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    A logarithmic model for hormone receptor-positive and breast cancer patients treated with neoadjuvant chemotherapy
    (Assoc Medica Brasileira, 2023) Seber, Erdoğan Selçuk; İriağaç, Yakup; Çavdar, Eyyüp; Karaboyun, Kubilay; Avcı, Okan; Yolcu, Ahmet; Gürdal, Sibel Özkan; Öznur, Meltem
    OBJECTIVE: The aim of this study was to investigate the predictive importance of the previously validated log(ER)*log(PgR)/Ki-67 predictive model in a larger patient population.METHODS: Patients with hormone receptor positive/HER-2 negative and clinical node positive before chemotherapy were included. Log(ER)*log(PgR)/ Ki-67 values of the patients were determined, and the ideal cutoff value was calculated using a receiver operating characteristic curve analysis. It was analyzed with a logistic regression model along with other clinical and pathological characteristics.RESULTS: A total of 181 patients were included in the study. The ideal cutoff value for pathological response was 0.12 (area under the curve=0.585, p=0.032). In the univariate analysis, no statistical correlation was observed between luminal subtype (p=0.294), histological type (p=0.238), clinical t-stage (p=0.927), progesterone receptor level (p=0.261), Ki-67 cutoff value (p=0.425), and pathological complete response. There was a positive relationship between numerical increase in age and residual disease. As the grade of the patients increased, the probability of residual disease decreased. Patients with log(ER)*log(PgR)/Ki-67 above 0.12 had an approximately threefold increased risk of residual disease when compared to patients with 0.12 and below (odds ratio: 3.17, 95% confidence interval: 1.48-6.75, p=0.003). When age, grade, and logarithmic formula were assessed together, the logarithmic formula maintained its statistical significance (odds ratio: 2.47, 95% confidence interval: 1.07-5.69, p=0.034).CONCLUSION: In hormone receptor-positive breast cancer patients receiving neoadjuvant chemotherapy, the logarithmic model has been shown in a larger patient population to be an inexpensive, easy, and rapidly applicable predictive marker that can be used to predict response.
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    A new predictive marker for predicting response after neoadjuvant chemotherapy in hormone receptor positive/HER2-negative patients: a logarithmic model
    (Zerbinis Publications, 2021) İriağaç, Yakup; Çavdar, Eyyüp; Karaboyun, Kubilay; Tacar, Seher Yıldız; Taskaynatan, H.; Avcı, Okan; Seber, Erdoğan Selcuk; Yolcu, A.; Gürdal, Sibel Özkan; Öznur, M.; Seber, E.S.
    Purpose: Estrogen receptor (ER) and progesterone receptor (PgR) levels as well as Ki-67 expression levels are independent predictive markers in patients with hormone receptor-positive breast cancer. In this study, we investigated the predictive significance of the formula of log (ER)*log (PgR)/Ki-67, which was created using 3 independent predictive markers, for the pathological complete response of the Hormone Receptor (HR)-positive/HER2-negative breast cancer patients receiving neoadjuvant chemotherapy (NACT). Methods: This retrospective study included 126 patients with HR-positive/HER2-negative breast cancer and axillary lymph node metastasis who received NACT. The log (ER)*log (PgR)/Ki-67 value was calculated from the pre-NACT pathological evaluation results in all patients. We determined the ideal predictive cut-off value, which separates patients into 2 groups according to pathological complete response (pCR) and pathological non-complete response (non-pCR), using Receiver Operating Characteristic (ROC) curve analysis. According to this cut-off point, patients were divided into 2 groups as cut-off ratio high and cut-off ratio low and were compared using logistic regression analysis along with clinicopathological features. Results: According to the predictive model, we estimated the ideal cut-off value that distinguishes patients as pCR and non-pCR to be 0.12 (p=0.015). According to this cut off value, %54.8 of the patients were categorized as cut-off value high and %46.2 were cut-off value low. The non-pCR rates of the groups were 91.3% and %71.9, respectively(p=0.004). A cutoff value of 0.12 provided the feature of being a predictive marker in the univariate analysis for distinguishing between pCR and non-pCR (OR=4.09 95% CI 1.48-11.33, p=0.007), and it preserved this feature in the multivariate analysis. (OR=3.27, 95% CI 1.12-9.56, p=0.030). Conclusion: The formula of log (ER)*log (PgR)/Ki-67 can be used as a simple and easy-to-use predictive marker for response to neoadjuvant therapy in patients with HR-positive/HER2-negative breast cancer receiving NACT. © 2021 Zerbinis Publications. All rights reserved.
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    A Risk Assessment Comparison of Breast Cancer and Factors Affected to Risk Perception of Women in Turkey: A Cross-sectional Study
    (Iranian Scientific Society Medical Entomology, 2017) Yüksel, Serpil; Altun Uğraş, Gülay; Çavdar, İkbal; Bozdoğan, Atilla; Gürdal, Sibel Özkan; Akyolcu, Neriman; Özmen, Vahit
    Background: The increase in breast cancer incidence has enhanced attention towards breast cancer risk. The aim of this study was to determine the risk of breast cancer and risk perception of women, factors that affect risk perception, and to determine differences between absolute risk and the perception of risk. Methods: This cross-sectional study was carried out among 346 women whose score in the Gail Risk Model (GRM) was >= 1.67% and/or had a 1(st) degree relative with breast cancer in Bahcesehir town in Istanbul, Turkey between Jul 2012 and Dec 2012. Data were collected through face-to-face interviews. The level of risk for breast cancer has been calculated using GRM and the Breast Cancer Risk Assessment Form (BCRAF). Breast cancer risk perception (BCRP), has been evaluated by visual analogue 100-cm-long scale. Results: Even though 39.6% of the women considered themselves as high-risk carriers, according to the GRM and the BCRAF, only 11.6% and 9.8% of women were in the high risk category, respectively. There was a positive significant correlation between the GRM and the BCRAF scores (P<0.001), and the BCRAF and BCRP scores (P<0.001). Factors related to high-risk perception were age (40-59 yr), post-menopausal phase, high-very high economic income level, existence of breast cancer in the family, having regular breast self-examination and clinical breast examination (P<0.05). Conclusion: In women with high risk of breast, cancer there is a significant difference between the women's risk perception and their absolute risk level.
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    Amiodarone induced thyrotoxicosis may not respond to therapeutic plasma exchange like patients with graves' disease: A report of two cases and literature review
    (2019) Yıldız, İsmail; Elbüken, Gülşah; Atasever, Tugay; Gürdal, Sibel Özkan; Zuhur, Sayid Shafi
    The achievement of euthyroid state has been suggested in patients with thyrotoxicosis undergoing surgery to reduce the risk of thyroid storm. However, euthyroid state could not always be achieved by antithyroid drugs. Therefore, therapeutic plasma exchange (TPE) is an option in this condition. A 58-year-old male patient with a history of type-2 diabetes using 200 mg amiodarone per day, admitted for diabetic ketoacidosis (DKA), induced by thyrotoxicosis. with palpitation, sweating, polyuria, and polydipsia. Euthyroid state could not be achieved, despite all apropriate treatments for thyrotoxicosis. Therefore, preparation with TPE followed by total thyroidectomy was planned. A 35% decrease in fT3 (free T3) and fT4 (free T4) levels were achieved, after two sessions of TPE. A 74-year-old male patient, admitted for acute anterior myocardial infarction (AMI) induced by thyrotoxicosis due to Graves’ disease. Multiple vessel disease was detected on primer percutanous coronary angiography, and an emergency coronary artery bypass grafting (CABG) was planned. Therefore, preperation with TPE was planned before surgery. A substential decrease in fT4 and fT3 levels (45% and 72%, respectively) levels were achieved, after one session of TPE. Most of the studies evaluating the efficacy of TPE in patients with thyrotoxicosis are including patients with Graves’ disease and toxic multinodular goiter, and TPE was indicated as an effective option for preparation of these patients for surgery. However, as presented in case 1, TPE may not be effective in amiodarone induced thyrotoxicosis (AIT) as in cases with thyrotoxicosis due to Graves’ disease.
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    Bahcesehir long-term population-based screening compared to National Breast Cancer Registry Data: effectiveness of screening in an emerging country
    (Turkish Soc Radiology, 2021) Gürdal, Sibel Özkan; Özaydın, Ayşe Nilüfer; Arıbal, Erkin; Özçınar, Beyza; Cabıoğlu, Neslihan; Şahin, Cennet; Özmen, Vahit
    PURPOSE We aimed to show the effects of long-term screening on clinical, pathologic, and survival outcomes in patients with screen-detected breast cancer and compare these findings with breast cancer patients registered in the National Breast Cancer Registry Data (NBCRD). METHODS Women aged 40-69 years, living in Bahcesehir county, Istanbul, Turkey, were screened every 2 years using bilateral mammography. The Bahcesehir National Breast Cancer Registry Data (BMSP) data were collected during a 10-year screening period (five rounds of screening). BMSP data were compared with the NBCRD regarding age, cancer stage, types of surgery, tumor size, lymph node status, molecular subtypes, and survival rates. RESULTS During the 10-year screening period, 8758 women were screened with 22621 mammograms. Breast cancer was detected in 130 patients; 51 (39.2%) were aged 40-49 years. The comparison of breast cancer patients in the two programs revealed that BMSP patients had earlier stages, higher breast-conserving surgery rates, smaller tumor size, more frequent negative axillary nodal status, lower histologic grade, and higher ductal carcinoma in situ rates than NBCRD patients (p = 0.001, for all). CONCLUSION These results indicate the feasibility of successful population-based screening in middle-income countries.
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    Bahcesehir mammography screening project (BMSP) is cost-effective in a developing country
    (Amer Assoc Cancer Research, 2016) Özmen, Vahit; Cabıoğlu, Neslihan; Gürdal, Sibel Özkan; Özaydın, Ayşe Nilüfer; Kayhan, Arda; Arıbal, Erkin
    [No Abstract Available]
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    Comparison of Intermittent Pneumatic Compression with Manual Lymphatic Drainage for Treatment of Breast Cancer-Related Lymphedema
    (Mary Ann Liebert, Inc, 2012) Gürdal, Sibel Özkan; Kostanoglu, Alis; Çavdar, İkbal; Özbaş, Ayfer; Cabıoğlu, Neslihan; Özçınar, Beyza; Özmen, Vahit
    Background: The aim of this prospective controlled study was to assess the efficacy of two different combination treatment modalities of lymphedema (LE). Manual lymphatic drainage (MLD) and compression bandage combination (complex decongestive therapy) have been compared with intermittent pneumatic compression (IPC) plus self-lymphatic drainage (SLD). Methods and Results: Both MLD with compression bandage (complex decongestive therapy) group (Group I, n = 15) and IPC with SLD group (Group II, n = 15) received treatment for LE 3 days in a week and every other day for 6 weeks. Arm circumferences were measured before and the 1st, 3rd, and 6th weeks of the treatment. EORTC-QLQ and ASES-tests were performed to assess the quality of life before and after 6 week-treatment. Patients in both groups had similar demographic and clinical characteristics. Even though both treatment modalities resulted in significant decrease in the total arm volume (12.2% decrease in Group II and 14.9% decrease in Group I) (p < 0.001), no significant difference (p = 0.582) was found between those two groups. Similarly, ASES scores were significantly (p = 0.001) improved in both Group I and II without any significant difference between the groups. While emotional functioning, fatigue, and pain scores were significantly improved in both groups, global health status, functional and cognitive functioning scores appeared to be improved only in patients of group I. Conclusions: Different treatment modalities consisting of MLD and compression bandage(complex decongestive therapy) or IPC and SLD appear to be effective in the treatment of LE with similar therapeutic efficacy in patients with breast cancer. However, combination modalities including IPC and SLD may be the preferred choices for their applicability at home.
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    Comparison of Qualitative and Volumetric Assessments of Breast Density and Analyses of Breast Compression Parameters and Breast Volume of Women in Bahcesehir Mammography Screening Project
    (Galenos Yayincilik, 2020) Gemici, Ayşegül Akdogan; Arıbal, Erkin; Özaydın, Ayşe Nilüfer; Gürdal, Sibel Özkan; Özçınar, Beyza; Cabıoğlu, Neslihan; Özmen, Vahit
    Objective: We aimed to compare visual and quantitative measurements of breast density and to reveal the density profile with compression characteristics. Materials and Methods: Screening mammograms of 1399 women between May 2014 and May 2015 were evaluated by using Volpara 4th and 5th version. First 379 mammograms were assessed according to ACR BI-RODS 4th- edition and compared to Volpara. We categorized the breast density in two subgroups as dens or non-dens. Two radiologists reviewed the images in consensus. Agreement level between visual and volumetric methods and volumetric methods between themselves assessed using weighted kappa statistics. Volpara data such as fibroglandular volume (FGV), breast volume (BV), compression thickness (CT), compression force (CF), compression pressure (CP) were also analyzed with relation to the age. Results: 1399 mammograms were distributed as follows: 12.7% VDG1, 39.3% VDG2, 34.1% VDG3, 13.9% VDG4 according to the 4th edition of Volpara; 1.2% VDC1, 46% VDG2, 36.8% VDG3, 15.9% VDG4 according to the 5 -5 edition of Volpara. The difference between two editions was 4.7% increase in dense cat. -gory. 379 mammograms, according to ACR BI-BADS 4th edition, were distributed as follows: 25.9% category A, 50.9% category B, 19.8% category C, 3.4% category D. The strength of agreement between the Volpara 4th and 5th editions was found substantial (k= 0.726). The agreements between visual assessment and both Volpara editions were poor (k=- 0.413, k-0.399 respectively). There was a 142% increase in dense group with the VDG 4th edition and 162% with the VDG 5th edition when compared to visual assessment. Compression force decreased while compression pressure increased with incasing Volpara Density Grade (VDG) (p for trend <0.001 for both). Compression thickness and breast volume decreased with increasing VDG (p for trend <0.001 for both).The FGV decreases with age and the breast volume increases with increasing age (p<0.001). Conclusion: Visual assessment of breast density doesn't correlate well with volumetric assessments. Obtaining additional information about physical parameters and breast profile by the results of quantified methods is important for breast cancer risk assessments and prevention strategies.
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    Comparison of the effect of erector spinae plane block for postoperative analgesia on neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients operated for breast cancer
    (2024) Karadil, Kübra Şahin; Gültekin, Ahmet; Şahin, Ayhan; Gürdal, Sibel Özkan; Yıldırım, İlker; Arar, Cavidan
    Objectives: It was seen that recurrence and metastasis after breast cancer surgery are related to the immune response of the host. Anesthetic agents modulate the surgical stress response or directly impair the functions of immune system cells. In our study, we aimed to compare the effects of nonsteroidal anti-inflammatory drugs and erector spinae plane block, which are among the methods we use for postoperative analgesia, on the neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients undergoing breast cancer surgery. Methods: One hundred female patients aged 18-75 years, scheduled for unilateral breast cancer surgery, and who agreed to participate were included in our study. These cases were divided into two groups of the analgesia method: Those with erector spinae plane block (Group E) and those who were administered nonsteroidal anti-inflammatory drugs (Group N). According to the results, preoperative and postoperative neutrophil/lymphocyte ratio and platelet/lymphocyte ratio values were calculated and recorded. Results: Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were statistically higher in both groups in the postoperative period. No statistically significant difference was found when the preoperative and postoperative measurement changes of the laboratory parameters between the groups were compared. Postoperative VAS scores were statistically significantly lower in Group E. Conclusions: We concluded that when erector spinae plane block and nonsteroidal anti-inflammatory drug use were compared in managing postoperative analgesia in breast cancer surgery, their effects on the neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were not superior to each other. However, the erector spinae plane block was superior for adequate pain control.
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    Cost-Effectiveness of Breast Cancer Screening in Turkey, a Developing Country: Results from Bahçeşehir Mammography Screening Project
    (Aves Press Ltd, 2017) Özmen, Vahit; Gürdal, Sibel Özkan; Cabıoğlu, Neslihan; Özçınar, Beyza; Özaydın, Ayşe Nilüfer; Kayhan, Arda; Alagöz, Oğuzhan
    Objective: We used the results from the first three screening rounds of Bahcesehir Mammography Screening Project (BMSP), a 10-year (20092019) and the first organized population-based screening program implemented in a county of Istanbul, Turkey, to assess the potential cost-effectiveness of a population-based mammography screening program in Turkey. Materials and Methods: Two screening strategies were compared: BMSP (includes three biennial screens for women between 40-69) and Turkish National Breast Cancer Registry Program (TNBCRP) which includes no organized population-based screening. Costs were estimated using direct data from the BMSP project and the reimbursement rates of Turkish Social Security Administration. The life-years saved by BMSP were estimated using the stage distribution observed with BMSP and TNBCRP. Results: A total of 67 women (out of 7234 screened women) were diagnosed with breast cancer in BMSP. The stage distribution for AJCC stages O, I, II, III, IV was 19.4%, 50.8%, 20.9%, 7.5%, 1.5% and 4.9%, 26.6%, 44.9%, 20.8%, 2.8% with BMSP and TNBCRP, respectively. The BMSP program is expected to save 279.46 life years over TNBCRP with an additional cost of $ 677.171, which implies an incremental cost-effectiveness ratio (ICER) of $ 2.423 per saved life year. Since the ICER is smaller than the Gross Demostic Product (GDP) per capita in Turkey ($ 10.515 in 2014), BMSP program is highly cost-effective and remains cost-effective in the sensitivity analysis. Conclusion: Mammography screening may change the stage distribution of breast cancer in Turkey. Furthermore, an organized population-based screening program may be cost-effective in Turkey and in other developing countries. More research is needed to better estimate life-years saved with screening and further validate the findings of our study.
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    Diagnostic Performance of AI for Cancers Registered in A Mammography Screening Program: A Retrospective Analysis
    (Sage Publications Inc, 2022) Kizildag Yirgin, İnci; Koyluoglu, Yılmaz Onat; Seker, Mustafa Ege; Gürdal, Sibel Özkan; Özaydın, Ayşe Nilüfer; Özçınar, Beyza; Arıbal, Erkin
    Purpose: To evaluate the performance of an artificial intelligence (AI) algorithm in a simulated screening setting and its effectiveness in detecting missed and interval cancers. Methods: Digital mammograms were collected from Bahcesehir Mammographic Screening Program which is the first organized, population-based, 10-year (2009-2019) screening program in Turkey. In total, 211 mammograms were extracted from the archive of the screening program in this retrospective study. One hundred ten of them were diagnosed as breast cancer (74 screen-detected, 27 interval, 9 missed), 101 of them were negative mammograms with a follow-up for at least 24 months. Cancer detection rates of radiologists in the screening program were compared with an AI system. Three different mammography assessment methods were used: (1) 2 radiologists' assessment at screening center, (2) AI assessment based on the established risk score threshold, (3) a hypothetical radiologist and AI team-up in which AI was considered to be the third reader. Results: Area under curve was 0.853 (95% CI = 0.801-0.905) and the cut-off value for risk score was 34.5% with a sensitivity of 72.8% and a specificity of 88.3% for AI cancer detection in ROC analysis. Cancer detection rates were 67.3% for radiologists, 72.7% for AI, and 83.6% for radiologist and AI team-up. AI detected 72.7% of all cancers on its own, of which 77.5% were screen-detected, 15% were interval cancers, and 7.5% were missed cancers. Conclusion: AI may potentially enhance the capacity of breast cancer screening programs by increasing cancer detection rates and decreasing false-negative evaluations.
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    Does hyperbaric oxygen therapy reduce the effects of ischemia on colonic anastomosis in laparoscopic colon resection?
    (Edizioni Luigi Pozzi, 2016) Emir, Seyfi; Gürdal, Sibel Özkan; Sözen, Selim; Bali, İlhan; Yeşildağ, Ebru; Çelik, Atilla; Topçu, Birol; Güzel, Savaş
    BACKGROUND: An increase in intra-abdominal pressure causes a decrease in the splanchnic blood flow and the intramucosal pH of the bowel, as well as increasing the risk of ischemia in the colon. The aim of the present study is to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the ischemia caused by laparoscopy in colonic anastomosis in an experimental model of laparoscopic colonic surgery. MATERIALS AND METHODS: We divided 30 male Wistar albino rats into three groups: Group A was the control (open colon anastomosis); Group B received LCA (laparoscopic colon anastomosis); while Group C received both LCA. and HBOT. Each group contained ten animals. We placed Group C (LCA and HBOT) in an experimental hyperbaric chamber into which we administered pure oxygen at 2.1 atmospheres absolute 100% oxygen for 60 min for ten consecutive days. RESULTS: The anastomotic bursting pressure value was found to be higher in the open surgery group (226 +/- 8.8) (Group A). The result for Group C (213 +/- 27), which received HBOT, was better than that for Group B (197 +/- 27). However, there was no statistically significant difference between Group B and Group C. Group A showed better healing than the other groups, while significant differences in the fibroblast proliferation scores were found between Groups A and B. In terms of tissue hydroxyproline levels, a significant difference was found between Groups A and B and between Groups A and C, but not between Groups B and C. CONCLUSIONS: HBOT increases the oxygen level in the injured tissue. Although HBOT might offer several advantages, it had only a limited effect on the healing of colonic anastomosis in rats with increased intra-abdominal pressure in our study.
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    Effectiveness of the diagnostic pathway of BLES: could it be safely used as a therapeutic method in selected benign Lesions?
    (Turkish Soc Radiology, 2019) Kurtoğlu Özçağlayan, Tuğba İlkem; Gürdal, Sibel Özkan; Öznur, Meltem; Özçağlayan, Ömer; Doğru, Mücahit; Topçu, Birol
    PURPOSE In this study, we aimed to investigate the breast lesion excision system (BLES) as a tool and a practical alternative technique to surgical biopsy and other percutaneous biopsy methods for spicious lesions. We also wanted to share our initial experience with BLES and compare it with standard percutaneous biopsy methods. METHODS From July 2015 to December 2016, a total of 50 patients who had high-risk lesions which were diagnosed with core needle biopsy (CNB) or had lesions with radiology pathology discordance, or had high-risk factors, high-grade anxiety, or suspicious follow-up lesions were enrolled in the study.These lesions were classified as Breast Imaging Reporting and Data System (BI-BADS) 3 or 4, which are under 2 cm. Pathologic diagnoses before and after BLES were evaluated comparatively. The diagnostic and therapeutic success and the complications of CNB and BLES were analyzed. RESULTS After BLES, two cases were diagnosed as atypical lobular hyperplasia and atypical ductal hyperplasia. Since the surgical margin was negative, re-excision was not required. Two cases were diagnosed as malignant, and no residual tissue was detected in the operation region. Total excision rates were reported as 56%. Minor hematoma was observed in only 1 out of 50 cases (2%), and spontaneous remission was observed. Two patients (4%) complained of pain during the procedure. Radiofrequency-related thermal damage to the specimen showed: Grade 0 (<0.5 mm) damage in 88%, Grade 1 (0.5-1.5 mm) in 10%, Grade 2 (>1.5 mm or thermal damage in diffuse areas) in 2%, and Grade 3 (diffuse thermal damage or inability to diagnose) in 0%. We found a significant positive correlation between classification of thermal damage and lesion fat cell content (r = 0.345, P = 0.015). CONCLUSION BLES is a safe technique that can be effectively used with low complication rates in the excision of benign and high-risk breast lesions in selected cases. It may also provide high diagnostic success and even serve as a therapeutic method in high-risk lesions, such as radial scar, papilloma, and atypical lobular hyperplasia with high complete excision rates without fragmentation of lesions.
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    Effects of the Ischemic Preconditioning on Anastomotic Healing in Laparoscopic Colon Operations
    (Lippincott Williams & Wilkins, 2013) Gürdal, Sibel Özkan; Çelik, Atilla; Çelik, Aysun S.; Güzel, Savaş; Mete, Rafet; Şahin, Onder; Polat, Coşkun; Soybir, Gürsel R.
    Background: Previous experimental studies have repeatedly demonstrated the potential protective effect of remote ischemic preconditioning (IPC) on colon anastomosis. The purpose of this experimental study was to investigate the possible positive effects of IPC by interval insufflations in laparoscopic colon operations.Methods: Thirty Wistar-albino rats were randomized into 3 groups. Colonic transsection and anastomosis were performed in the control group. In the laparoscopic colon operation without IPC group, the intra-abdominal pressure was raised to 14 mm Hg for 60 minutes, and then laparotomy and colonic anastomosis were performed. In the IPC group, the intra-abdominal pressure was raised to 14 mm Hg for 5 minutes, followed by desufflation. Laparotomy and colonic anastomosis were performed exactly as in the non-IPC group. On the seventh postoperative day, all animals were killed, and blood and tissue samples were obtained. Anastomotic healing and inflammatory responses were determined by histopathologic examination and by measuring the anastomotic bursting pressure, tissue hydroxyproline level, and tissue and serum nitric oxide, malondialdehyde (MDA), and catalase activity levels. Differences with P-values of <0.05 were considered to be statistically significant.Results: Although the best anastomotic healing was detected in the control group, anastomotic healing was better in the IPC group than that in the non-IPC group. In terms of anastomotic bursting pressure, plasma MDA, serum catalase activity, and tissue nitric oxide levels, the IPC group was superior to the non-IPC group. No significant differences were found between the control and IPC groups, except in the plasma MDA levels.Conclusions: Use of IPC with colon anastomosis had positive effects on wound healing and may serve as a safe method to reduce the adverse effects of ischemia and wound healing in laparoscopic colon operations.
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    Factors Predicting Microinvasion in Ductal Carcinoma in situ
    (Asian Pacific Organization Cancer Prevention, 2014) Gürdal, Sibel Özkan; Cabıoğlu, Neslihan; Özçınar, Beyza; Müslümanoğlu, Mahmut; Özmen, Vahit; Keçer, Mustafa; İğci, Abdullah
    Background: Whether sentinel lymph node biopsy (SLNB) should be performed in patients with pure ductal carcinoma in situ (DCIS) of the breast has been a question of debate over the last decade. The aim of this study was to identify factors associated with microinvasive disease and determine the criteria for performing SLNB in patients with DCIS. Materials and Methods: 125 patients with DCIS who underwent surgery between January 2000 and December 2008 were reviewed to identify factors associated with DCIS and DCIS with microinvasion (DCISM). Results: 88 patients (70.4%) had pure DCIS and 37 (29.6%) had DCISM. Among 33 DCIS patients who underwent SLNB, one patient (3.3%) was found to have isolated tumor cells in her biopsy, whereas 1 of 14 (37.8%) patients with DCISM had micrometastasis (7.1%). Similarly, of 16 patients (18.2%) with pure DCIS and axillary lymph node dissection (ALND) without SLNB, none had lymph node metastasis. Furthermore, of 20 patients with DCISM and ALND, only one (5%) had metastasis. In multivariate analysis, the presence of comedo necrosis [relative risk (RR)=4.1, 95% confidence interval (CI)=1.6-10.6, P=0.004], and hormone receptor (ER or PR) negativity (RR=4.0, 95% CI=1.5-11, P=0.007), were found to be significantly associated with microinvasion. Conclusions: Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with comedo necrosis or hormone receptor negativity are more likely to have a microinvasive component in definitive pathology following surgery, and should be considered for SLNB procedure along with patients who will undergo mastectomy due to DCIS.
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    Feasibility of Mammary Ductoscopy in Management of Pathologic Nipple Discharge
    (Springer, 2015) Cabıoğlu, Neslihan; Aliyev, Vusal; Özkurt, Enver; Gürdal, Sibel Özkan; Özçınar, Beyza; Kurt, Mehmet; Bender, Omer
    [No Abstract Available]
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    First Round Results of A Long Term Population- Based Breast Cancer Screening Program From Bahcesehir
    (Aves, 2012) Kayhan, Arda; Gürdal, Sibel Özkan; Özaydın, Ayşe Nilüfer; Öztürk, Enis; Cabıoğlu, Neslihan; Arıbal, Erkin; Özmen, Vahit
    Introduction: The Bahcesehir Breast Cancer Screening Project is the first organized population based breast cancer screening project in Turkey. The objectives of this prospective observational study are to determine implementation of a population-based organized breast cancer screening program in Turkish women and to find out the effect of screening on stage shift. Materials and Methods: A total of 3758 women within 40-69 years of age were recruited in this prospective study. The screening was done biannually and five rounds were planned. After completing a clinical breast examination (CBE), two-view mammograms were obtained and classified according to Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology (ACR). True positivity, false positivity, positive predictive values (PPV) according to ACR, cancer detection rate, minimal cancer detection rate, axillary node positivity and recall rate were calculated. Results: Seventeen cancers were detected in the first round. The overall cancer detection rate was 4.5 per 1000 women. Minimal cancer detection rate and axillary node positivity were 52.9 % and 11.7 %, respectively. A positive prediction for biopsy was 32%. The overall recall rate was 18.4 %. Discussion: These are the first round results of the screening project. Our results showed that screening can be done effectively in a population based organization.
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    In vitro culture of tumor infiltrating lymphocytes for adoptive immunotherapy in breast cancer patients
    (Elsevier Sci Ltd, 2018) Şeber, Erdoğan Selçuk; Yetişyiğit, Tarkan; Turgut, Burhan; Buluş, Stephen; Gürdal, Sibel Özkan; Öznur, Meltem
    [No Abstract Available]
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    Laparoskopik kolesistektomi sırasında safra kesesi yatağından meydana gelen kanamalarda fibrin yapıştırıcı uygulamasının etkinliği
    (2013) Emir, Seyfi; Bali, İlhan; Sözen, Selim; Yazar, Fatih Mehmet; Kanat, Burhan Hakan; Gürdal, Sibel Özkan; Özkan, Zeynep
    Amaç: Laparoskopik kolesistektomi sırasında safra kesesi yatağından gelişen ve klasik yöntemlerle durdurulamayan kanamalarda fibrin yapıştırıcı uygulama deneyimimizi sunmak.Gereç ve Yöntemler: Laparoskopik kolesistektomi uygulanan 382 hastadan, safra kesesi yatağında kanama meydana gelen ve konservatif yöntemlerle durdurulamayan ve bu nedenle de fibrin glue kullanılan 14 hasta retrospektif olarak incelendi.Bulgular: Fibrin yapıştırıcı kullanılan hastaların 10'u (%71) kadın, 4'ü (%29) erkekti. Hastaların ortalama yaşı 55,7 idi. 14 hasta da semptomatik safra kesesi taşı nedeniyle ameliyat edildi. On üç hastada (%92) yandaş bir hastalık mevcuttu. Kanamanın kontrol altına alınarak hemostazın sağlanması için harcanan zaman ortalama olarak 23,9 dakika olarak saptandı. Hemoglobin değeri 8 mg/dL altına düşen 2 hastaya kan transfüzyonu yapıldı. Bir hastada fibrin yapıştırıcı kullanılmasına rağmen kanama kontrolü sağlanamadı ve açık cerrahiye geçildi.Sonuç: Laparoskopik kolesistektomi yapılan hastalarda, karaciğerde safra kesesi yatağından meydana gelen kanamalarda fibrin yapıştırıcı uygulanmasının açığa geçme oranlarını düşürdüğü saptanmış olup bu konu ile ilgili daha geniş çalışmalara da ihtiyaç duyulmaktadır
  • Küçük Resim
    Öğe
    Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options
    (Springer-Verlag Italia Srl, 2022) Ağcaoğlu, Orhan; Sezer, Atakan; Makay, Özer; Erdoğan, Murat Faik; Bayram, Fahri; Güldiken, Sibel; Yazıcı, Dilek; Gürdal, Sibel Özkan
    Purpose The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole +/- beta-blocker combination for Graves' disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3-4 cytological results and papillary microcarcinoma. Conclusion This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible.