Publications by authors named "Mustafa Tukenmez"

33 Publications

The Effect of Primary Surgery in Patients with De Novo Stage IV Breast Cancer with Bone Metastasis Only (Protocol BOMET MF 14-01): A Multi-Center, Prospective Registry Study.

Ann Surg Oncol 2021 Feb 2. Epub 2021 Feb 2.

Department of Food and Engineering, Faculty of Engineering, Izmir Institute of Technology, Izmir, Turkey.

Background: More evidence shows that primary surgery for de novo metastatic breast cancer (BC) prolongs overall survival (OS) in selected cases. The aim of this study was to evaluate the role of locoregional treatment (LRT) in BC patients with de novo stage IV bone only metastasis (BOM).

Methods: The prospective, multicenter registry study BOMET MF14-01 was initiated in May 2014. Patients with de novo stage IV BOM BC were divided into two groups: those receiving systemic treatment (ST group) and those receiving LRT (LRT group). Patients who received LRT were further divided into two groups: ST after LRT (LRT + ST group) and ST before LRT (ST + LRT group).

Results: We included 505 patients in this study; 240 (47.5%) patients in the ST group and 265 (52.5%) in the LRT group. One hundred and thirteen patients (26.3%) died in the 34-month median follow-up, 85 (35.4%) in the ST group and 28 (10.5%) in LRT group. Local progression was observed in 39 (16.2%) of the patients in the ST group and 18 (6.7%) in the LRT group (p = 0.001). Hazard of death was 60% lower in the LRT group compared with the ST group (HR 0.40, 95% CI 0.30-0.54, p < 0.0001).

Conclusion: In this prospectively maintained registry study, we found that LRT prolonged survival and decreased locoregional recurrence in the median 3-year follow-up. Timing of primary breast surgery either at diagnosis or after ST provided a survival benefit similar to ST alone in de novo stage IV BOM BC patients.
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http://dx.doi.org/10.1245/s10434-021-09621-8DOI Listing
February 2021

Comparison between body composition parameters and response to neoadjuvant chemotherapy by using pre-treatment PET CT in locally advanced breast cancer.

Eur J Radiol Open 2020 19;7:100286. Epub 2020 Nov 19.

Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34390, Capa, Turkey.

Purpose: To compare the adipose and muscle tissue areas in patients who responded differently to neoadjuvant chemotherapy.

Methods: One hundred and eighty six patients diagnosed with breast cancer who underwent neoadjuvant chemotherapy between January 2015- October 2019 and were operated after the treatment were retrospectively included in the study. Pathological results were divided into five groups using the Miller-Payne grading systems. Grade 1 indicating no significant reduction in malignant cells; Grade 2: a minor loss of malignant cells (≤ 30 %); Grade 3: reduction in malignant cells between 30 % and 90 %; Grade 4: disappearance of malignant cells >90 %; Grade 5: no malignant cells identifiable. Pre-treatment PET CT scans were evaluated, and calculation of body composition parameters were performed on a single axial section passing through the L3 vertebrae. Spearman's correlation test was used to analyze the correlation between SAT, VAT, MT parameters and pathological responses.

Results: There was no strong correlation between the 5 groups separated according to neoadjuvant chemotherapy treatment response and tissue distributions. However, that there was a very low correlation found between superficial adipose tissue and pathological response (r=, 156).

Conclusion: In conclusion, our results have provided a very low correlation between SAT and more than 30 % response. More research is required to evaluate the role of the body fat and muscle parameters in response to neoadjuvant chemotherapy in larger patient populations.
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http://dx.doi.org/10.1016/j.ejro.2020.100286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689395PMC
November 2020

Survival Outcomes for Patients With Clinical Complete Response After Neoadjuvant Chemotherapy: Is Omitting Surgery an Option?

Ann Surg Oncol 2019 Oct 24;26(10):3260-3268. Epub 2019 Jul 24.

Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.

Background: Surgery after neoadjuvant chemotherapy (NCT) is an accepted treatment approach for locally advanced and some early-stage breast cancers, even for patients with a clinical complete response (cCR) after NCT. This study sought to evaluate the survival outcomes for patients with cCR to NCT who did not undergo surgery.

Methods: The National Cancer Data Base (NCDB) was used to identify 93,417 women age 18 years or older with a diagnosis of invasive breast cancer who received NCT between 2010 and 2015. The study identified 350 women with cT1-4, N0-3, and M0 tumors who underwent NCT and did not have surgery. A matched surgical cohort was extracted from the NCDB, and overall survival (OS) was compared between the surgical and nonsurgical patients after NCT.

Results: Of the 350 NCT patients who did not undergo surgery, 45 (12.9%) had cCR, 51 (14.6%) had a partial response, 241 (68.9%) had a response but whether complete or partial was not recorded, and 13 (3.7%) had no response/progression. The 5-year OS was better in the cCR group than in the no-cCR group (96.8% vs 69.8%; p = 0.004). A 5-year OS analysis of the cCR patients without surgery (n = 45; median follow-up period, 37 months) compared with the patients with a pathologic complete response who underwent surgery (n = 3938; median follow-up period, 43 months) showed no statistically significant difference (96.8% vs 92.5%, respectively; p = 0.15).

Conclusion: This retrospective cohort study demonstrated that active surveillance or de-escalation therapy may be an option for patients who achieve cCR. Prospective studies are underway to determine whether a subgroup of patients may forgo surgery in the setting of cCR after NCT.
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http://dx.doi.org/10.1245/s10434-019-07534-1DOI Listing
October 2019

Our 20-Year Institutional Experience with Surgical Approach for Breast Hamartomas.

Eur J Breast Health 2019 Jul 1;15(3):171-175. Epub 2019 Jul 1.

Department of General Surgery, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey.

Objective: Hamartomas are rare, slowly-growing breast tumours. Clinical, radiological and histopathological examination together increase the diagnostic accuracy. To evaluate the clinicopathologic features of hamartomas and outline our clinical approach to hamartomas in our 20-year experience at our Breast Clinic.

Materials And Methods: Between 1995 and 2015, 24 cases were retrospectively analyzed with a diagnosis of breast hamartoma at our Breast Clinic followed by excisional biopsy. Data was obtained on patient demographics, clinical examination, radiological findings and histopathological subtypes.

Results: Of 1338 benign breast tumours excised from January 1995 to January 2015, 24 (1.8%) were identified as breast hamartoma. Median age of patients was 42 (range, 13-70), whereas the median tumour size was 5 cm (1-10 cm). On preoperative imaging, hamartoma was most commonly misdiagnosed as fibroadenoma. Pathological examination of the 24 biopsy specimens revealed 3 cases with pseudoangiomatous stromal hyperplasia, and another hamartoma associated with a radial scar within the centre of the lesion. Of those, one patient was diagnosed with malignant phylloides tumour in the same breast. At a median follow-up 58.4 months, none of the patients recurred or developed malignancy.

Conclusion: Hamartomas can often be missed by clinicians, due to its benign nature which is poorly understood. Despite their slow growth, hamartomas can reach large sizes and can cause breast asymmetry. Although it is rare, hamartoma can be seen along with malignancy, as it is formed from similar components of breast tissue. Therefore, careful diagnosis and appropriate management including surgery are required.
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http://dx.doi.org/10.5152/ejbh.2019.4624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619774PMC
July 2019

Is laparoscopic splenectomy safe in patients with immune thrombocytopenic purpura and very low platelet count? A single-institution experience.

Ann Ital Chir 2019 ;90:417-420

Purpose: Minimal invasive procedures has become increasingly popular during the last decades. The aim of this retrospective study was to evaluate the safety and feasibility of laparoscopic splenectomy in patients with immune thrombocytopenic purpura who has very low platelet counts.

Methods: Between March 28, 2005 and June 08, 2013, a total of 132 patients with the diagnosis of immune thrombocytopenic purpura were included to study. The patients who underwent laparoscopic splenectomy were alienated into two groups according to their platelet counts lower than 10000 (group 1) and higher than 10000 (group 2) RESULTS: There were 16 patients in group 1 with very low platelet counts, and 116 in group 2. One patient in group 1 had converted to laparotomy due to peroperative bleeding, and there were 5 conversion to open in group 2. There were also 2 patients in group 2 who underwent laparatomy on post operative day 1 due to delayed intra-abdominal bleeding. Moreover, one patient in each group had pancreatic fistula.

Conclusions: Laparoscopic splenectomy is a safe technique in patients with ITP even the patients have very low platelet counts.

Key Words: ITP, Laparoscopy, Low platelet count, Splenectomy.
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May 2020

Intraoperative palpation of sentinel lymph nodes can accurately predict axilla in early breast cancer.

Breast J 2019 01 12;25(1):96-102. Epub 2018 Nov 12.

Department of General Surgery, Breast Unit, Istanbul University Istanbul Faculty of Medicine, Topkapi, Istanbul, Turkey.

Recent randomized trials have shown that completion axillary lymph node dissection (ALND) is not required in all patients with a positive sentinel lymph node (SLN) who will receive radiation therapy. Although routine intraoperative pathologic assessment (IPA) becomes unnecessary and less indicated by breast surgeons in the United States and some European countries, it is still widely used all around the world. In this prospective study, the feasibility of intraoperative nodal palpation (INP) as opposed to IPA of the SLN has been analyzed. Between March 2014 and June 2015, 305 patients with clinical T1-2/N0 breast cancer from two different breast clinics (cohort A; [n = 225] and cohort B; [n = 80]) who underwent any breast surgery with sentinel lymph node biopsy (SLNB) were included in this study. Surgeons evaluated the SLNs by manual palpation before sending for IPA, and findings compared with the final pathology. The positive predictive values (PPV) of INP and IPA were 81.8% and 97.9%, respectively, whereas the negative predictive values (NPV) of INP and IPA were 83% and 92.4%. The accuracies of INP and IPA were 82.6% and 94.1%, respectively. If patients with SLNB including micrometastasis were also considered in the final pathologic assessment (FPA) (-) group that would not require a further axillary dissection, the revised NPV of INP and FPA were found to be 92.6% and 98.1%, respectively. The revised accuracy of INP also found to be increase to 86.9%. Our study, which is the only prospective one about palpation of dissected SLNs in the literature, suggests that INP can help to identify patients who do not need ALND, which encourages omitting IPA in cT1-2 N0 breast cancer.
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http://dx.doi.org/10.1111/tbj.13149DOI Listing
January 2019

Favorable Long-Term Outcome in Male Breast Cancer.

Eur J Breast Health 2018 Jul 1;14(3):180-185. Epub 2018 Jul 1.

Department of General Surgery, Istanbul University, Istanbul School of Medicine, İstanbul, Turkey.

Objective: Male breast cancer (MBC) is a rare type of cancer in the breast cancer series and in the male population. Data is usually extrapolated from female breast cancer (FBC) studies. We aim to study the clinicopathological characteristics and outcome of MBC patients at our institution and we aim to emphasize the differences compared with FBC.

Materials And Methods: Between January 1993 and April 2016, 56 male patients who were diagnosed as breast cancer and underwent surgical operation were retrospectively analyzed. Patients were evaluated for demographical characteristics, surgery type, clinicopathological characteristics, adjuvant and neoadjuvant treatments, follow-up time, overall survival (OS), disease free survival (DFS), and disease specific survival (DSS).

Results: The ratio of MBC among all breast cancers at our institution is 1%. The median age was 64 (34-85). Surgical procedures were modified radical mastectomy (MRM) in 41 patients (77%), simple mastectomy in 11 patients (21%), and lumpectomy in 1 patient (2%). Two patients were Stage 0 (4%), 7 were Stage 1 (13%), 12 were Stage 2 (22.6%), and 32 were Stage 3 (60.4%). Molecular subtypes of the invasive tumors were luminal A in 40 (80%), luminal B in 6 (12%), HER-2 type in 1 (2%), and basal-like in 3 (6%). Median follow-up time was 77 (3-287) months. 5-year and 10-year OS, DFS, and DSS rates were 80.7%, 96%, 95.6% and 71.6%, 81.9%, 91.7% respectively.

Conclusion: MBC presents different clinicopathological and prognostic factors when compared to FBC. Our survival rates are higher than the average presented in available literature. Because of the high rate of hormone receptor positivity, hormonal therapy is the mainstay for the treatment of estrogen receptor (ER)+ male breast cancer.
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http://dx.doi.org/10.5152/ejbh.2018.3946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092152PMC
July 2018

Improved False-Negative Rates with Intraoperative Identification of Clipped Nodes in Patients Undergoing Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy.

Ann Surg Oncol 2018 Oct 5;25(10):3030-3036. Epub 2018 Jul 5.

Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Millet cad. Çapa Fatih, Istanbul, 34390, Turkey.

Background: Identification and resection of a clipped node was shown to decrease the false-negative rate (FNR) of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) for patients presenting with initially node-positive breast cancer.

Methods: Between March 2014 and March 2016, a prospective trial analyzed 98 patients with axilla-positive locally advanced breast cancer (T1-4, N1-3) to assess the feasibility and efficacy of placing clips into most suspicious biopsy-proven node. The study considered blue, radioisotope active, and suspiciously palpable nodes as sentinel lymph nodes (SLNs).

Results: The SLN identification rate was 87.8%. The median age of the patients with an SLNB (n = 86) was 44 years (range 28-66 years). Of these patients, 77 (88.4%) had cT1-3 disease, and 10 (11.6%) had cT4 disease. The majority of the patients (n = 66, 76.7%) had cN1, whereas 21 patients (23.3%) had cN2 and cN3. A combined method was used for 37 patients (43%), whereas blue dye alone was used for the remaining patients (57%). The clipped node was the SLN in 70 patients (81.4%). For the patients with cN1 before NAC, the FNR was found to be 4.2% (1/24) when the clipped node was identified as an SLN. However, the FNR was estimated to be as high as 16.7% (1/6) for the patients with cN1 before NAC when the clipped node was found to be a non-SLN.

Conclusions: The study results also suggest that axillary dissection could be omitted for patients presenting initially with N1 disease and with a negative clipped node as the SLN after NAC due to the low FNR.
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http://dx.doi.org/10.1245/s10434-018-6575-6DOI Listing
October 2018

Surgeon Variability and Factors Predicting for Reoperation Following Breast-Conserving Surgery.

Ann Surg Oncol 2018 Sep 21;25(9):2573-2578. Epub 2018 May 21.

Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.

Background: Reoperation after breast-conserving surgery (BCS) is common and has been partially associated with the lack of consensus on margin definition. We sought to investigate factors associated with reoperations and variation in reoperation rates across breast surgeons at our cancer center.

Methods: Retrospective analyses of patients with clinical stage I-II breast cancer who underwent BCS between January and December 2014 were conducted prior to the recommendation of 'no ink on tumor' margin. Patient demographics and tumor and surgical data were extracted from medical records. A multivariate regression model was used to identify factors associated with reoperation.

Results: Overall, 490 patients with stage I (n  = 408) and stage II (n  = 89) breast cancer underwent BCS; seven patients had bilateral breast cancer and underwent bilateral BCS procedures. Median invasive tumor size was 1.1 cm, reoperation rate was 22.9% (n  = 114) and varied among surgeons (range 15-40%), and, in 100 (88%) patients, the second procedure was re-excision, followed by unilateral mastectomy (n  = 7, 6%) and bilateral mastectomy (n  = 7, 6%). Intraoperative margin techniques (global cavity or targeted shaves) were utilized in 50.1% of cases, while no specific margin technique was utilized in 49.9% of cases. Median total specimen size was 65.8 cm (range 24.5-156.0). In the adjusted model, patients with multifocal disease were more likely to undergo reoperation [odds ratio (OR) 5.78, 95% confidence interval (CI) 2.17-15.42]. In addition, two surgeons were found to have significantly higher reoperation rates (OR 6.41, 95% CI 1.94-21.22; OR 3.41, 95% CI 1.07-10.85).

Conclusions: Examination of BCS demonstrated variability in reoperation rates and margin practices among our breast surgeons. Future trials should look at surgeon-specific factors that may predict for reoperations.
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http://dx.doi.org/10.1245/s10434-018-6526-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6264913PMC
September 2018

Favorable Outcome with Close Margins in Patients Undergoing Nipple/Skin Sparing Mastectomy with Immediate Breast Reconstruction: 5-year Follow-up.

Balkan Med J 2018 01 29;35(1):84-92. Epub 2017 Sep 29.

Department of General Surgery, Breast Unit, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.

Background: Implant-based breast reconstruction after mastectomy has recently been reported to be the preferred type of surgery among breast-specific surgeons and plastic surgeons.

Aims: To explore the significant clinicopathological factors associated with long-term outcome related to local recurrences of the nipple among patients who underwent immediate breast reconstruction with tissue expander or implant after mastectomy.

Study Design: Retrospective cohort.

Methods: From January 2007 to January 2013, 51 breast cancer patients who underwent immediate breast reconstruction with tissue expander or implant were retrospectively analysed. Patients' demographic data, clinicopathological characteristics, and clinical outcome by disease-free survival and disease-specific survival analyses were determined.

Results: The median follow-up was 64 (31-114) months. Of the 57 mastectomies, 41 were skin sparing mastectomy (72%) and 16 were nipple-areola sparing mastectomy (28%). Immediate breast reconstruction surgery included tissue expander (n=46, 81%) or implant (n=11, 19%) placement. The molecular subgroups of 47 invasive cancers were as follows: luminal A (n=23, 49%), luminal B (n=16, 34%), non-luminal HER2 (n=5, 10.6), triple negative breast cancer (n=3, 6.4%). The 5-years disease-specific survival, disease-free survival, and locoregional recurrence-free survival rates were 96.8%, 90%, and 97.6% respectively. Patients with luminal A cancer were found to have an improved 5-year disease-free survival time than other (luminal A; 100% vs. non-luminal A; 78%; p=0.028). Of the 14 nipple-areola sparing mastectomy, 13 had a close median tumour distance to nipple-areola complex (<20 mm) with a 5-year locoregional recurrence free survival of 100%.

Conclusion: Immediate breast reconstruction with implant or tissue expander can be safely applied in patients undergoing skin sparing mastectomy or nipple-areola sparing mastectomy. Patients with luminal-A type show the most favourable outcome. During the 5-year follow-up period, patients even with close margins (<20 mm) to nipple-areola complex with nipple-areola sparing mastectomy have excellent locoregional and overall survival when treated by contemporary multidisciplinary oncological management.
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http://dx.doi.org/10.4274/balkanmedj.2017.0029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820453PMC
January 2018

Factors Associated With Delays in Chemotherapy Initiation Among Patients With Breast Cancer at a Comprehensive Cancer Center.

J Natl Compr Canc Netw 2016 12;14(12):1519-1526

From Department of Medical Oncology and Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts; Oncoclinicas, Sao Paulo, Brazil; Department of General Surgery, Istanbul Medical School, Istanbul, Turkey; and Department of Surgery, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.

Background: National guidelines endorse time-dependent quality metrics for breast cancer care. We examined factors associated with delays in chemotherapy initiation at an NCI-Designated Comprehensive Cancer Center.

Patients And Methods: We identified 523 patients who received postoperative adjuvant chemotherapy between January 2011 and December 2013 at our center. We defined 28 days from last definitive surgery (LDS) to chemotherapy as the target time frame, and an unacceptable delay in chemotherapy initiation (UCD) as greater than 42 days from LDS. Multivariate regression models were used to identify factors associated with UCD and the impact of Oncotype DX testing in patients with hormone receptor (HR)-positive breast cancer.

Results: Median days between LDS and chemotherapy initiation was 34 (interquartile range, 15), with 30% of patients starting within 28 days of LDS and 26.9% having UCD. Tumor characteristics such as subtype and stage affected UCD; patients with HR-positive or HER2-positive tumors were more likely to be delayed compared with those with triple-negative breast cancer. Patients with stage I disease, those undergoing mastectomy with or without immediate reconstruction, and those whose pathology sign-out was greater than 10 days postoperatively were more likely to be delayed. A higher proportion of UCD was found in HR-positive patients (31%) for whom Oncotype DX testing was ordered compared with those in whom it was not ordered (20%).

Conclusions: This study provides insight into subpopulations that may be at risk to experience delays in chemotherapy initiation, directing interventions to improve the timeliness of care.
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http://dx.doi.org/10.6004/jnccn.2016.0163DOI Listing
December 2016

A low cost training phantom model for radio-guided localization techniques in occult breast lesions.

J Surg Oncol 2015 Sep 6;112(4):449-51. Epub 2015 Aug 6.

Women's Cancer Center, Dana-Farber/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Radio-guided localization (RGL) for identifying occult breast lesions has been widely accepted as an alternative technique to other localization methods, including those using wire guidance. An appropriate phantom model would be an invaluable tool for practitioners interested in learning the technique of RGL prior to clinical application. The aim of this study was to devise an inexpensive and reproducible training phantom model for RGL. We developed a simple RGL phantom model imitating an occult breast lesion from inexpensive supplies including a pimento olive, a green pea and a turkey breast. The phantom was constructed for a total cost of less than $20 and prepared in approximately 10 min. After the first model's construction, we constructed approximately 25 additional models and demonstrated that the model design was easily reproducible. The RGL phantom is a time- and cost-effective model that accurately simulates the RGL technique for non-palpable breast lesions. Future studies are warranted to further validate this model as an effective teaching tool.
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http://dx.doi.org/10.1002/jso.23984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4583351PMC
September 2015

Safety and feasibility of laparoscopic adrenalectomy: What is the role of tumour size? A single institution experience.

J Minim Access Surg 2015 Jul-Sep;11(3):184-6

Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Background: Although, there are studies in the literature having shown the feasibility and safety of laparoscopic adrenalectomy, there are still debates for tumour size and the requirement of the minimal invasive approach. Our hypothesis was that the use of laparoscopy facilitates minimally invasive resection of large adrenal tumours regardless of tumour size.

Materials And Methods: Within 7 years, 149 patients underwent laparoscopic adrenalectomy at one institution. The patients were divided into two study groups according to tumour size. Group 1 included patients with adrenal tumours smaller than 5 cm and group 2 included larger than 5 cm. Patient demographics and clinical parameters, operative time, complications, hospital stay and final pathology were analysed. Statistical analyses of clinical and perioperative parameters were performed using Student's t-test and Chi-square tests.

Results: There were 88 patients in group 1 and 70 in group 2. There were no significant differences between study groups regarding patient demographics, operative time, hospital stay, and complications. Estimated blood loss was significantly higher in group 2 (P = 0.002). The conversion to open rate was similar between study groups with 5.6% versus 4.2%, respectively. Pathology was similar between groups.

Conclusion: Our study shows that the use laparoscopy for adrenal tumours larger than 5 cm is a safe and feasible technique. Laparoscopic adrenalectomy is our preferred minimally invasive surgical approach for removing large adrenal tumours.
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http://dx.doi.org/10.4103/0972-9941.144091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499923PMC
July 2015

Comparison of single port and three port laparoscopic splenectomy in patients with immune thrombocytopenic purpura: Clinical comparative study.

J Minim Access Surg 2015 Jul-Sep;11(3):172-6

Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Aim: Single-port laparoscopic surgery (SILS) has become increasingly popular during the last decades. This prospective study was undertaken to evaluate the feasibility of single-port laparoscopic splenectomy compared with conventional multiport laparoscopic splenectomy.

Materials And Methods: Between February 2, 2009 and August 29, 2011, a total of 40 patients with the diagnosis of immune thrombocytopenic purpura were included to study. Patients were alienated into two groups according to the procedure type including SILS and conventional multiport splenectomy.

Results: There were 19 patients in group 1, and 21 in group 2. Operative time was significantly shorter in group 1 versus group 2 (112.4 ± 13.56 vs 71.2 ±18.1 minutes, respectively, P < 0.05). One patient in group 1 had converted to laparatomy due to preoperative bleeding. Postoperative pain analyses (VAS Score) revealed superiority of SILS in the early post-operative days (P < 0.05).

Conclusions: SILS splenectomy is a safe and effective alternative to standard laparoscopic splenectomy.
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http://dx.doi.org/10.4103/0972-9941.159853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499921PMC
July 2015

Can Steroids plus Surgery Become a First-Line Treatment of Idiopathic Granulomatous Mastitis?

Breast Care (Basel) 2014 Oct;9(5):338-42

Surgical Oncology Unit, Institute of Oncology, Istanbul University, Turkey.

Background: The aim of this study is to compare the clinical course of idiopathic granulomatous mastitis (IGM) treated with low-dose oral corticosteroid therapy alone as opposed to treatment with low-dose corticosteroid therapy followed by surgery.

Patients And Methods: 37 patients were treated with an approach that consisted of methylprednisolone at a dose of 0.5 mg/kg/day followed by wide excision, and 23 patients were treated with an approach that consisted only of methylprednisolone. The treatment efficacy was compared between the two groups.

Results: Clinical and radiological regression was reported in all patients with steroid therapy, and the regression rate had a median of 75% (25-100%). No recurrence was observed in patients who were treated with wide surgical excision after steroid therapy during the median follow-up period of 38 (22-78) months. The control group of 23 patients was treated only with steroid therapy, and 7 (30%) of these patients experienced recurrence in the follow-up period (p < 0.001).

Conclusions: Steroid therapy was effective in the treatment of IGM by reducing the lesion size and extent. With regard to the current treatment options available for IGM, surgical excision after steroid therapy seems the better treatment option compared to steroid therapy without surgical excision. This treatment sequence reduces the rate of recurrence.
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http://dx.doi.org/10.1159/000366437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322692PMC
October 2014

Comparison of the histopathology and prognosis of bilateral versus unilateral multifocal multicentric breast cancers.

World J Surg Oncol 2014 Aug 20;12:266. Epub 2014 Aug 20.

Department of General Surgery, Bezmialem Vakif University, Istanbul Adnan Menderes Bulvarı Vatan Caddesi, 34093 Fatih/İstanbul, Turkey.

Background: Multiple breast cancers may present with different clinical and biological characteristics. The data indicate that multifocal (MF), multicentric (MC), and bilateral synchronous (BS) breast cancers (BC) are more aggressive and have an equivalent or moderately poorer survival rate compared with unilateral cases. However, a comparison of these multiple breast cancers has not been covered in the literature. The aim of this study was to describe the histopathological characteristics of patients suffering from MF, MC, and BS breast carcinoma and to compare their prognoses.

Methods: Retrospective data for MF, MC, and BS breast carcinoma patients treated in five different breast cancer units in Turkey between 2003 and 2012 were collected. MF and MC cancers were defined as more than one lesion in the same quadrant or in separate quadrants, respectively.

Results: There were 507 patients (271 MF, 147 MC, and 89 BS) treated in this time period. BS breast carcinoma patients were younger than the other groups (44.83 ± 9.6, 47.27 ± 11.6, and 51.11 ± 11.8 years for BS, MF, and MC breast carcinoma patients, respectively). MFBC and MCBC patients in this study were younger than the ages reported in Western literature, but this result was similar to the ages reported in Eastern literature. The five-year survival rates and recurrence rates were not statistically different among groups (P = 0.996 and P = 0.263, respectively). According to univariate analyses, tumor size, histological grade, and lymph node status were statistically significant factors that affected survival. However, only lymph node involvement was significant for survival according to multivariate analyses.

Conclusions: The clinical significance of MF, MC, and BS breast cancers is still unclear and their influence on prognosis is controversial. Disease-free and overall survival rates of BS breast cancers might be similar to MF and MC breast cancers.
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http://dx.doi.org/10.1186/1477-7819-12-266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247688PMC
August 2014

Fibroadenomatosis involving bilateral breasts and axillary accessory breast tissues in a renal transplant recipient given cyclosporin A.

J Clin Ultrasound 2014 Oct 6;42(8):495-7. Epub 2014 Aug 6.

Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, 34390, Capa, Istanbul, Turkey.

We present the mammographic and sonographic findings in a case of fibroadenomatosis involving both breasts and axillae in a renal transplant patient after 16 years of treatment with cyclosporin A. Awareness of the fact that cyclosporin A may induce the formation of fibroadenomas, including in accessory breast tissue, is important for correct diagnosis and preventing unnecessary intervention.
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http://dx.doi.org/10.1002/jcu.22220DOI Listing
October 2014

Abundant circulating microRNAs in breast cancer patients fluctuate considerably during neoadjuvant chemotherapy.

Oncol Lett 2014 Aug 28;8(2):845-848. Epub 2014 May 28.

Department of Clinical Oncology, Oncology Institute, Istanbul University, Istanbul 34093, Turkey.

Previous studies have revealed the aberrant expression of a number of microRNAs (miRNA/miRs) in the blood circulation of patients with breast cancer (BC). The aim of the present study was to assess the effect of neoadjuvant chemotherapy on the levels of a panel of BC-associated miRNAs, which are at relatively low (let-7, miR-10b, miR-34, miR-155, miR-200c and miR-205) or abundant (miR-21, miR-195 and miR-221) levels in the circulation. Patients with primary operable or locally advanced BC were enrolled in the study. The plasma levels of the miRNAs at baseline and at the fourth cycle of treatment were compared. Patients with stage II disease exhibited higher basal miRNAs levels than those with higher stages. The difference was most evident for miR-155 and miR-21 (P=0.05). From the initial to the fourth cycle of chemotherapy, the miRNA levels changed substantially. In samples in which the miRNA levels generally declined, a marked decrease (≤15,500-fold) was evident for the abundant miRNAs. Notably, the occurrence of a decrease in miRNA levels was more frequent in patients with smaller tumor sizes (P<0.05 for miR-21 and miR-195). This proof-of-concept study provides evidence that highly expressed miRNAs are affected most frequently by chemotherapy, particularly in patients with early stage tumors. This information may be valuable in assessing the response of the patients to therapy.
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http://dx.doi.org/10.3892/ol.2014.2188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081437PMC
August 2014

Crystallized phenol treatment of pilonidal disease improves quality of life.

Indian J Surg 2014 Feb 29;76(1):81-4. Epub 2012 Jun 29.

Kayseri Training and Teaching Hospital, Radiology Clinic, Kayseri, Turkey.

The effects of crystallized phenol treatment of pilonidal sinus on quality of life has not been investigated before. This study aimed to compare the phenol treatment with surgical excision plus primary closure technique in terms of life quality by means of a life quality questionnaire. This is a prospective randomized clinical study. The study was conducted at Training and Teaching Hospital, Kayseri, Turkey. In total, 40 patients with pilonidal disease were randomly assigned into 2 clinically comparable groups between September 2010 and June 2011. Cristallyzed phenol application was done to 20 patients and surgical excision plus primary closure was done to 20 patients for the treatment of pilonidal disease. Data regarding demographic variables were recorded. To evaluate quality of life and patient comfort all patients asked to fill the questionnaire after complete healing occurred. There was no difference between the groups in age, sex and occupation. Two of the 20 patients in the excision and primary closure group had complication of wound dehiscience and needed prolonged wound care. There was significant differences in favor of the phenol group in all terms of life quality except for complete healing time. As a first degree treatment, phenol treatment is better than the other treatment choices of pilonidal disease in terms of time off work perioperative pain, being away from school and social life. Also phenol treatment can be done without any pretreatment laboratory examination. Further studies will be needed about cost-effectivity of phenol treatment.
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http://dx.doi.org/10.1007/s12262-012-0610-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006000PMC
February 2014

Videoendoscopic single-port nipple-sparing mastectomy and immediate reconstruction.

J Laparoendosc Adv Surg Tech A 2014 Feb 8;24(2):77-82. Epub 2014 Jan 8.

1 Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .

Purpose: Single-incision videoendoscopic surgery has recently become popular as a result of the ongoing search for less invasive procedures. The aim of this study was to evaluate the safety and efficacy of endoscopic single-port nipple-sparing mastectomy, axillary lymphadenectomy, and immediate reconstruction in patients with breast cancer.

Patients And Methods: From May 14, 2012 through January 23, 2013, 10 patients underwent videoendoscopic single-port nipple-sparing mastectomy and axillary dissection via a single, limited incision and immediate prosthetic reconstruction. Patient charts were reviewed, and demographic data, operative time, complications and pathology results were analyzed.

Results: In all patients, videoendoscopic surgery was performed successfully. Of 10 patients, 7 were diagnosed as having invasive ductal carcinoma, 2 had a ductal carcinoma in situ, and 1 underwent bilateral prophylactic mastectomy. The weight of the resected gland was 300-650 g, with a mean of 420 g. There were no operative complications, and the mean operative time was 250 minutes (range, 160-330 minutes). One-stage reconstruction with implants was performed on 4 patients, whereas expanders were placed in the remaining 6. Surgical margins of all cases were pathologically negative, and there were no recurrences observed during the early follow-up period.

Conclusions: Videoendoscopic single-port nipple-sparing mastectomy is technically feasible even in larger breasts, enabling immediate reconstruction with good cosmetic outcomes. However, further studies with larger clinical series and long-term follow-up are required to compare the safety and efficacy of the technique with those of the standard nipple-sparing mastectomy.
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http://dx.doi.org/10.1089/lap.2013.0172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935461PMC
February 2014

Laparoscopic surgery of the splenic artery and vein aneurysm with spontaneous arteriovenous fistula.

Surg Laparosc Endosc Percutan Tech 2013 Jun;23(3):e127-30

Department of General Surgery, İstanbul Medical Faculty, İstanbul University, İstanbul, Turkey.

Visceral artery aneurysms are rare and important vascular entities due to the quarter of all cases presented as surgical emergency. Nevertheless, splenic artery aneurysm (SAA) is the most common visceral and third most common intra-abdominal artery aneurysm after aorta and iliac artery. SAA accompany splenic vein aneurysm because arteriovenous fistula communication between them is a very rare entity. Location and size of the SAA determine the likelihood of rupture. Women of child-bearing age who have SAAs are at particularly high risk of death as a result of aneurysm rupture and should be treated with elective repair. Herein, we report a case of a splenic artery and vein aneurysm with arteriovenous fistula in a 25-year-old young female patient who presented with left upper quadrant pain. Diagnosis was established by computerized tomography angiogram. The patient underwent laparoscopic resection of splenic artery and vein, as well as with splenectomy. Laparoscopic therapy for SAA should be considered for the patient with a low periprocedural morbidity at experienced surgical clinics.
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http://dx.doi.org/10.1097/SLE.0b013e31827775f2DOI Listing
June 2013

Multiple gastrointestinal stromal tumors and pheochromocytoma in a patient with von Recklinghausen's disease.

Int J Surg Case Rep 2013 23;4(2):216-8. Epub 2012 Nov 23.

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

Introduction: Neurofibromatosis type 1 is a genetic disease characterized by neoplastic and non neoplastic disorders involving tissues of neuroectodermal and mesenchymal origin. Herein, we present a case with von Recklinghausen's disease, right adrenal heochromocytoma and multiple gastrointestinal stromal tumors.

Presentation Of Case: A forty-eight year old male patient was admitted to our Emergency Department with melena. His physical examination revealed multiple neurofibromas all over the skin, kyphosis, multiple cafe au lait spots and Lisch nodules on the eye and, melena on digital rectal examination. Abdominal computerized tomography scan showed a mass on right adrenal gland and multiple soft tissue mass lesions between distal part of pancreas and small bowel. Adrenal mass was determined as a pheochromocytoma and small bowel lesions were verified as stromal tumors.

Discussion: In patients with NF1, pheochromocytomas and GISTs are well known neoplasms seen with increased incidence than the general population.

Conclusion: In patients with NF1, any symptoms with other systems should be managed carefully for underlying malignity.
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http://dx.doi.org/10.1016/j.ijscr.2012.10.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540221PMC
January 2013

Ileus due to Meckel's diverticulum: case reports.

Ulus Travma Acil Cerrahi Derg 2012 Jul;18(4):351-4

Kayseri Training and Research Hospital, Kayseri, Turkey.

Meckel's diverticulum is the most common congenital anomaly of the small intestine, with an estimated incidence of approximately 1-3% in the general population. Intestinal obstruction is the most common complication in adult patients. Since accurate diagnosis before the operation is difficult, decision for surgery is delayed, and serious problems may be encountered. Here in, we present the diagnosis and management of our patients with intestinal obstruction due to Meckel's diverticulum.
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http://dx.doi.org/10.5505/tjtes.2012.06887DOI Listing
July 2012

Pure SILS Floppy Nissen Fundoplication with Hiatal Repair: A Case Report.

ISRN Gastroenterol 2011 3;2011:347487. Epub 2011 Jul 3.

Department of General Surgery, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey.

Background. Single-incision laparoscopic surgery has recently became popular on behalf of inventing less invasive procedures. In this paper, we present a case of Pure SILS Nissen Fundoplication. Patient and Methods. In February 2010 a 29-year old male patient with a 4 cm sliding hiatus hernia presenting with reflux symptoms had undergone a standard floppy Nissen Fundoplication with a hiatus repair via single 2 cm incision in umbilicus. Results. The procedure had obeyed the standard natural orifice surgery rules, and no needlescopic assistance for any stage of the operation was used so to be a pure single-incision procedure. The operation lasted for 120 minutes without any need of conversion, and the patient was discharged the following day of operation. Conclusion. In the recent time, hybrid single incision laparoscopy techniques have been defined with the use of extra-abdominal supplements for retraction of liver or stomach for Nissen procedure. In addition the main issue in single-incision upper GI and/or hiatus surgery is still the retraction of liver. We succeeded to retract the left lobe of liver through the incision and completed the operation without any need for supplemental access besides the umbilical incision till the end. SILS Hiatus Surgery can be safely and effectively done but the issue needs further clinical studies to state the efficacy when compared to standard laparoscopy.
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http://dx.doi.org/10.5402/2011/347487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168390PMC
November 2011

SILS Incisional Hernia Repair: Is It Feasible in Giant Hernias? A Report of Three Cases.

Diagn Ther Endosc 2011 11;2011:387040. Epub 2011 Aug 11.

Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, 34452 Istanbul, Turkey.

Aim. Three incisional ventral abdominal wall hernias were repaired by placing a 20 × 30 cm composite mesh via single incision of 2 cm. Methods. All three cases had previous operations and presented with giant incisional defects clinically. The defects were repaired laparoscopically via single incision with the placement of a composite mesh of 20 × 30 cm. Nonabsorbable sutures were needed to hang and fix the mesh only in the first case. Double-crown technique was used in all of the cases to secure the mesh to the anterior abdominal wall. Results. The mean operation time was 120 minutes. The patients were mobilized and led for oral intake at the first postoperative day. No morbidity occurred. Conclusion. Abdominal incisional hernias can be repaired via single incision with a mesh application in experienced centers.
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http://dx.doi.org/10.1155/2011/387040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154386PMC
November 2011

Breast cancer risk factors in Turkish women--a University Hospital based nested case control study.

World J Surg Oncol 2009 Apr 8;7:37. Epub 2009 Apr 8.

Istanbul University, Istanbul Medical Faculty, Department of Surgery, Capa, Istanbul, Turkey.

Background: Breast cancer has been increased in developing countries, but there are limited data for breast cancer risk factors in these countries. To clarify the risk for breast cancer among the Turkish women, an university hospital based nested case-control study was conducted.

Methods: Between January 2000 and December 2006, a survey was prospectively conducted among women admitted to clinics of Istanbul Medical Faculty for examination and/or treatment by using a questionnaire. Therefore, characteristics of patients diagnosed with breast cancer (n = 1492) were compared with control cases (n = 2167) admitted to hospital for non-neoplastic, non-hormone related diseases.

Results: Breast cancer risk was found to be increased in women with age (> or = 50) [95% confidence interval (CI) 2.42-3.18], induced abortion (95% CI 1.13-1.53), age at first birth (> or = 35) (95% CI 1.62-5.77), body mass index (BMI > or = 25) (95% CI 1.27-1.68), and a positive family history (95% CI 1.11-1.92). However, decreased breast cancer risk was associated with the duration of education (> or = 13 years) (95% CI 0.62-0.81), presence of spontaneous abortion (95% CI 0.60-0.85), smoking (95% CI 0.61-0.85), breast feeding (95% CI 0.11-0.27), nulliparity (95% CI 0.92-0.98), hormone replacement therapy (HRT) (95% CI 0.26-0.47), and oral contraceptive use (95% CI 0.50-0.69). On multivariable logistic regression analysis, age (> or = 50) years (OR 2.61, 95% CI 2.20-3.11), induced abortion (OR 1.66, 95% CI 1.38-1.99), and oral contraceptive use (OR 0.60, 95% CI 0.48-0.74) were found to be associated with breast cancer risk as statistically significant independent factors.

Conclusion: These findings suggest that age and induced abortion were found to be significantly associated with increased breast cancer risk whereas oral contraceptive use was observed to be associated with decreased breast cancer risk among Turkish women in Istanbul.
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http://dx.doi.org/10.1186/1477-7819-7-37DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2678125PMC
April 2009

Reduced coronary flow reserve and early diastolic filling abnormalities in patients with nephrotic syndrome.

Ren Fail 2008 ;30(9):914-20

Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. huseyinoflaz@ yahoo.com

Background: Increased cardiovascular disease risk is very well known in nephrotic syndrome. Coronary flow reserve measurement by trans-thoracic echocardiography reflects coronary microvascular and endothelial function. However, diastolic filling abnormalities by echocardiography may indicate diastolic dysfunction. Our aim was to evaluate endothelial and diastolic functions by trans-thoracic echocardiography in nephrotic syndrome.

Methods: Eighteen patients with nephrotic syndrome (five females, 34 +/- 17 years) and 30 controls (10 females, 35 +/- 10 years) were evaluated in this cross-sectional observational study. Age, weight, lipid profile, glucose, blood urea nitrogen, creatinine, serum albumin, total protein, C-reactive protein, erythrocyte sedimentation rate, blood pressures, 24-hour urine volume, and protein were recorded. Glomerular filtration rate was estimated by Cockcroft-Gault Formula. Doppler flow and other echocardiographic parameters were measured by Vivid 7 echocardiography.

Results: Coronary flow reserve was significantly lower in patients than controls (p < 0.001) and was negatively correlated with proteinuria (p < 0. 001), creatinine levels (p = 0.03), total cholesterol (p = 0.02), C-reactive protein (p = 0.02), and erythrocyte sedimentation rate (p = 0.005). E/A ratio was significantly lower in patients than in controls (p = 0.005). DT was significantly higher in patients than in controls (p = 0.01) and isovolumic relaxation time was similar in both groups.

Conclusion: Coronary flow reserve and left ventricular diastolic filling are significantly impaired in nephrotic syndrome. Proteinuria, serum creatinine, total cholesterol and inflammation may have all contributory effects on endothelial dysfunction. Early evaluation of patients with nephrotic syndrome should include coronary flow and diastolic function by echocardiography.
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http://dx.doi.org/10.1080/08860220802353819DOI Listing
January 2009

Ascaris as a leading point for small-bowel intussusception in an adult: a rare cause of intussusception.

Am J Emerg Med 2008 Mar;26(3):381.e3-4

Department of General Surgery, Okmeydani Training and Research Hospital, Istanbul 34394, Turkey.

Adult intussusception represents 1% of patients with bowel obstructions and requires a surgical approach. Malignancy is associated with 31% of small bowel intussusception and 70% of large bowel intussusception. Intestinal intussusception caused by ascaris, however, is very uncommon. This report describes our experience of this rare cause of intussusception and its clinical findings.
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http://dx.doi.org/10.1016/j.ajem.2007.05.022DOI Listing
March 2008

Impact of adenoma weight and ectopic location of parathyroid adenoma on localization study results.

World J Surg 2008 Apr;32(4):566-71

Department of General Surgery, Istanbul Medical Faculty, Istanbul University, 34093, Capa, Istanbul, Turkey.

Although the sensitivity of preoperative localization techniques is high for solitary parathyroid adenomas, negative imaging study results are inevitable. The weight and location of the parathyroid adenoma may contribute to the negative results. We aimed to study the impact of adenoma weight and ectopic location of the parathyroid adenoma on ultrasonography and sestamibi scan results. The patients were divided into two groups according to adenoma location. Group 1 consisted of 36 patients with ectopic location, and group 2 consisted of 149 patients with normal location. Parathyroid adenoma weight and the results of imaging studies were determined in all patients. Of 185 patients operated on for hyperparathyroidism, 36 (19.4%) had ectopic parathyroid glands. There was a positive correlation between adenoma weight and positive imaging studies, whereas ectopic location did not correlate with negative imaging study results. There was no significant difference between the ectopic adenoma ratio of patients with negative and positive imaging study results. The weight of the ectopic parathyroid adenoma was significantly lower in patients with negative imaging study results than in patients with positive imaging study results (p = 0.001). According to the analysis of variance, patients with higher-weight adenomas have positive imaging study results irrespective of ectopic location. For both normal and ectopic adenoma locations, adenoma weight was found only to be a factor that positively influences imaging study results.
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http://dx.doi.org/10.1007/s00268-007-9389-4DOI Listing
April 2008