Background and purpose Perfusion parameters obtained in F-18 FDG PET/CT performed for staging purposes in breast cancers may provide additional information about tumor biology as well as glucose metabolism. The aim of this study was to evaluate throughout F-18 FDG PET/CT the relationship between blood flow and glucose metabolism and histological parameters of the primary tumor, normal mammary gland, and axillary lymph nodes in breast cancer patients. Materials and methods Sixty six female patients (mean age 51 y ± 12,81) were prospectively included to this study. We performed dynamic blood flow ( f ) study that started with 296–444 MBq (8–12 mCi) F-18 FDG injection and lasted for 10 minutes, and glucose metabolism ( m ) imaging one hour later. On each frame, mean activity concentration (AC) values (Bq/mL) were recorded on a spherical volume of interest (VOI) having a volume of ~ 1 cm3 on the hottest voxel of primary tumor (T), across normal breast gland (NG) and ipsilaterally axillary lymph nodes (iLN). Correlations among PET parameters and estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (c-erbB2) and Ki67 index were analyzed. Results T volume (TV) ranged from 1.1 to 85.28 cm3 [median (IR): 6.44 (11.78)]. There were positive correlations between c-erbB2 and TAC f and between c-erbB2 and iLNAC f ( p = 0.045, r = + 0.248; p = 0.050, r = + 0.242). In the ER positive (ERP) patients, TV and TAC m were significantly lower than those of ER negative (ERN) (respectively p = 0.044 and p = 0.041). In patients with two positive Ki-67 indices, iLN-SUVmax was significantly higher than one-positive patients ( p = 0.020). There was a negative correlation between NGAC m and histological grade of tumor ( p = 0.005, r = − 0.365). Conclusions Breast cancer shows differences in progression, metastasis and survival due to its diversity in terms of molecular, biological and angiogenesis. High glucose metabolism in breast cancers is associated with tumor aggressiveness. Being able to examine tumor tissue characteristics such as blood flow and glucose metabolism with a single diagnostic technique and to reveal its relationship with histological parameters can provide a reliable pretherapeutic evaluation in breast cancers.

Objective: Breast cancer is a heterogenous disease, and genetic profiling helps to individualize adjuvant treatment. The Oncotype DX is a validated test to predict benefit of adjuvant systemic treatment. The aims of this study are to determine the costs of chemotherapy in government hospitals in Turkey and evaluate the cost-effectiveness of the Oncotype DX from the national insurance perspective. Materials and Methods: A Markov model was developed to make long term projections of distant recurrence, survival, quality adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative or up to 3 node-positive early stage breast cancer. Turkish decision impact study patient data were captured for model reference. In that study, ten academic centers across Turkey participated in a prospective trial. Of 165 patients with pT1-3, pN0-N1mic, ER-positive, and HER-2 negative tumors, 57% had low recurrence score (RS), 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in chemotherapy treatment decisions following Oncotype DX was 33%. Results: The cost of adjuvant chemotherapy in public hospitals was estimated at $3.649, and Oncotype Dx test was $5.141. Based on the cost-effectiveness analysis, Oncotype DX testing was estimated to improve life expectancy (+0.86 years) and quality-adjusted life expectancy (+0.68 QALYs) versus standard care. The incremental cost-effectiveness ratio (ICERs) of Oncotype DX was estimated to be $7207.9 per QALY gained and $5720.6 per LY gained versus current clinical practice. Conclusion: As Oncotype DX was found both cost-effective and life-saving from a national perspective, the test should be introduced to standard care in patients with ER+, HER-2 negative early-stage breast cancer in Turkey.

Objective: The aim of the present study was to investigate the association between non sentinel lymph node metastasis (NSLNM) and clinicopathological factors, particularly in the case of sentinel lymph node (SLN) metastasis in one or two, in clinically node negative patients with breast cancer. Methods: Between 10/2010 and 10/2014, 350 sentinel lymph node biopsy (SLNB) were performed in patients with histologically proven primary breast cancer in our clinic. The data collection includes the following characteristics: age, pathological tumor size, histological type, histological grade, lymphovascular invasion (LVI), number of positive SLN, size of the SLN metastasis (macrometastasis, micrometastasis, isolated tumor cells), multifocality (MF), extracapsuler invasion (ECI) of the SLN, the estrogen receptor (ER) status, the progesterone receptor (PR) status and the Her 2 receptor status, Ki 67 reseptor status. Data were collected retrospectively and then analyzed. Results: A successful SLN biopsy were performed in 345 (98.5%) cases. SLN metastases were detected in 110 (31.8%) cases. These patients then underwent axillary dissection; among these patients, 101 (91.8%) had only one to two positive SLNs. Of the 101 patients with positive SLN biopsies, 32 (31.6%) had metastases in the NSLNs. Univariate and multivariate analysis showed that lymphovascular invasion, extracapsular invasion (ECI), Her- 2 receptor positive, and Ki- 67 > 14% were related to NSLNM (p<. 0.05). Conclusion: The predicting factors of NSLNM were LVI, ECI, Ki-67 level, Her-2 reseptor positive and but should be further validated in our institutions, different institutions and different patient groups prospectively. (C) 2016 Asian Surgical Association and Taiwan Robotic Surgical Association. Publishing services by Elsevier B.V.

OBJECTIVE:Breast cancer is the most common malignancy among Turkish women and the rate of early stage disease is increasing. The Oncotype DX 21-gene assay is predictive of distant recurrence in ER-positive, HER2-negative early breast cancer. We aimed to evaluate the correlations between Recurrence Score (RS) and routine risk factors.MATERIALS AND METHODS:Ten academic centers across Turkey participated in this prospective trial. Consecutive patients with breast cancer who had pT1-3, pN0-N1mic, ER-positive, and HER2-negative tumors were identified at tumor conferences. Both pre- and post-RS treatment decisions and physician perceptions were recorded on questionnaire forms. Correlations between RS and classic risk factors were evaluated using univariate and multivariate analyses.RESULTS:Ten centers enrolled a total of 165 patients. The median tumor size was 2 cm. Of the 165 patients, 57% had low RS, 35% had intermediate RS, and 8% had high RS, respectively. Multivariate analysis indicated that progesterone receptor (PR) and Ki67 scores were significantly related to RS.CONCLUSION:Oncotype DX Recurrence Score does not seem to have a significant correlation with the majority of classic risk factors, but it may have a correlation with PR score and Ki67 score.

Introduction: Breast cancer is the most common malignancy among Turkish women and the rate of early stage disease is increasing. The Oncotype DX® 21-gene assay is predictive of distant recurrence in ER-positive, HER2-negative early breast cancer. We aimed to evaluate the impact of the Recurrence Score® (RS) on treatment decisions and physician perceptions in Turkey. We also studied correlations between RS and routine risk factors. Patients and Methods: Ten academic centers across Turkey participated in this prospective trial. Consecutive breast cancer patients with pT1-3, pN0-N1mic, ER-positive, and HER2-negative tumors were identified at multidisciplinary tumor conferences. The initial treatment decision was recorded before tumor blocks were sent to the central laboratory. Each case was brought back to tumor conference after receiving the RS result. Both pre- and post-RS treatment decisions and physician perceptions were recorded on questionnaire forms. Correlations between RS and classical risk factors were evaluated using univariate and multivariate analyses. Results: Ten centers enrolled a total of 165 patients. The median tumor size was 2 cm. Of 165 patients, 57% had low RS, 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in treatment decision was 33%. Initially, chemotherapy followed by hormonal therapy (CT+HT) was recommended to 92 (56%) of all patients, which decreased to 61 (37%) patients post-RS assay (p<0.001). Multivariate analysis indicated that progesterone receptor (PR) and Ki-67 scores were significantly related to RS. Conclusion: Oncotype DX testing may provide meaningful additional information in carefully selected patients.

Background: Laparoscopic adrenalectomy (LA) is a safe and minimally invasive operation for benign adrenal tumours. The purpose of this study was a retrospective analysis of outcomes following laparoscopic lateral transabdominal adrenalectomy performed for benign adrenal tumours responsible for various endocrinological disorders and non-functioning tumours.Methods: A total of 100 laparoscopic adrenalectomy were carried out between January 2007 and March 2013 via the lateral transabdominal approach. The analysed factors included demographic data of patients, indication for surgery, tumour size and side, intraoperative and postoperative outcome of laparoscopic lateral transabdominal adrenalectomy including duration of surgery, length of hospital stay, the complication rate, as well as the conversion rate to open adrenalectomy.Results: There were 34 patients with non-functioning tumours (Group 1) and 66 with functioning tumours (Group 2). The intraoperative and postoperative outcomes were not significantly different in the cases among the analysed groups of patients. The median operative time was 101 4.3 (range, 30-210) minute in group 1 and 95 +/- 5.9 (range, 30-190) minute in group 2, there was not statistically significant (p = 0.56). The median duration of the postoperative hospital stay in the group 1 was bigger than group 2, this did not differ significantly (p = 0.08). Peroperative complications were occured in 9 (9%) patients, observing 6 (9%) patients in Group 1 and 3 (8.8%) patients in Group 2. There was not statistically significant (p = 0.96). In the postoperative period, three patients in group I, 1 patient in group II developed complications, this difference was not statistically significant (p = 0.69). The conversion to open surgery was found in 9 (9%) patients.Conclusion: This study shows that laparoscopic lateral transabdominal adrenalectomy is a safe, effective, and technically feasible procedure in the treatment of both functioning and nonfunctioning benign tumours of the adrenal gland. Copyright (C) 2015, Asian Surgical Association. Published by Elsevier Taiwan LLC.

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The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/cku082 Advance Access published on 4 July 2014 . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . Decision-making criteria among European patients: exploring patient preferences for primary care services

e11515 Background: The 21-gene Oncotype DX assay is accepted as an important predictive factor in the adjuvant treatment of node negative, estrogen receptor (ER) positive and HER2 (-) breast cancer. The test is not widely available for Turkish physicians as itÕs currently not reimbursed.We performed a prospective analysis to find the impact of the Recurrence Score result (RS) on treatment decisions. Methods: Ten centers across Turkey participated in this prospective trial. Consecutive breast cancer patients with pT1-3, pN0-N1mic, ER(+) , and HER2 (-) tumors were identified and adjuvant treatment decisions were made at breast tumor boards. The pre assay treatment decision was recorded on a questionnaire form. Cases were discussed at tumor boards again when the RS was available and investigators filled the post-assay questionnaire forms with the final decision. Results: 165 patients were enrolled. Mean age was 49.8 (SD±10.3) years. 108(65.5%) patients had pT1 tumors. Mean RS was 18.8±14.0. RS was low in 56.8%, intermediate in in 35.2% and high in 8.5%. There was an overall treatment decision change in 33% of patients with a reduction of chemotherapy (CT) from 56% to 35% overall and a 48% reduction in patients originally recommended CT. Among the patients with low and intermediate results, the decision changed from CT to Òhormonal therapy (HT) aloneÓ in 36 (85.7%) and 7 (36.8%) patients, respectively. Conclusions: The 21-gene assay has a significant impact on treatment decisions at specialty tumor boards in Turkish hospitals. Our initial findings warrant further consideration for the use of this genomic assay in patients with early stage breast cancer in Turkey. Health economic analysis will be reported separately in the near future. Chemotherapy decision in patients before and after RS by risk groups. Post-RS Decision HT CT+HT N n % n % p value* Pre-RS Decision All patients HT 73 63 86.3 10 13.7 <0.001 CT+HT 92 44 47.8 48 52.2 Total 165 107 64.8 58 35.2 Low RS HT 51 51 100.0 0 0.0 CT+HT 42 36 85.7 6 14.3 Total 93 87 93.5 6 6.5 Intermediate RS HT 19 12 63.2 7 36.8 CT+HT 39 8 20.5 31 79.5 Total 58 20 34.5 38 65.5 High RS HT 3 0 0.0 3 100.0 CT+HT 11 0 0.0 11 100.0 Total 14 0 0.0 14 100.0 *McNemar test

Rupert Bartsch, Wien Ute Berndt, Halle Serban-Dan Costa, Magdeburg Peter Dall, Lüneburg Peter Dubsky, Wien Florian Fitzal, Wien Alexander Gaiger, Wien Oleg Gluz, Mönchengladbach Volker Hanf, Fürth Kerstin Hermelink, München Reinhard Horvat, Wien Jens Huober, Ulm Wolfgang Janni, Ulm Walter Jonat, Kiel Michael Knauer, St. Gallen Rolf Kreienberg, Ulm Christiane Kuhl, Bonn Annette Lebeau, Hamburg Cornelia Liedtke, Lübeck Sibylle Loibl, Neu-Isenburg Helmut Madjar, Wiesbaden Christian Marth, Innsbruck Volker Möbus, Frankfurt/M. Ulrike Nitz, Mönchengladbach Angelo Paradiso, Bari Richard Pötter, Wien Kurt Possinger, Berlin Rita Schmutzler, Köln Andreas Schneeweiss, Heidelberg Christian Singer, Wien Isabell Witzel, Hamburg Rachel Würstlein, München Christoph Zielinski, Wien Editors-in-Chief

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon chronic inflammatory disease of the breast with uncertain optimal treatment regimen. In this study, our purpose was to report our clinical experience with 74 IGM patients who were treated wide local excision with or without steroid therapy. Patients and Method: 74 cases diagnosed histologically as IGM were identified from surgical and pathological records between January 1995 and January 2012. Group 1 (surgery-only group) comprised 53 patients, and the 21 patients in group 2 were treated with corticosteroids prior to surgical treatment (steroid-and-surgery group). Results: Follow-up data were complete for 67 (91.7%) of the 73 patients. Recurrence developed in 4 (7.5%) patients in the surgery-only group, while there was no recurrence in the steroid-and-surgery group; the difference was not statistically significant (p = 0.19). Conclusion: Systemic steroid therapy with surgical resection is the recommended first-line treatment strategy for IGM.

OBJECTIVE:Lipid emulsions containing omega-3 are known to have positive effects on patient's prognosis due to anti-inflammatory properties. The aim of this study was to investigate the effects of omega-3 enriched total parenteral nutrition (TPN) emulsion containing omega-9 on biochemical parameters, inflammatory mediators in septic patients.METHODS:Thirty-two participants who were not fed orally for over five days and needing TPN support were included in this prospective, randomized and double-blind clinical study. Patients were randomly divided into control (n=16), treatment (n=16) groups. The treatment group received TPN containing 80% olive oil+20% soy oil additionally 10 g fish oil enriched TPN. Control group received only olive oil containing standard lipid emulsion (1.3±0.1 g/kg/day). Blood samples were collected for biochemical analysis on the 1(st) and 6(th) days of study.RESULTS:The serum albumin levels significantly increased (p<0.05) in both groups whereas total protein and prealbumin levels did not show any significant changes. In treatment group, significant decreases were determined in LTB4 and CRP levels (p<0.05) while decreases in IL-6, TNF-α and leukocyte levels were not significant. No statistically significant changes were found in LTB4, CRP, IL-6, TNF-α and leukocyte levels of controls.CONCLUSION:RESULTS of the study have shown that omega-3 enriched TPN solution containing omega-9 contributes to decrease in the levels of inflammatory mediators and to improvement in the biochemical parameters in septic patients.

OBJECTIVEThe aim of the study was to evaluate the effectiveness of gastric tonometry in the diagnosis of acute mesenteric ischemia in cases where a contrast-enhanced computed tomography cannot be obtained.MATERIAL AND METHODSThe gastric pH (pHi) and gastric CO2 (gpCO2) were measured with gastric tonometry catheter, preoperatively and postoperatively at 24 hours, in patients with suspicion of acute mesenteric ischemia. Simultaneous evaluation of blood gases and blood lactate levels were performed. Patients were divided into two groups after surgery. Group 1 included patients with mesenteric ischemia, and Group 2 consisted of patients without mesenteric ischemia.RESULTSForty-two patients (26 males, 16 females) were evaluated. The mean age was 61.4±13.3 years. There was no significant difference between the groups in terms of demographic factors and co-morbid diseases. There were no significant differences between groups in terms of pHi and gpCO2 levels (7.24±0.2 and -3±12.0 in Group 1, 7.18±0.06 and -3±1.9 in Group 2, respectively), intra-abdominal pressure, lactate levels, and survival. Among all the study parameters, only arterial pH had statistical significance in the diagnosis of acute mesenteric ischemia (7.23±0.21 versus 7.35±0.07 for Groups 1 and 2, respectively,) (p<0.05).CONCLUSIONGastric tonometry is not a useful method in the early diagnosis of acute mesenteric ischemia.

Background: One of the most important factors in breast cancer (BC) mortality is treatment delay. The primary goal of this survey was to identify factors affecting the total delay time (TDT) in Turkish BC patients. Methods: A total of 1031 patients with BC were surveyed using a uniform questionnaire. The time between discovering the first symptom and signing up for the first medical visit (patient delay time; PDT) and the time between the first medical visit and the start of therapy (system delay time; SDT) were modelled separately with multilevel regression. Results: The mean PDT, SDT and TDT were 4.8, 10.5 and 13.8 weeks, respectively. In all, 42% of the patients had a TDT >12 weeks. Longer PDT was significantly correlated with disregarding symptoms and having age of between 30 and 39 years. Shorter PDT was characteristic of patients who: had stronger self-examination habits, received more support from family and friends and had at least secondary education. Predictors of longer SDT included disregard of symptoms, distrust in success of therapy and medical system and having PDT in excess of 4 weeks. Shorter SDT was linked to the age of >60 years. Patients who were diagnosed during a periodic check-up or opportunistic mammography displayed shorter SDT compared with those who had symptomatic BC and their first medical examination was by a surgeon. Conclusion: TDT in Turkey is long and remains a major problem. Delays can be reduced by increasing BC awareness, implementing organized population-based screening programmes and founding cancer centres.

e17529 Background: One of the most important reasons of BC mortality is delay in treatment. Due to lack of BC awareness and organized screening programs, total delay time (from first symptoms of BC to initiation of treatment; TDT) is longer in low-middle income countries. The primary goal of this survey was to identify factors affecting TDT in patients with BC. Methods: As a part of previously presented multinational survey, a total of 1.031 BC patients from 12 cities of 5 districts in Turkey were surveyed using a uniform questionnaire. TDT was determined using 8 individual scales, including one pertaining to patient delay and 7 related to subsequent steps in a typical diagnostic process. Regression models were constructed using 17 variables concerning diverse contextual and personal patient characteristics. Time between first symptom and first medical visit (Patient Delay Time; PDT) and time between first medical visit and start of therapy (System Delay Time; SDT) were modeled separately with multilevel regression. Results: Mean PDT, SDT and TDT were 4.8, 10.5 and 13.8 weeks respectively, with 42% of the patients with a delay of >12 weeks. Multilevel regression equation indicated that disregard of discovered symptoms (p<0.001) and having at least secondary level of education (p=0.021) were significantly correlated with longer PDT. Patients with stronger self-examination habits (p=0.009), reporting more support from friends and family (p<0.001) and living in metropolitan areas (>500k) (p=0.006) had shorter PDT. Predictors of longer SDT included disregard (p<0.001) and having a PDT>4 weeks (p<0.001). Shorter SDT was correlated to being older than 60 years of age (p=0.027). Results revealed that diagnosis during periodic check-up or opportunistic mammography vs. symptomatic BC (p<0.001) and having first medical examination by a surgeon resulted in shorter SDT. Conclusions: TDT in Turkey is unacceptably long and system delay accounted for a substantial part of the total delay experienced by breast cancer patients. This points to a need for shortening clinical pathways if possible. A long patient delay calls for research into patient awareness of BC.