Bülent Çomçali

Purpose Accurate assessment of residual disease after neoadjuvant chemotherapy (NAC) is essential for surgical planning and prevention of incomplete excision. This study evaluated artificial intelligence (AI)–assisted digital breast tomosynthesis (DBT) as a decision-support tool for post-NAC assessment in breast cancer. Methods This retrospective study included 151 patients treated with NAC followed by surgery. Post-NAC DBT images were analyzed using Lunit INSIGHT DBT. An AI score threshold of 70 was used to classify patients as having low (< 70) or high (≥ 70) scores. In a paired subgroup of 70 patients, pre- and post-NAC AI scores were compared. Diagnostic performance and univariable and multivariable analyses were performed. Results The overall pathological complete response (pCR) rate was 41.1% (62/151). Patients with low AI scores had higher pCR rates than those with high scores (49.5% vs. 28.3%, p = 0.010). High AI scores were associated with persistent microcalcifications and residual ductal carcinoma in situ (p < 0.001). Overall accuracy was 58.3% and varied by molecular subtype, with higher performance in triple-negative breast cancer and limited discrimination in HR+/HER2 − tumors. In multivariable analysis, AI score showed borderline significance (p = 0.070). In the paired cohort, AI scores decreased after NAC (p < 0.001), but delta change did not differ between pCR and non-pCR groups (p = 0.877). Conclusion AI-assisted DBT may have potential complementary value as a decision-support tool for post-NAC surgical planning, particularly in triple-negative breast cancer and in cases with residual microcalcifications.

Background: Idiopathic granulomatous mastitis (IGM) is a benign, chronic inflammatory breast disease frequently associated with autoimmune disorders. This prospective cohort study explored the prevalence of Hashimoto thyroiditis (HT) in patients with IGM and the relationship between this co-occurrence and systemic inflammatory markers. Methods: Between March 2019 and September 2022, 179 women were enrolled: IGM without HT (n = 52), IGM + HT (n = 19), and age-matched healthy controls (n = 89). Hematological indices, including white blood cell count, C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR), were measured at diagnosis before any treatment. Results: The prevalence of HT among patients with IGM was 26.8 %. Compared with isolated IGM, the IGM + HT group had a lower smoking rate (16.3% vs 40.4%, P = .028) and displayed a significantly lower median NLR (1.91 vs 2.76, P < .001) but higher median LMR (6.47 vs 4.75, P = .001). Conclusion: Approximately 1 in 4 women with IGM also had HT. A low NLR-high LMR pattern may reflect a distinct inflammatory milieu in this overlap cohort and could help tailor follow-up strategies for these patients. Routine thyroid screening should be considered in patients with IGM.

Background: Molecular testing is recommended to refine risk stratification in indeterminate thyroid nodules (Bethesda III–IV), but data on dual-gene (BRAF and RAS) testing using fresh FNA washout specimens are limited. We aimed to evaluate the performance of BRAF and RAS mutation analysis from fresh thyroid FNA washout material, with a focus on indeterminate cytology. Methods: We retrospectively analyzed 1139 patients who underwent washout-based molecular testing between May 2022 and October 2024 at a tertiary endocrine center. Of these, 307 had available histopathologic results after surgery. Primary outcomes were sample adequacy, mutation spectrum, and diagnostic metrics (sensitivity, specificity, PPV, NPV, and accuracy). Analyses were repeated under two assumptions that classified borderline/low-risk neoplasms as benign vs. malignant, and within the Bethesda III–IV subset. Results: Adequate material for molecular analysis was obtained in 1037/1139 samples (90.9%). In the operated cohort (n = 307), malignant lesions comprised 31.9% and low-risk neoplasms 8.5%. When borderline lesions were considered benign, mutation positivity yielded a sensitivity of 48.0%, a specificity of 89.6%, a PPV of 75.9%, an NPV of 71.9%, and an accuracy of 72.9%. In Bethesda III–IV nodules (n = 153), sensitivity, specificity, and accuracy were 41.0%, 85.2%, and 66.0% (malignant assumption). Isolated BRAF positivity showed high specificity (~96.7%) with modest sensitivity. Conclusions: Our findings extend current diagnostic approaches by showing that dual-gene (BRAF and RAS) testing from fresh FNA washouts is technically feasible (≥90% adequacy) and provides high specificity with modest sensitivity for malignancy in indeterminate nodules. In settings lacking comprehensive commercial panels, this low-complexity approach offers a practical adjunct to cytology and imaging for preoperative decision-making.

Background: It is known that Primary hyperparathyroidism (pHPT) is the most common cause of hypercalcemia. It is characterized by high serum calcium and parathyroid hormone (PTH) levels. Also, hyperactivity is seen in one or more of the parathyroid glands and preoperative ultrasonography (USG) usually localizes the location of parathyroid adenomas. In this study, the factors that affect the success of parathyroid surgery have been investigated. Methods: In total, the medical records of 245 patients with pHPT who underwent parathyroidectomy have been reviewed, retrospectively. In order to confirm the location of hyperactive parathyroid gland and the factors that affect the success of laboratory methods have been examined by using imaging techniques. Results: As a result, false localization is found in 7.8% (19) of the patients. The weight calculated by using the preoperative USG measurements has been approximately similar to the macroscopic weight (p = 0.651). When the preoperative USG results in patients with false localization have been analyzed, it is seen that the lesion diameter was significantly less than 12 mm and the calculated weight was significantly less than 39 g (p = 0.005 and p < 0.001). Conclusion: It has been concluded that a second-line imaging should be used to obtain an accurate localization in patients with a small lesion suspected of being a parathyroid adenoma on preoperative USG. In addition, an intraoperative PTH (IOPTH) should be used to increase the success rate of the surgery in patients who cannot undergo a second-line imaging.

Objective Tumors of women with breast cancer show clinical and biological differences depending on the hormonal changes that develop with age. Therefore, in this study, we compared the radiologic, and clinicopathological features of breast cancer patient’s < 40 age and ≥55 age. Material and Method The files of a total of 759 patients, including 92 patients under 40 aged, and 322 patients 55 aged and over who were operated on for breast cancer over a 10-year period in three centres were retrospectively reviewed and Estrojen Reseptor (ER), Progesteron Reseptor (PR), Human epidermal growth factor receptor 2 (HER2), Lymphovascular invasion (LVI) status, presence of axillary lymph node metastasis (ALNM), multifocality, presence of Ductal Carsinoma İnsitu (DCIS) or Lobular Carsinoma İnsitu (LCIS), tumor size, tumor histopathological type, grade, and score were recorded. Results In patients under the age of 40, the tumor is less localized in the upper-inner and lower-inner quadrants of the breast, multifocality is more common, most of them have dense breast structure, the histological grade of the tumor is higher, LVI and LNM are more common. It was found that they had ER receptor positivity and higher Ki-67 proliferation index (p

Aim: The aim of the study is examining the factors determining the need for thoracic approaches to remove an intrathoracic goitre. Material and Method: This retrospective study was conducted between 2011 and 2018. Patients were categorized into two groups; Group A consisted of patients who underwent surgery via the transcervical approach, and Group B consisted of patients who underwent surgery via the transcervical plus thoracic approaches. The extension, size, and localization of the intrathoracic goitre was measured on computed tomography scans. Histopathological examination results were recorded. Results: Group A was consisted of 268 patients, Group B was consisted of 17 patients. There was statistically significant difference in terms of recurrence between groups. There were no statistically significant difference for length of goitre in computed tomography, volume and superoinferior size of the specimen between groups. There was a statistically significant correlation between the choice of thoracotomy and the localization of the intrathoracic goitre. There was a statistically significant correlation between the choise of thoracotomy and pathological subtypes. Conclusion: While dimentions of the goitre were not important in determining the necessity of thoracic approaches; recurrence, localization, and histopathological features were found to be determinants in removing an intrathoracic goitre.

Objective: This study aimed to evaluate seasonal effects on the mechanisms of burn injuries in patients requiring hospitalization. Material and Methods: A retrospective evaluation was made using the information of 419 hospitalized burns patients, including demographic data, degree and percentage of burn injury, cause and mechanism of burn injury, morbidity and mortality. Burn mechanisms were grouped as thermal burns (flame, boiling liquid, contact), chemical burns and electrical burns. When calculating the percentage of body surface area burned, the rule of nines was applied. Seasonal classification was made appropriate to the northern hemisphere. Results: According to the seasons, the most burns were seen in spring months (n= 130, 31.0%). In the examination of the mechanism of burn injury, the most common type of injury was boiling liquid in 159 patients followed by flame injury in 146 patients. There was an increase in electrical and chemical burns in spring and summer. A statistically significant difference was determined between the types of burns according to the seasons (p= 0.024). The burn injury occurred as a result of a workplace accident in 82 cases, the majority of which were in autumn, and summer, and the difference in the seasons was determined to be statistically significant (p= 0.045). There was a statistically significant increase in the exposure of individuals aged >65 years to boiling liquid burns in winter and summer months (p= 0.014). Conclusion: The results of this study showed a seasonal effect on the types of burn injuries. A higher rate of thermal burns was expected to be found in winter, but this was not the case in patients with indications for hospitalization, as chemical and electrical burns in workplace accidents were seen more frequently in warmer seasons of spring and summer. In this context, burns units should be prepared for patient profiles to vary according to the season.

Çomçalı B, et al. Ann Surg Treat Res. 2022 Feb;102(2):83-89. https://doi.org/10.4174/astr.2022.102.2.83