Wire-guided Localization Biopsy to Determine Surgical Margin Status in Patients with Non-palpable Suspicious Breast Lesions

Dogan, Lutfi,Gulcelik, M. Ali,Yuksel, Murat,Uyar, Osman,Reis, Erhan Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.10

Purpose: Guide-wire localization (GWL) has been a standard technique for many years. Excision of nonpalpable malignant breast lesions with clear surgical margins reduces the risk of undergoing re-excision. The objective of the present study was to evaluate the efficacy of GWL biopsy for assessing surgical margins. Methods: This retrospective study concerned 53 patients who underwent GWL biopsy for non-palpable breast lesions and breast carcinoma diagnosed by histological examination. Age of the patients, tumour size, radiographic findings, breast density specifications, specimen volumes, menopausal status and family history of the patients and surgical margin status were recorded. Results: Median age was 53.3 years, median tumour size was 1.5 cm and median specimen volume was $71.5cm^3$. In fifteen patients (28%) DCIS and in 38 patients (72%) invasive ductal carcinoma was diagnosed. There was positive surgical margins in twenty eight (52.8%) patients. The median distance to the nearest surgical margin was 7.2 mm in clear surgical margins. Younger age and denser breast specifications were found as statistically significant factors for surgical margin status. Median age of the patients who had positive margins was 49.4 years where it was 56.9 years in the patients with negative margins (p=0.04). 79% of the patients with positive margins had type 3-4 pattern breast density according to BIRADS classification as compared to 48% in the patients who had negative margins (p=0.03). Some 38 patients who had positive or close surgical margins received re-excision (72%). Conclusion: Positive margin rates may be higher because of inherent biological differences and diffuse growth patterns in younger patients. There are also technical difficulties that are relevant to denser fibroglandular tissue in placing hooked wire. High re-excision rates must be taken into consideration while performing GWL biopsy in non-palpable breast lesions.

The Evaluatıon of Contralateral Breast Lesıons in Breast Cancer Patıents Usıng Reductıon Mammoplasty

Lutfi Dogan,Mehmet ali Gulcelik,Melda Bulut,Niyazi Karaman,Gamze Kiziltan,Cihangir Ozaslan 한국유방암학회 2011 Journal of breast cancer Vol.14 No.3

Purpose: This study evaluated the importance of routine pathological examination of contralateral breast specimens in breast cancer patients using reduction mammoplasty. Methods: The weight of breast tissue resected from the contralateral breast in 71 patients and the number of slices used for pathological evaluation were recorded. Breast lesions found in the contralateral breast and accompanying lesions with tumors were examined. Results: High risk proliferative lesions were reported in the contralateral breast of eight (11.2%) patients, and low-risk lesions were detected in 18 (25%). While the mean age of the patients with high-risk lesions was 45.6, it was 52.8 for the other patients (p=0.036). Conclusion: Bilateral reduction mammoplasty may be beneficial to delineate some pathologies in contralateral breasts even in those patients with normal clinical and radiological findings. The incidental discovery of these pathologies is much more likely in young breast cancer patients.

The Effect of Plasmakinetic Cautery on Wound Healing and Complications in Mastectomy

Lutfi Dogan,Mehmet ali Gulcelik,Murat Yuksel,Osman Uyar,Osman Erdogan,Erhan Reis 한국유방암학회 2013 Journal of breast cancer Vol.16 No.2

Purpose: Surgical equipment used in breast cancer surgery that affects wound healing and minimizes complications seems to be a popular investigation topic. The aim of this study is to evaluate the effect of plasmakinetic cautery on wound healing in patients receiving mastectomy. Methods: Forty-six consecutive breast cancer patients receiving modified radical mastectomy were evaluated prospectively. Plasmakinetic cautery was used in 24 operations and electrocautery was used in 22 operations in random order to manage skin flaps and excise breast tissue. In the postoperative period, vacuum drainage amount and duration time as well as the start time of arm exercises were recorded. Complications like seroma, surgical site infection, hematoma, and flap necrosis were determined. Results: Age, body mass index, breast volume and flap area parameters were similar in each group. Mean drainage duration was found to be 5.5 days in the plasmacautery group and 7.9 days in the electrocautery group (p=0.020). In the plasmacautery and electrocautery groups, mean drainage volume was 707 and 1,093 mL, respectively (p=0.025). There was no statistical significance between the groups when operation duration, amount of blood loss, time to start arm exercises, seroma, hematoma, surgical site infection, and flap necrosis were considered. Conclusion: Plasmakinetic cautery is a promising new surgical instrument that provides atraumatic, scalpel-like cutting precision and electrosurgical-like hemostasis, resulting in minimal tissue injury. So, plasmacautery shortens the drainage amount and duration time compared to electrocautery without elongating operation duration or increasing the amount of blood loss.

Value of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Previous Excisional Biopsy

Gokhan Coskun,Lutfi Dogan,Niyazi Karaman,Cihangir Ozaslan,Can Atalay 한국유방암학회 2012 Journal of breast cancer Vol.15 No.1

Purpose: Sentinel lymph node biopsy (SLNB) in breast cancer patients with clinically negative axilla will ensure axillary dissection only for cases with lymph node metastasis and provide information about pathologic staging as accurate as the axillary dissection. It was shown that SLNB could be successfully performed regardless of the type of biopsy. The aim of this study was to investigate the feasibility of SLNB after excisional biopsy. Methods:One hundred patients diagnosed with excisional biopsy or guide wire-localization and operated on with SLNB between February 2007 and March 2009 were retrospectively analyzed. SLNB was performed with 10 cc of 1% methylene blue alone or both methylene blue and 1 mCi of Tc-99m nanocolloid combination. Age, tumor localization and size, length of the biopsy incision, size of the biopsy specimen, multifocality, lymphovascular invasion, tumor grade, staining with methylene blue, localization, number and metastatic status of the lymph nodes stained, and success rate with a gamma probe were evaluated. Results: Sentinel lymph node (SLN) could not be identified in 9 (16.9%) of patients in the methylene blue group (n=53). In the combination group (n=47), SLN could not be identified in one patient. Of 32 patients with negative SLNB, metastatic involvement was found to be present in 5 patients after axillary lymph node dissection (false negatives). The average numbers of SLNs found in the methylene blue group and combination group were 1.4 and 1.6, respectively. SLN detection and false negative rates in the methylene blue group were 83% and 15.7%, respectively. The rates for the combination group were 98% and 6.4%, respectively. None of the parameters related to patient, tumor or process were found to affect detection rates of SLN. Conclusion: Only SLNB using a combination method is a safe and reliable technique for breast cancer patients diagnosed with excisional biopsy.

Comparison of Outcomes of Standard and Oncoplastic Breast-Conserving Surgery

Mehmet ali Gulcelik,Lutfi Dogan,Murat Yuksel,Mithat Camlibel,Cihangir Ozaslan,Erhan Reis 한국유방암학회 2013 Journal of breast cancer Vol.16 No.2

Purpose: The aim of this study is to determine and to compare the oncological outcomes of bilateral reduction mammoplasty to standard breast-conserving surgery for breast cancer. Methods: One hundred sixty-two patients who received a quadrantectomy because of breast cancer (group 1) and 106 breast cancer patients with macromastia who underwent breast-conserving surgery via bilateral reduction mammoplasty (group 2) between 2003 and 2010 were enrolled in this study. Results: The mean follow-up time was 37 months for group 1 and 33 months for group 2. Surgical margins were wider than 2 mm in 82.7% and 10 mm in 76.5% of the patients in group 1. Eleven percent of patients had positive surgical margins in this group. When compared to group 2, the rates were 89%, 84%, and 8.4%, respectively. Three patients (1.8%) in group 1 and one patient (0.9%) in group 2 had local recurrence of the disease and received a mastectomy. No statistical significances were noted for either local recurrence or overall survival between the two groups. Conclusion: Bilateral reduction mammoplasty has some advantages as compared to the standard conventional breast-conserving surgery techniques without having any unfavorable effects on surgical margin confidence, local recurrence, and survival rates.

Comparing Scalpel, Electrocautery and Ultrasonic Dissector Effects: The Impact on Wound Complications and Pro-Inflammatory Cytokine Levels in Wound Fluid from Mastectomy Patients

Kerim Bora Yilmaz,Lutfi Dogan,Handan Nalbant,Melih Akinci,Niyazi Karaman,Cihangir Ozaslan,Hakan Kulacoglu 한국유방암학회 2011 Journal of breast cancer Vol.14 No.1

Purpose: Introducing the relationship between the surgical instruments used in modified radical mastectomy and wound complications is important for preventing and decreasing complications. This prospective randomized trial was designed to assess the impact of scalpel, electrocautery, and ultrasonic dissector usage on wound complications and tissue damage. Methods: Eighty-two consecutive patients operated with mastectomy were studied. The postoperative time period needed for hemovac drainage, the amount and duration of seroma, infection, flap ecchymosis and necrosis rates were compared. Tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) levels in drainage fluids were determined to confirm the inflammatory response and tissue damage. Results: The numbers of patients included in the scalpel, electrocautery and ultrasonic dissector groups were 27, 26, and 29, respectively. The groups were homogenous with respect to age, body mass index, stage, cormorbidities, breast volume and flap area. Operation time and the amount of bleeding were statistically higher in the scalpel group. The incidence of seroma was higher in the electrocautery group and arm mobilization had to be delayed in this group. There were no differences between groups with respect to hematoma, infection, ecchymosis, necrosis, hemo- vac drainage and the total and first 3 days of seroma volume. TNF-α and IL-6 levels were significantly higher in samples obtained from the drains of patients operated with electrocautery. Conclusion: Ultrasonic dissector decreases operation time by decreasing the amount of bleeding without increasing the seroma incidence. High cytokine levels in drainage fluids from patients operated with elecrocautery indicates that electrocautery induces more tissue damage and acute inflammatory response. Therefore, seroma, due to acute inflammatory response, was seen more frequently in the electrocautery group. Ultrasonic dissector coagulates protein by breaking hydrogen bonds which may close vascular and lymphatic channels more precisely. But, its actual preventive effect on seroma formation might be related to diminished inflammatory response.

Associations between Adiponectin and Two Different Cancers: Breast and Colon

Gulcelik, Mehmet Ali,Colakoglu, Kadri,Dincer, Halil,Dogan, Lutfi,Yenidogan, Erdinc,Gulcelik, Nese Ersoz Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.1

Objectives: Breast and colon cancer are neoplasms well known to be related to obesity. Adiponectin, a protein that increases in obesity, seems to be involved in the relationship but clinical data are limited. Methods: In this study, we therefore evaluated the serum adiponectin levels in 87 breast and 27 colon cancer patients and assessed the relation with BMI, menopausal status, receptor status and stage of disease. Results: Serum adiponectin levels were lower in cancer cases ($8583{\pm}2095$ ng/ml for breast cancer, $9513{\pm}2276$ for colon cancer) than in controls ($13905{\pm}3263$). Conclusion: A low serum adiponectin level may be associated with both breast and colon cancer, and that this association is not statistically significant for either receptor or menopausal status in breast cancer groups.