Person: UĞURLU, MUSTAFA ÜMİT
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UĞURLU
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MUSTAFA ÜMİT
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Publication Open Access Changes in 18F-FDG-PET/CT tumor metabolism are not consistent with pathologic complete response in hormone-positive breast cancer(2017-09-01) DEDE, FUAT; KAYA, HANDAN; UĞURLU, MUSTAFA ÜMİT; Kaya S., Aktas B., Tanrikulu E., ÖZTÜRK M. S., DEDE F., KAYA H., Ugurlu U., Ozgen Z., Koca S., Halil S., et al.© 2017 Zerbinis Publications. All rights reserved.Purpose: Current evaluation of response to neoadjuvant chemotherapy (NAC) shows that it could achieve pathological complete response (pCR). The purpose of this study was to assess the consistency of maximum uptake values (SUVmax) changes and pCR in hormone-positive locally advanced breast cancer (LABC). Methods: Ninety hormone-positive LABC patients treated at Marmara University Medical Oncology Clinic, Istanbul, Turkey, between 2009 and 2015 were retrospectively studied. All eligible patients (n=51) received NAC (4-8 cycles) and were evaluated for pCR. 18F-fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG-PET/CT) scan was performed before and after the completion of NAC. The relative changes of SUVmax both in the primary tumor and the axilla were assessed for consistency with pCR. Results: The patient median age was 46 years (range 26-76). The patients 13.7% achieved pCR. Values of >50% (n=40) and 75% SUVmax changes could achieve pCR of 20%. Interestingly, most patients with complete metabolic response did not achieve pCR (81%). The difference of the Ki67 levels before and after NAC, tumor localization, HER-2 positivity, menopausal status, grade of differentiation, lymphovascular and perineural invasion were not associated with pCR. Conclusion: SUVmax changes in later cycles of NAC as commonly practised in oncology clinics were not consistent with pCR (p=1.0). Complete metabolic response may not be associated with pCR in hormone-positive LABC. However, almost 80% of patients had >50% decrease in SUVmax and may still have a chance for conservative surgery and less postoperative morbidity. Therefore, 18F-FDG-PET/CT may still have a role to evaluate the tumor response with a need of larger studies and analysis for cost-effectiveness.Publication Open Access Clinicopathologic and radiologic characteristics of pleomorphic lobular breast cancer(2021-01-01) KAYA, HANDAN; BUĞDAYCI, ONUR; UĞURLU, MUSTAFA ÜMİT; ARIKAN R., AKIN TELLİ T., ALAN Ö., DEMİRCAN N. C. , BAŞOĞLU T., ERCELEP Ö., KAYA H., BUĞDAYCI O., UĞURLU M. Ü. , ÖZGEN Z., et al.Objectives: The objective of the study was to evaluate clinicopathologic and radiologic features of patients with pleomorphic lobular breast cancer (pleomorphic lobular carcinoma [PLC]). Methods: We retrospectively evaluated the clinicopathologic and radiologic features of 25 PLC patients treated in our division from 2012 to 2018. Results: Median age was 50 (range, 42–55) and 48% were postmenopausal. The presence of spiculated mass was 92%. Median tumor size was 21.9 mm (SD±12.7 mm) and axillary lymph node positivity was 44%. Frequency of microcalcification was 12% and frequency of occult breast cancer was 8%. About 72% of patients had Stage 2 or 3 disease. De novo metastatic disease was 8% and another 8% developed metastasis during follow-up. ER, PR, and Her2/neu were positive in 76%, 44%, and 8%, respectively, and 16% of patients were triple negative. All tumors were Grade III. Median Ki-67 was 22% (range 3–90%). Frequency of lymphovascular invasion was 52%. Patients were followed median of 34.5 months (95% CI, 22.2–46.8), since during this period, two patients recurred and five died, median disease-free survival and overall survival could not be reached. Conclusion: Our data suggest that patients with PLC present with poor prognostic features such as large tumor size, axillary lymph node positivity, and high lymphovascular invasion and tumor grade and Ki-67Publication Open Access Is insulin resistance a predictor for complete response in breast cancer patients who underwent neoadjuvant treatment?(BMC, 2020-12) DANE, FAYSAL; Alan, Ozkan; Akin Telli, Tugba; Aktas, Bilge; Koca, Sinan; Okten, Ilker Nihat; Hasanov, Rahib; Basoglu, Tugba; Arikan, Rukiye; Demircan, Nazim Can; Ercelep, Ozlem; Kaya, Serap; Ugurlu, Mustafa Umit; Kaya, Handan; Akgul Babacan, Nalan; Dane, Faysal; Yumuk, Perran FuldenPurpose Neoadjuvant chemotherapy is the standard front-line treatment modality in locally advanced breast cancer. Achieving pathological complete response (pCR) is a significant prognostic factor for prolonged disease-free and overall survival. Insulin resistance is defined as a pathological condition in which insulin effect is impaired in peripheral target tissues such as the skeletal muscle, liver, and adipose tissue. The relationship between breast cancer and insulin resistance is controversial. In this study, our aim is to evaluate the role of insulin resistance, body mass index (BMI), metabolic syndrome, and inflammation markers to predict complete response in breast cancer patients who underwent neoadjuvant treatment. Methods Data from 55 locally advanced non-diabetic breast cancer patients, treated with neoadjuvant chemotherapy between 2015 and 2017, were retrospectively evaluated. Homeostatic model assessment, IR = insulin resistance (HOMA-IR) was calculated by using the obtained insulin and fasting blood glucose values before neoadjuvant chemotherapy (fasting insulin x fasting glucose/405). We considered a cut-off of 2.5 for insulin resistance. The systemic inflammatory index (SII), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were calculated. Results Twenty-five patients had no insulin resistance. The most common pathologic subtype (56%) was hormone receptor (HR) positive and human epidermal growth factor receptor-2 (Her-2)-negative invasive ductal carcinoma. Sixteen (29%) patients had a pathological complete response (pCR). We found that the probability of pCR in patients with insulin resistance was 4.7 times lower than that in patients without insulin resistance [OR: 4.7 (95%CI 1.7-17.2),p= 0.01]. Conclusion Our results revealed that insulin resistance may have a negative effect on pathological complete response (pCR) following neoadjuvant therapy particularly with hormone-positive and Her-2-negative cases of non-diabetic breast cancer.Publication Open Access Diagnostic Value of Diffusion-weighted Imaging and Apparent Diffusion Coefficient Values in the Differentiation of Breast Lesions, Histpathologic Subgroups and Correlation with Prognostic Factors using 3.0 Tesla MR(AVES, 2016-07-13) KAYA, HANDAN; Akin, Yasin; Ugurlu, M. Umit; Kaya, Handan; Aribal, ErkinObjective: The aim of this study was to evaluate the effect of the apparent diffusion coefficient (ADC) and diffusion-weighted imaging in differentiating benign from malignant breast lesions, histopathologic subtypes of breast tumors, and to find a correlation with prognostic factors using 3T MR. Materials and Methods: A total of 165 patients aged between 16 and 78 years with 181 histopathologically-verifed breast lesions were enrolled in this study. A 3T MR system and bilateral phased array breast coil was used. Diffusion-weighted imaging was performed with spin echo echo planar'' with b'' values: 50, 400, and 800 seconds/mm(2). ADC values were calculated for normal fibroglandular tissue and breast lesions. ADC values of independent groups were compared using Student's t-test. ROC analysis was used to find a threshold ADC value in the differentiation of lesions. Results: The mean ADC values were 1.35 +/- 0.16 x10(-3) mm(2)/s for normal fibroglandular tissue, 1.41 +/- 0.24 x10(-3) mm(2)/s for benign breast lesions and 0.83 +/- 0.19 x10(-3) mm(2)/s for malignant breast lesions. The AUC with ROC analysis was 0.945 and the threshold for ADC was 1.08 x10(-3) mm(2)/s with a sensitivity and specificity of 92% and 92%, respectively. The threshold value for ADC ratio was 0.9 with 96% sensitivity and 89% specificity. The mean ADC of malignant breast lesions was statistically lower for benign lesions (p<0.01). We found no correlation between the mean ADC values and ER-PR receptor, Her2, and Ki-67 values. Conclusion: Diffusion-weighted imaging has high diagnostic value with high sensitivity and specificity in differentiating malignant and benign breast lesions.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.