dx.doi.org/10.5152/UCD.2014.2450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379782PMC
May 2015

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

Expert Rev Med Devices 2014 Jan 22;11(1):53-63. Epub 2013 Nov 22.

Department of General Surgery, Istanbul University, Cerrahpasa Medical Faculty, Cerrahpasa Tip Fakultesi, Genel Cerrahi AD 34098 Fatih/Istanbul, Turkey.

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.
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http://dx.doi.org/10.1586/17434440.2014.864233DOI Listing
January 2014

The management and the diagnosis of fever of unknown origin.

Expert Rev Anti Infect Ther 2013 Aug;11(8):805-15

Infectious Diseases Department, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.

Prolonged fever presents a challenge for the patient and the physician. Fever with a temperature higher than 38.3°C on several occasions that lasts for at least 3 weeks and lacks a clear diagnosis after 1 week of study in the hospital is called a fever of unknown origin (FUO). More than 200 diseases can cause FUO, and the information gathered from history taking, physical examination, laboratory and imaging studies should be evaluated with care. History taking and physical examination may provide some localizing signs and symptoms pointing toward a diagnosis. Infection, cancers, noninfectious inflammatory diseases and some miscellaneous diseases are the main etiologies, and some patients remain undiagnosed despite investigations. Tuberculosis, lymphoma and adult-onset Still's disease are the main diseases. Fluorodeoxyglucose PET is a promising imaging modality in FUO. Establishing a uniform algorithm for FUO management is difficult. Every patient should be carefully evaluated individually considering the previous FUO management experience.
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http://dx.doi.org/10.1586/14787210.2013.814436DOI Listing
August 2013

Diagnostic magnetic resonance imaging of the breast.

Eurasian J Med 2012 Aug;44(2):106-14

Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Contrast enhanced breast magnetic resonance imaging is a modality that is frequently used into the breast radiologist's daily clinical practice. MRI examination should have optimal technical proficiency in order to attain diagnostic quality avoiding false positive and negative diagnoses. Furthermore, due to increasing usage fields of the examinations uniting with high sensitivity phenomenon, excessive usage and excision/interventional procedures are inevitable. Therefore, we hope to highlight the appropriate usage of the MRI technique and it's clinical applications.
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http://dx.doi.org/10.5152/eajm.2012.24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4261287PMC
August 2012

Symptomatic unilateral submandibular gland aplasia associated with ipsilateral sublingual gland hypertrophy.

Dysphagia 2010 Mar 16;25(1):70-2. Epub 2009 Jun 16.

Department of Otorhinolaryngology, Istanbul University, Istanbul, Turkey.

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http://dx.doi.org/10.1007/s00455-009-9238-8DOI Listing
March 2010

Radiological evaluation with Doppler sonography and multidetector CT angiography in congenital hepatic arteriovenous malformation in a newborn.

Pediatr Radiol 2006 Nov 14;36(11):1204-7. Epub 2006 Sep 14.

Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, 34303 Kocamustafapaşa, Istanbul, Turkey.

Although hepatic arteriovenous malformations are rarely reported, they frequently have life-threatening complications such as cardiac failure and are associated with a high mortality rate. Consequently, accurate prenatal and early postnatal diagnosis is important and therapeutic procedures depend on the imaging features. We report the early postnatal sonographic, Doppler sonographic, multidetector CT and CT angiography findings of a congenital hepatic arteriovenous malformation in a newborn.
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http://dx.doi.org/10.1007/s00247-006-0285-0DOI Listing
November 2006
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