Person: GÜLLÜOĞLU, MAHMUT BAHADIR
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GÜLLÜOĞLU
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MAHMUT BAHADIR
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Publication Open Access Localization techniques for non-palpable breast lesions: Current status, knowledge gaps, and rationale for the MELODY study (EUBREAST-4/iBRA-NET, NCT 05559411)(2023-02-01) GÜLLÜOĞLU, MAHMUT BAHADIR; Banys-Paluchowski M., Kuehn T., Masannat Y., Rubio I., de Boniface J., Ditsch N., Karadeniz Cakmak G., Karakatsanis A., Dave R., Hahn M., et al.Simple Summary Most breast cancers are small and can be treated using breast-conserving surgery. Since these tumors are non-palpable, they require a localization step that helps the surgeon to decide which tissue needs to be removed. The oldest localization technique is a guidewire placed into the tumor before surgery, usually using ultrasound or mammography. Afterwards, the surgeon removes the tissue around the wire tip. However, this technique has several disadvantages: It can cause the patient discomfort, requires a radiologist or another professional specialized in breast diagnostics to perform the procedure shortly before surgery, and 15-20% of patients need a second surgery to completely remove the tumor. Therefore, new techniques have been developed but most of them have not yet been examined in large, prospective, multicenter studies. In this review, we discuss all available techniques and present the MELODY study that will investigate their safety, with a focus on patient, surgeon, and radiologist preference. Background: Surgical excision of a non-palpable breast lesion requires a localization step. Among available techniques, wire-guided localization (WGL) is most commonly used. Other techniques (radioactive, magnetic, radar or radiofrequency-based, and intraoperative ultrasound) have been developed in the last two decades with the aim of improving outcomes and logistics. Methods: We performed a systematic review on localization techniques for non-palpable breast cancer. Results: For most techniques, oncological outcomes such as lesion identification and clear margin rate seem either comparable with or better than for WGL, but evidence is limited to small cohort studies for some of the devices. Intraoperative ultrasound is associated with significantly higher negative margin rates in meta-analyses of randomized clinical trials (RCTs). Radioactive techniques were studied in several RCTs and are non-inferior to WGL. Smaller studies show higher patient preference towards wire-free localization, but little is known about surgeons\" and radiologists\" attitudes towards these techniques. Conclusions: Large studies with an additional focus on patient, surgeon, and radiologist preference are necessary. This review aims to present the rationale for the MELODY (NCT05559411) study and to enable standardization of outcome measures for future studies.Publication Open Access Breast-Gynaecological & Immuno-Oncology International Cancer Conference (BGICC) Consensus and Recommendations for the Management of Triple-Negative Breast Cancer(MDPI, 2021-05-08) GÜLLÜOĞLU, MAHMUT BAHADIR; Elghazaly, Hesham; Rugo, Hope S.; Azim, Hamdy A.; Swain, Sandra M.; Arun, Banu; Aapro, Matti; Perez, Edith A.; Anderson, Benjamin O.; Penault-Llorca, Frederique; Conte, Pierfranco; El Saghir, Nagi S.; Yip, Cheng-Har; Ghosn, Marwan; Poortmans, Philip; Shehata, Mohamed A.; Giuliano, Armando E.; Leung, Jessica W. T.; Guarneri, Valentina; Gligorov, Joseph; Gulluoglu, Bahadir M.; Abdel Aziz, Hany; Frolova, Mona; Sabry, Mohamed; Balch, Charles M.; Orecchia, Roberto; El-Zawahry, Heba M.; Al-Sukhun, Sana; Abdel Karim, Khaled; Kandil, Alaa; Paltuev, Ruslan M.; Foheidi, Meteb; El-Shinawi, Mohamed; ElMahdy, Manal; Abulkhair, Omalkhair; Yang, Wentao; Aref, Adel T.; Bakkach, Joaira; Bahie Eldin, Nermean; Elghazawy, HagarSimple Summary Despite the impressive progress in the treatment of triple-negative breast cancer (TNBC), oncologists still face several provocative clinical scenarios in daily practice where clear evidence-based recommendations are lacking, and expert opinion is of utmost importance. In an attempt to seek guidance for these controversial topics in TNBC management, a consensus recommendations session for TNBC was held during the 12th round of the Breast-Gynaecological & Immuno-oncology International Cancer Conference (BGICC) Egypt, 2020. This special session convened a multidisciplinary committee of 35 panellists who specialize in breast cancer care from 13 countries. The consensus covered all the aspects of TNBC management starting from defining TNBC to the management of metastatic disease and highlighted the rapidly evolving landscape in this field. Consensus was reached in 70% of the statements (35/50). In addition, areas of warranted research were identified to guide future prospective clinical trials. Background: The management of patients with triple-negative breast cancer (TNBC) is challenging with several controversies and unmet needs. During the 12th Breast-Gynaecological & Immuno-oncology International Cancer Conference (BGICC) Egypt, 2020, a panel of 35 breast cancer experts from 13 countries voted on consensus guidelines for the clinical management of TNBC. The consensus was subsequently updated based on the most recent data evolved lately. Methods: A consensus conference approach adapted from the American Society of Clinical Oncology (ASCO) was utilized. The panellists voted anonymously on each question, and a consensus was achieved when >= 75% of voters selected an answer. The final consensus was later circulated to the panellists for critical revision of important intellectual content. Results and conclusion: These recommendations represent the available clinical evidence and expert opinion when evidence is scarce. The percentage of the consensus votes, levels of evidence and grades of recommendation are presented for each statement. The consensus covered all the aspects of TNBC management starting from defining TNBC to the management of metastatic disease and highlighted the rapidly evolving landscape in this field. Consensus was reached in 70% of the statements (35/50). In addition, areas of warranted research were identified to guide future prospective clinical trials.Publication Open Access Association of biochemical and clinical parameters with parathyroid adenoma weight. Turkish-Bulgarian endocrine and breast surgery study group, hyperparathyroidism registry study(2022-01) GÜLLÜOĞLU, MAHMUT BAHADIR; Özçınar, Beyza; Öner, Gizem; Makay, Özer; Soyder, Aykut; Zafer Cantürk, N.; Ümit Uğurlu, M.; Atakan Sezer, Y.; Görgülü, Semih; Girgin, Mustafa; Özemir, A. İbrahim; Özbaş, Serdar; Ünal, Bülent; Pandev, Rumen; Erel, Serap; Uğur Emre, A.; İlker Filiz, A.; Nuran Akçay, M.; Demircioğlu, Salih; Güler, S. Ata; Öztürk, Erkan; Yıldız, Ramazan; Çakmak, Güldeniz Karadeniz; Kurt, Yavuz; Erbil, Yeşim; Güllüoğlu, Bahadır M.Publication Open Access Fertility and breast cancer: Recommendations of the 2019 Izmir Consensus Conference(TURKISH SURGICAL ASSOC, 2020) GÜLLÜOĞLU, MAHMUT BAHADIR; Kocdor, Mehmet Ali; Dogan, Erbil; Kasapoglu, Isil; Gulluoglu, Bahadir; Guven, Davut; Canturk, Nuh Zafer; Isik, Ahmet Zeki; Altintas, Sevilay; Emiroglu, Mustafa; Atahan, Kemal; Gode, Funda; Posaci, Cemal; Mentes, Oner; Saatli, Bahadir; Sanci, Muzaffer; Kurt, Sefa; Ozeren, Mehmet; Kebudi, Abut; Uncu, Gurkan; Celiloglu, MuratPublication Open Access Global variations in the definition and management of multifocal and multicentric breast cancer: the MINIM international survey(2022-07-15) GÜLLÜOĞLU, MAHMUT BAHADIR; Masannat Y. A., Rocco N., Garreffa E., GÜLLÜOĞLU M. B., Kothari A., Maglia A., Nava M. B., Omar O. S., Potter S., Catanuto G.The aim of this survey was to understand variation in the definition and management of multifocal and multicentric breast cancer globally. Some 743 physicians from 100 countries responded to this survey, which has provided a clear snapshot of international practice that can inform future work in this area. There is variation in the definition and management of multifocal/multicentric breast cancer among the international breast surgical community, the most controversial aspect being the use of MRI.Publication Open Access Prediction of nipple involvement in breast cancer after neoadjuvant chemotherapy: Should we rely on breast MRI to preserve the nipple(2023-01-01) UĞURLU, MUSTAFA ÜMİT; BUĞDAYCI, ONUR; AKMERCAN, AHMET; KAYA, HANDAN; AKOĞLU, HALDUN; GÜLLÜOĞLU, MAHMUT BAHADIR; UĞURLU M. Ü., BUĞDAYCI O., AKMERCAN A., KAYA H., AKIN TELLİ T., AKOĞLU H., GÜLLÜOĞLU M. B.Background: Indications for nipple sparing mastectomy (NSM) is extending to post-neoadjuvant chemotherapy (NAC) setting. Eligibility for NSM with an optimum tumor-nipple distance (TND) after NAC is unclear. We examined predictive factors for nipple tumor involvement in patients undergoing total mastectomy following NAC. Methods: Clinical and pathological data from prospectively collected medical records of women with invasive breast carcinoma, who were undergone NAC and total mastectomy with sentinel lymph node biopsy and/or axillary lymph node dissection were analyzed. PreNAC and postNAC magnetic resonance imaging (MRI) views were examined and a cut-off TND value for predicting the negative nipple tumor status was determined. Results: Among 180 women, the final mastectomy specimen analysis revealed that 12 (7%) had nipple involvement as invasive carcinoma. Patients with nipple involvement had more postNAC multifocal/multicentric tumors (p: 0.03), larger tumors on preNAC and postNAC images (p: 0.002 and p 2mm) on preNAC and postNAC images (p < 0.001 and p: 0.01). The best likelihood ratios (LR) belonged to the postNAC positivity of the < 20 mm TND, with a + LR of 3.40, and − LR of 0.11 for nipple involvement. PreNAC positivity of the < 20 mm TND also had a similar − LR of 0.14. Conclusion: A TND-cut-off ≥ 2 cm on preNAC and postNAC MRI was shown to be highly predictive of negative nipple tumor involvement.Publication Open Access Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy(2022-06-01) GÜLLÜOĞLU, MAHMUT BAHADIR; Weber W. P., Shaw J., Pusic A., Wyld L., Morrow M., King T., Matrai Z., Heil J., Fitzal F., Potter S., et al.Aim: Demand for nipple-and skin-sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario. Methods: A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology. Results: The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recom-mendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR. Conclusions: The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BRPublication Open Access Value-Based Quality Care for Breast Cancer: More Than Guidelines(GALENOS YAYINCILIK, 2021-10-04) GÜLLÜOĞLU, MAHMUT BAHADIR; Canturk, Nuh Zafer; Gulluoglu, Bahadir M.Although guidelines recommend some of the most expensive diagnostic methods and therapies, some patients do have the opportunity to use them, but some others have overused or misused such methods. The cost of cancer care is increasing, but the satisfaction levels of patients and healthcare workers have not increased in line with this rise. Value-based care for cancer, especially breast cancer, should be implemented. For this reason, all unnecessary screening, tests, treatments, and follow-up parameters should be avoided.Publication Open Access Assessing variability in breast cancer management across the world: results of a questionnaire survey amongst global international experts in breast cancer management(2022-09-01) GÜLLÜOĞLU, MAHMUT BAHADIR; Thekkinkattil D., Vidya R., Kwong A., Alajmi A. A. , Mutebi M., GÜLLÜOĞLU M. B. , Deo S., Fukuma E., Elder E., Gonzalez E., et al.Background: Breast cancer is the most common cancer in women worldwide with an estimated 2.3 million breast cancer cases diagnosed annually. The outcome of breast cancer management varies widely across the globe which could be due to a multitude of factors. Hence, a blanket approach in standardisation of care across the world is neither practical nor feasible.Aim: To assess the extent and type of variability in breast cancer management across the globe and to do a gap analysis of patient care pathway.Method: An online questionnaire survey and virtual consensus meeting was carried out amongst 31 experts from 25 countries in the field of breast cancer surgical management. The questionnaire was designed to understand the variability in diagnosis and treatment of breast cancer, and potential factors contributing to this heterogeneity.Result: The questionnaire survey shows a wide variation in breast surgical training, diagnosis and treatment pathways for breast cancer patients. There are several factors such as socioeconomic status, patient culture and preferences, lack of national screening programmes and training, and paucity of resources, which are barriers to the consistent delivery of high-quality care in different parts of the world.Conclusion: On-line survey platforms distributed to global experts in breast cancer care can assess gaps in the diagnosis and treatment of breast cancer patients. This survey confirms the need for an in-depth gap analysis of patient care pathways and treatments to enable the development of personalised plans and policies to standardise high quality care.