Person: GÜLLÜOĞLU, MAHMUT BAHADIR
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GÜLLÜOĞLU
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MAHMUT BAHADIR
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Publication Open Access Ultrasonography and duplex doppler ultrasonography based indices in nodular thyroid disease(2013-10-01) ASLAN, MUHAMMED; ÇİMŞİT, NURİ ÇAGATAY; GÜLLÜOĞLU, MAHMUT BAHADIR; ASLAN A., Sancak S., ASLAN M., ÇİMŞİT N. Ç. , GÜLLÜOĞLU M. B. , Ahiskali R. A. , Akalin N. S. , ARIBAL M. E.Background. Fine needle aspiration biopsy (FNAB) is an important tool in the diagnosis of thyroid nodules. Aim. Our aim was to investigate the malignancy criteria in thyroid nodules by gray-scale ultrasonography (US) and duplex Doppler ultrasonography (DDUS), and their usefulness in reducing the number of unnecessary FNAB’s. Study design. This was a prospective observational study. Subjects and methods. 181 benign and 18 malignant thyroid nodules were evaluated by US and DDUS before FNAB or thyroidectomy. US was used to note size, shape, internal structure, nodule echogenicity, marginal properties, peripheral hypoechogenic halo, and microcalcifications. DDUS studies were used to evaluate the maximum and minimum flow velocity (Vmax and Vmin), systolic/diastolic flow velocity ratio (S/D), pulsatility index (PI), resistive index (RI), acceleration time (AT) and acceleration value. Results. Contour irregularity, size and presence of microcalcifications (p<0.001, p=0.02 and p=0.002, respectively) and S/D, Vmin, PI, RI and AT were significantly different (p=0.004, p=0.007, p=0.032, p=0.003 and p=0.003, respectively) were significant for malignant nodules. Benign and malignant nodules with or without suspicious US findings had similar DDUS findings. Vmax, Vmin, PI, RI, and AT were significantly different in the presence of microcalcification (p=0.043, p=0.001, p=0.031, p=0.04, and p=0.019 respectively). AT was significantly different in the case of absence of microcalcification (p=0.019). Comparing the irregular margins, Vmin, PI and RI were significantly different (p=0.014, p=0.003, and p=0.014 respectively). Conclusion. Benign and malignant thyroid nodules can be differentiated using gray-scale US findings and DDUS based indices together to reduce the number of unnecessary FNAB’s.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 Metadata only Text mining and word embedding for classification of decision making variables in breast cancer surgery(2022-07-01) GÜLLÜOĞLU, MAHMUT BAHADIR; Catanuto G., Rocco N., Maglia A., Barry P., Sgroi G., Russo G., Pappalardo F., Nava M., Heil J., Karakatsanis A., et al.© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical OncologyIntroduction: Decision making in surgical oncology of the breast has increased its complexity over the last twenty years. This Delphi survey investigates the opinion of an expert panel about the decision making process in surgical procedures on the breast for oncological purposes. Methods: Twenty-seven experts were invited to partake into a Delphi Survey. At the first round they have been asked to provide a list of features involved in the decision making process (patient\"s characteristics; disease characteristics; surgical techniques, outcomes) and comment on it. Using text-mining techniques we extracted a list of mono-bi-trigrams potentially representative of decision drivers. A technique of \"natural language processing\" called Word2vec was used to validate changes to texts using synonyms and plesionyms. Word2Vec was also used to test the semantic relevance of n-grams within a corpus of knowledge made up of books edited by panel members. The final list of variables extracted was submitted to the judgement of the panel for final validation at the second round of the Delphi using closed ended questions. Results: 52 features out of 59 have been approved by the panel. The overall consensus was 87.1% Conclusions: Text mining and natural language processing allowed the extraction of a number of decision drivers and outcomes as part of the decision making process in surgical oncology on the breast. This result was obtained transforming narrative texts into structured data. The high level of consensus among experts provided validation to this process.Publication Metadata only New media platforms for teaching and networking: emerging global opportunities for breast surgeons(2023-02-01) GÜLLÜOĞLU, MAHMUT BAHADIR; Khosla M., Vidya R., Kothari A., GÜLLÜOĞLU M. B.Background: The framework of breast care is changing rapidly due to the increasing success of systemic therapies for breast cancer and consequently, surgeons need to adapt themselves to the changing role of surgery in its management. Real-world evidence indicates that breast cancer patient-related outcomes are better if they are managed by specialized physicians and surgeons. On the other hand, the curriculum for the training of breast surgeons is expanding and includes skills that involve newer surgical techniques and non-surgical technologies. De-escalation of surgery and also the fact that quality of life is becoming one of the priorities in breast cancer management require breast surgeons to be competent in all aspects of multidisciplinary management. Classical teaching including master-apprentice relation-based training is no more sufficient to satisfy the expectations of the trainees. However, on the other hand, the sources for contemporary postgraduate education are relatively scarce when considering these fast changes in the field. Therefore, there is a continuing quest among breast surgeons for finding ways to maintain their professional development. Summary: Classrooms and operating theaters without walls that came with the internet boom brought substantial opportunities for breast surgeons. Platforms such as BreastGlobal, Breastics24h, Global Breast Hub, Oncoplastic Academy-Brazil, ibreastbook, Virtual Breast Oncoplastic Surgical Simulator and CluBreast helped surgeons who needed to get contemporary training and interaction for their professional continuous development. Networking sites such as YouTube, Facebook and Twitter are also among the social media platforms for professional groups to interact. National and global breast surgery societies also provide periodical online meetings and congresses for their members in order to satisfy the ongoing demand for training, interaction and networking. Therefore, web-based platforms helped many surgeons from different parts of the world who could not afford to travel or did not have time to attend the necessary meetings due to their limited time and resources. Moreover, these online programs may have also encouraged surgeons to pursue specialized training in breast surgery which in turn should be expected to increase the quality of breast care in their countries. Key messages: The platforms have downsides such as practical training and role modeling are limited and the opportunity of receiving real-time feedback on skills requirements lacks and networking would not be productive as expected. Nevertheless, web-based platforms require certain technology and infrastructure which still could not be provided everywhere.Publication Metadata only Conventional tools for predicting satisfactory response to neoadjuvant chemotherapy in HR+/HER2- breast cancer patients(2023-10-01) GÜLLÜOĞLU, MAHMUT BAHADIR; EREN, ÖZGÜR CAN; KAYA, HANDAN; UĞURLU, MUSTAFA ÜMİT; Oprea A. L., GÜLLÜOĞLU M. B., Aytin Y. E., EREN Ö. C., Aral C., Szekely T. B., TAŞTEKİN E., KAYA H., BADEMLER S., Karanllk H., et al.Aim: The aim of the study was to assess the role of Magee Equation 3 (MagEq3), IHC4 score, and HER2-low status in predicting \"satisfactory response (SR)\"to neoadjuvant chemotherapy (NAC) in HR+/HER2- breast cancer (BC) patients. Methods: In a retrospective study, female patients of any age with T1-4, N0-2, M0 HR+/HER2- BC who received NAC and underwent adequate locoregional surgical treatment were included. Patients were grouped according to 2 outcomes: (a) overall response to NAC in breast and axilla by using residual cancer burden (RCB) criteria and (b) axillary downstaging after NAC by using N staging. 2 cohorts for overall response were overall SR (RCB 0-1) and no SR (RCB 2-3). On the other hand, for axillary downstaging, 2 cohorts constituted from axillary SR (ypN0 and ypN0i+) and no SR (ypNmic-N3). MagEq3 and IHC4 scores were calculated from their pathological tumor slides in each patient. HER2 status was categorized as either \"no\"or \"low.\"In addition, patient age, family history, tumor histology, stage at admission, and Ki-67 status were compared between cohorts according to predefined outcomes. Results: In a total of 230 BC patients, 228 patients were included to compare according to their RCB levels. The mean age of patients with overall SR was significantly lower than those without. Patients with high Ki-67 expression, high (>30) MagEq3 score, high ICH4 quartile, and HER2-low status had significantly more overall SR. On the other hand, only patients with high Ki-67 expression had significantly more axillary SR. MagEq3 score levels, ICH4 quartiles, and HER2 status were similar between patients with axillary SR and not. Conclusion: MagEq3 and IHC4 tools seemed to be useful to predict those HR+/HER2- BC patients who are most likely to get benefit from NAC. But, only high Ki-67 expression level significantly predicted satisfactory axillary downstaging in HR+/HER2- BC patients.Publication Metadata only Treatment outcomes of breast cancer patients older than 65 years old received local radiotherapy(2014-09-30) ATASOY, BESTE MELEK; ÖZGEN, ZERRİN; YUMUK, PERRAN FULDEN; UĞURLU, MUSTAFA ÜMİT; KAYA, HANDAN; GÜLLÜOĞLU, MAHMUT BAHADIR; Atasoy B. M., Kefeli A., Özgen Z., Rzayev R., Yumuk P. F., Uğurlu M. Ü., Kaya H., Arıbal M. E., Güllüoğlu M. B.Publication 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 Metadata only The value of preoperative contrast-enhanced breast magnetic resonance imaging on surgical planning in breast cancer patients(2012-01-01) KAYA, HANDAN; GÜLLÜOĞLU, MAHMUT BAHADIR; ÇİMŞİT, NURİ ÇAGATAY; Sever A., Kayhan A., Cimsit C., KAYA H., GÜLLÜOĞLU M. B. , Aribal E.Objective: Accurate detection of tumor stage and no recurrent tumor after surgery play a determinant role in surgical planning in breast cancer patients. Breast magnetic resonance imaging (MRI) is being increasingly used in preoperative planning for breast cancer. The aim of this study is to evaluate the incremental value of preoperative breast MRI to surgical planning in women with diagnosis of breast cancer. Patients and methods: Thirty patients were enrolled in this study. Lesions were categorized according to the Breast Imaging Reporting and Data System (BI-RADS) classification. The data were analyzed according to the benefits and detriments of MRI findings and changes in surgical planning made according to MRI results. Results: There was a high correlation between primary tumor size and breast MRI-histopathologic measurements (r:0.796, p:0.00). Fourteen additional lesions were detected in 11 patients (%36) with MRI. MRI findings were concordant with histopathologic results except in 2 patients. In 17% of total patient group, the surgical approach changed according to breast MRI findings. An additional breast-conserving surgery (BCS) was applied in 1 of 16 (%6.5) patients with synchroneus contrlateral breast cancer whom were planned to undergo mastectomy. In 4 patients (28%) with BCS decision, the surgical approach was changed to mastectomy. In one patient, the border and extansion of the primary cancer was detected more clearly by MRI and the decision of BCS was changed to mastectomy.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 BR