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Yayın Akciğer lezyonlarında bilgisayarlı tomografi eşliğinde transtorasik aspirasyon biyopsi sonuçları; işlem, komplikasyonlar ve tanı değeri(Maltepe Üniversitesi, 2009) Çubuk, Rahmi; Tasalı, Nuri; Midi, Ahmet; Tozan Bayrak, Esra; Arslan, Gül; Örki, Alpay; Atasoy, Mehmet; Çelik, Levent; Güney, ŞefikAmaç: Kliniğimizde bilgisayarlı tomografi (BT) eşliğinde yapılan perkütan transtorasik ince iğne aspirasyon biyopsi (TT-İİAB) bulguları retrospektif olarak değerlendirilmiş, TT-İİAB'nin tanı değeri ve komplikasyonlarının literatür ile birlikte tartışılması amaçlanmıştır. Gereç ve Yöntem: Çalışma grubu akciğerinde lezyon olan ve Maltepe Üniversitesi Tıp Fakültesi Radyoloji Anabilim Dalında Ocak 2007 ve Mayıs 2009 tarihleri arasında BT eşliğinde perkütan transtorasik ince iğne aspirasyon biyopsisi uygulanan yetmiş iki olgu dahil edildi. Tüm olgularda biyopsi işlemi 2 dedektör ve 64 dedektör BT cihazı kullanılarak gerçekleştirildi. Hasta dosyaları ve resim arşivleme ve iletişim sisteminde arşivlenen BT imajları tarandı. Hedef lezyonların en büyük boyutları, lokalizasyonları ve morfolojik özellikleri değerlendirildi. Girişim sayısı, komplikasyonlar ve histopatolojik tanılar kaydedildi. Bulgular: Patolojik tanı 60 olguda patolojik tanı malign, 7 olguda benign olarak değerlendirildi. Beş olguda TT-İİAB sırasında yapılan sitolojik değerlendirmede tanı konulamadı. Böylece olguların %93.1'inde TT-İİAB ile tanı konuldu Malign lezyonlar için sensitivite %89.6, spesifite %100 ve doğruluk % 95.5 bulundu. Benign lezyonlar için ise bu değerler sırasıyla %42.9, %100 ve %94'tü. TT-İİAB'de olgulara 1-3 arasında girişim yapılmış olup ortalama değer 1.43'tü. 10 olguda (%13.8) pnömotoraks, 7 olguda hemoptizi görüldü. Sadece 2 olguda toraks tüpü takılması gerekti. Sonuç: Akciğer hastalıklarının tanısında; BT eşliğinde yapılan TTİİAB, etkin, güvenilir ve fatal komplikasyon oranı oldukça düşük bir tanı yöntemidir. Özellikle işlem sırasında sitopatoloğun eşlik ettiği durumlarda çok yüksek tanı oranına sahip bir metoddur.Yayın Diagnostic performance of two versions of an artificial intelligence system in interval breast cancer detection(Sage Publications Ltd, 2023) Çelik, Levent; Guner, Davut Can; Özcaglayan, Omer; Çubuk, Rahmi; Aribal, Mustafa ErkinBackground Various versions of artificial intelligence (AI) have been used as a diagnostic tool aid in the diagnosis of breast cancer. One of the most important problems in breast screening progmrams is interval breast cancer (IBC).Purpose To compare the diagnostic performance of Transpara v1.6 and v1.7 in the detection of IBC.Material and Methods Reports of screening mammograms of a total 2,248,665 of women were evaluated retrospectively. Of 2,129,486 mammograms reported as Breast Imaging Reporting and Data System (BIRADS) 1 and 2, the IBC group consisted of 323 cases who were diagnosed as having cancer on mammography and were correlated with pathology in second mammogram taken >30 days after first mammogram. Four hundred and forty-one were defined as the control group because they did not change over 2 years. Cancer risk scores of both groups were determined from 1 to 10 with Tranpara v1.6 and v1.7. Diagnostic performances of both versions were evaluated by the receiver operating characteristic curve.Results Cancer risk scores 1 and 10 in v1.7 increased compared to v1.6 (P < 0.001). In all cases, sensitivity for v1.6 was 56.6%, specificity was 90%, and, for v1.7, sensitivity was 65.9% and specificity was 90%, respectively. In all cases, area under the curve values were 0.812 for v1.6 and 0.856 for v1.7, which was higher in v1.7 (P < 0.001). Diagnostic performance of v1.7 was higher than v1.6 at the 7-12-month period (P < 0.001).Conclusion The present study showed that Tranpara v1.7 has a higher specificity, sensitivity and diagnostic performance in IBC determination than v1.6. AI systems can be used in breast screening as a secondary or third reader in screening programs.Yayın DUCTAL CARCINOMA INSITU SITUATED INSIDE A FIBROADENOMA: A CASE REPORT(Aves, 2012) Manukyan, Manuk Norayık; Deveci, Uğur; Kebudi, Abut; Midi, Ahmet; Yener, Nese; Çelik, LeventFibroadenomas are tumors consisting of a fibrous stroma without cytologic atypia and ductal carcinoma insitu is a malign epitelial proliferation limited within the breast ducts. A 21 years old patient was operated by her choice with the ultrasonographic diagnosis of a 27*16 mm fibroadenoma. The pahtological evaluation detected ductal carcinoma insitu situated inside the fibroadenoma. Some authorities prefer to enucleate the fibroadenomas while the others prefer a diagnostic biopsy and a long term follow up because fibroadenomas are usually detected in young women at ages that cancer is rarely diagnosed. Although ductal carcinoma insitu situated inside fibroadenomas has been reported before the treatment is controversial. Local excision with radiotherapy is the most popular choice. But in our case the ductal carcinoma insitu was totally inside the adenoma and regarding the side effects in such a young age radiotherapy was ommited. The follow up of the other fibroadenomas detected by magnetic resonance imaging is also contoversial.Yayın Effects of iron oxide particles on MRI and mammography in breast cancer patients after a sentinel lymph node biopsy with paramagnetic tracers(Elsevier Science Inc, 2021) Aribal, Erkin; Çelik, Levent; Yılmaz, Cem; Demirkiran, Cem; Guner, Davut CanObjective: The aim of this study is to evaluate the effect of iron oxide particle deposition on follow-up mammograms and MRI examinations of patients who underwent sentinel lymph node detection with iron oxide particles. Materials and methods: Two hundred and eighteen patients who had sentinel lymph node biopsy (SLNB) with iron oxide particles were evaluated. Follow-up MRI and mammography were available in 36 and 69 cases respectively. MRI examinations were evaluated for ferromagnetic artifacts that were graded as follows: 0 = No artifact, 1 = Focal area, 2 = Segmental and 3 = Regional signal void artifact. Mammography artifacts were evaluated for the presence of dense particles. Pearson's chi-square test was used for statistical analyses and P < 0.05 was accepted as significant. Results: MRI artifact grading was as follows: Grade 0: 11 (30.6%), Grade 1: 14 (38.9%), Grade 2: 3 (8.3%), and Grade 3: 8 (22.2%). The grade of artifacts differed across surgery types (P = 0.019). Grade 3 artifacts were higher in breast conserving cases whereas Grade 0 was more frequent in subcutaneous mastectomy cases. Three out of 69 (4.4%) cases who had follow-up mammography had artifacts due to iron oxide particle accumulation which presented as Grade 3 MRI artifact in all. Conclusion: Accumulation of iron oxide particles after SLNB with paramagnetic tracers causes artifacts on followup MRI examinations in half of the cases but it is significantly low in mammograms. These artifacts may be confusing in the evaluation of the images. Radiologists must be aware of these tracers and their artifacts whereas patients should be questioned for the type of SLNB before a follow-up examination.Yayın Evaluation of Vacuum-assisted stereotactic biopsy for isolated BI-RADS 4 microcalcifications VASB for isolated BI-RADS 4 microcalcifications(Bayrakol Medical Publisher, 2021) Mermi Yetiş, Esra Ümmühan; Gunaldi, Alev Özturk; Atasoy, Mehmet Mahir; Çelik, LeventAim: The aim of this study was to evaluate the long-term results of vacuum-assisted stereotactic biopsy (VASB) for microcalcifications with isolated Breast Imaging Reporting and Data System (BI-RADS 4). Material and Methods: Three hundred sixty-seven patients who underwent VASB due to microcalcifications between June 2011 and October 2017 were screened. VASB was performed in all patients using stereotaxy in the lateral decubitus position. VASB, surgical pathology results and long-term follow-up findings were evaluated. Statistical analysis was evaluated with mean values and underestimation rates. Results: Among 76 patients and 78 microcalcifications, 20 were defined as ductal carcinoma in-situ (DC15), two were defined as atypical lobular hyperplasia (ALH), one as atypical ductal hyperplasia (ADH) and 56 as benign. The two cases reported as ALH in VASB refused the operation and were followed up, and no progression was detected in their follow-up. The DCIS underestimation rate was 20% (4/20). The mean follow-up time was 55.46 months, and the mean follow-up time in benign lesions was 53.4 months. No conversion to malignancy was detected in any of the patients whose VASB results were found benign (false negative rate 0%). Discussion: In our study, no conversion to malignancy was detected in the long-term follow-up results of patients with isolated BI-RADS 4 microcalcification and having benign VASB results (false negative rate 0%). This method eliminated the necessity of surgical excision in 71.7% (56/78) of the cases with isolated BI-RADS 4 microcalcification in our study. VASB may be the standard method for BI-RADS 4 microcalcifications.Yayın Fibroadenom içine yerleşmiş duktal karsinoma insitu: Olgu sunumu(2012) Manukyan, Manuk Norayık; Yener, Neşe; Midi, Ahmet; Çelik, Levent; Kebudi, Abut; Deveci, UğurFibroadenom sitolojik atipi olmaksızın düşük sellülarite gösteren fibröz stromadan oluşan tümörlere verilen isimdir. Duktal karsinoma in situ ise meme duktusuna sınırlı malign epitelyal hüre proliferasyonu ile karakterize, patolojik ve biyolojik davranış özellikleri ile heterojen bir lezyon grubudur.Sağ meme saat 12 hizasında ele gelen kitle şikayeti ile başvuran 21 yaşında bayan hastada çekilen ultrasonografide 27*16 mm boyutunda düzgün sınırlı fibroadenom görüntüsü ile uyumlu kitle hastanın isteği ile çıkarıldı. Patolojik inceleme sonrası fibroadenom içine yerleşmiş duktal karsinoma in situ saptandı. Hastanın ameliyat sonrası çekilen MR görüntülemesinde bilateral multiple en büyüğü 15mm fibroadenomlar saptandı. Bazı araştırmacılar fibroadenomların tamamının çıkarılmasını savunmaktadırlar. Bazıları ise kesin tanının biopsi ile konulup, genç yaşlarda görülmesi nedeni ile bu yaşlardaki kadınlarda meme kanseri insidansının az olduğu düşünülerek fibroadenomların dönemler halinde izlenebileceğini savunurlar. Daha önce fibroadenom içi duktal karsinoma in situ bildirilmiş olmakla beraber tedavi yaklaşımı tartışmalıdır. Lokal eksizyon ve radyoterapi, mastektomi ve hormonoterapiye kıyasla duktal karsinoma in situ tedavisinde en popüler yaklaşım olmakla beraber bu vakada lezyonun tümü ile fibroadenom içi sınırlı olması ve hastanın genç yaşı sebebi ile radyoterapi sonrası uzun dönemde oluşabilecek komplikasyonlar dikkate alınmalıdır. Hastada var olan diğer fibroadenomlara nasıl yaklaşılması gerektiği ise başka bir tartışma konusudur.Yayın İnvazif lobüler meme karsinomu olgusunda geçirilmiş polio hastalığı nedeniyle gelişmiş aksesuar pektoral kas invazyonu(Maltepe Üniversitesi, 2014) Gül, Burcu; Çubuk, Rahmi; Yener, Neşe; Midi, Ahmet; Atasoy, Mehmet; Sezgin, Gülbüz; Kebudi, Abut; Çelik, Leventİnvazif lobüler karsinom, invazif meme kanserlerinin % 12'sini oluşturmakta olup memenin ikinci sıklıkta görülen malignitesidir. Tümör diffüz infiltran karakterde olduğundan, klinik ve radyolojik olarak tanısı güçtür. Bu yazıda, kliniğimizde invazif lobüler karsinom tanısı alan bir olgu sunulmuş; polio hastalığı nedeniyle gelişmiş aksesuar pektoral kasa tümöral invazyon ve tümörün preoperatif radyolojik bulguları tartışılmıştır.Yayın Is it Possible to Differentiate Types of Breast Implants by Imaging in the Era of Implant-associated Lymphoma?(Bentham Science Publ Ltd, 2022) Çelik, Levent; Güneş, GözdeObjectives: Breast Implant-Associated Anaplastic Large-cell Lymphoma (BIA-ALCL) has been recognised in recent years, and there is extensive ongoing research. Although the exact mechanism and cause are still unclear, we now know that the disease is more associated with textured implants. To the best of our knowledge, no previous studies investigating the radiological differential of various implants have been conducted. In this essay, we aimed to demonstrate dicriminating in vitro and in vivo imaging features of variuos types of breast implant devices using mammography, ultrasound, and Magnetic Resonance Imaging (MRI). Methods: Five different implant devices from various manufacturers with various surface textures, including smooth, micro-textured, regular macro-textured, lightweight macro-textured, and polyurethane-coated were used. In vitro mammography was performed with a digital mammogram (Amulet Innovality, Fuji, Japan), and in vitro and in vivo sonography were performed with Esaote MyLab9 using a 7.5 MHz linear probe. In vitro MRI was performed with a 1.5T magnet (Symphony TIM upgrade and Aera, Siemens Healthcare, Erlangen, Germany) with a 7-channel breast coil (Sense coil, Innova, Germany). MRI studies included fat sat T2 Weighted Sequences (T2WS), non-fat sat T2WS, and silicone only sequences. Results: Each imaging technique had different contributions to dealing with this challenge. Mammography and MRI were limited to identifying the capsule's double bands. We could only differentiate the lightweight macro-textured implant on the mammogram as the borosilicate microspheres were represented by tiny, round lucencies within the gel. Ultrasound imaging with the proper technique was very helpful in identifying the surface. The inner capsule (implant shell) was identified as parallel double echogenic bands on the in vitro sonogram. Bands of the smooth implant were better delineated compared to the textured implants. The double echogenic bands of the polyurethane-coated implant were not even identified individually. The reverberation artifact caused by the smooth implant was the main discriminating in vivo sonographic feature of smooth implants. The hyperintense polyurethane-coated capsule was identified on fat-saturated T2WS and non-fat-saturated T2WS via in vitro MRI. The tiny hypointense microspheres of the lightweight implant were also identified on the silicone-only sequence of the in vitro MRI. Conclusion: In this study, we have shown that breast implant material and type may differ with the help of in vitro and in vivo imaging characteristics on different radiological modalities. These different imaging features could be used for recognising and labelling the implant type, especially macro-textured implants that are reported to be more associated with breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) compared to other types. We believe evaluating these imaging characteristics during daily practice will help radiologists become aware of the implant type and possible complications or diseases associated with that type.Yayın Model-Free automatic segmentation of the aortic valve in multislice computed tomography images(Pamukkale Univ, 2021) Unay, Devrim; Harmankaya, Ibrahim; Oksuz, Ilkay; Çubuk, Rahmi; Çelik, Levent; Kadipasaoğlu, KamuranValvular diseases may affect one or more of the cardiac valves, which may need to be replaced or restored for effective treatment. The surgical procedure can be guided by a patient-specific and dynamic model containing information complementary to the 2D/3D static images of the valves. To this end, in this study a novel automated model-free aortic valve segmentation method is presented, and its performance is evaluated against expert annotations over conventional contrast-enhanced ECG-gated multislice CT data of the aortic valve at its closed position. Detailed evaluation of the proposed method in 19 real cases revealed an encouraging performance of 3D region growing over Hessian based approach but also demonstrated the complexity of the problem.Yayın Polisplenizm ile karakterize erişkin situs ambiguous olgusu(Galenos Yayınevi, 2006) Özkurt, Hüseyin; Narin, Burcu; Akman, Alper; Tasalı, Nuri; Çelik, LeventSitus ambiguous is a rare anomaly that is characterised by abnormal arrangement of abdominal organs with congenital heart diseases. Patients rarely survive beyond first decade of life as this anomaly generally coexists with cyanotic heart diseases. The correct recogniation and characterisation of cases is important for planning surgical, radiologic and endoscoping interventions. In this case we present an incidentally diagnosed case with midline located liver, multiple spleens and stomach in the right upper quadrant, interruptured inferior vena cava with azygos continuation. The heart was left sided and there was no sign of congenital cardiac anomaly. Hereby we present this case as it was found incidentally at adult age and there was no accompanying congenital heart anomaly.Yayın Radiological Imaging in Cervix cancer(Duzce Univ, 2010) Tasalı, Nuri; Çubuk, Rahmi; Midi, Ahmet; Çelik, Aygen; Çelik, Levent; Guney, SefikCervical cancer is the third most common malignancy following the endometrium and ovary among the gynecologic disorders. Although, the mortality of the cervix cancer markedly decreased after the introduction of the specific screening method relatively, this type of cancer still preserves its importance. The current system of staging for cervical cancer is based on the International Federation of Gynecology and Obstetrics (FIGO) classification which is the mainstay for the treatment planning. There is no imaging finding in the stage IA and in situ cancer. In this article, the role of the advanced imaging modalities like magnetic resonance imaging, computed tomography and ultrasonography in the evaluation of the tumor itself, nodal involvement, response to therapy and recurrencies will be discussed.Yayın Radyolojik olarak bı-rads kategori 3-5 olarak değerlendirilen meme lezyonlarının histopatolojik değerlendirilmesinde ultrason rehberliğinde yapılan tru-cut iğne biyopsinin etkinliği: üç yıllık deneyimimiz(Maltepe Üniversitesi, 2009) Çubuk, Rahmi; Tasalı, Nuri; Midi, Ahmet; Arslan, Gül; Tozan Bayrak, Esra; Manukyan, Manuk Norayık; Atasoy, Mehmet; Çelik, Levent; Güney, ŞefikAmaç: BI-RADS (Breast Imaging Reporting and Data System) kategori 3–5 olarak değerlendirilen lezyonlara kliniğimizde yapılan ultrasonografi (US) eşliğinde tru-cut biyopsi sonuçları retrospektif olarak değerlendirildi. US rehberliğinde tru-cutmeme biyopsisinintanı değeri araştırıldı. Ve kliniğimizdeki sonuçlar güncel literatür ile birlikte yorumlandı. Gereç ve Yöntem: Bu çalışmada Maltepe Üniversitesi Tıp Fakültesi Radyoloji Anabilim Dalında Eylül 2006 ve Mayıs 2009 tarihleri arasında US eşliğinde tru- cutbiyopsisiuygulanan97 olgunun bulguları sunulmaktadır. Bu çalışmada US, mamografi ve manyetik rezonans görüntüleme ile BI-RADS kategori 3–5olarak değerlendirilen ve US'de görülebilenmeme lezyonlarına US eşliğinde tru-cut biyopsi yapıldı. Tüm lezyonların boyutları, lokalizasyonları, BIRADS kategorileri, yapılan girişim sayısı ve histopatolojik tanıları kaydedildi. Bulgular: Histopatoloijk değerlendirme sonucu toplam 61 olgu (%62.9) benign, 35 olgu (%36.1) malign ve 1 (%1) olguda atipik duktal hiperplazi tanısı aldı. Toplam 97 olgunun 94'ünde (%96.9) patolojik tanı tru-cut ile konulmuş olup metodunsensitivitesi%96.9, spesifitesi%100 bulundu. Örneklemeiçin olgulara 4–6 arasında girişim (ortalama 4.3) yapılmasına rağmen sadece 3 olguda meme cildinde ekimoz şeklinde minör komplikasyon oluştu. Sonuç: Meme hastalıklarının tanısı için US rehberliğinde yapılan tru-cut biyopsi yöntemi; sterotaksive MRG rehberliğinde yapılan tru-cutveya vakum destek likör biyopsilerine göre sadece daha hızlı ve ucuz değil aynı zamanda kolaytolere edilebilen ve uygulanabilen bir tanı yöntemi olup son dönemlerde cerrahi biyopsinin etkin bir alternatifi haline gelmiştir.Yayın Türk radyoloji derneği meme radyolojisi çalışma grubu meme kanseri radyolojik tarama standartları(2012) Tunçbilek, Nermin; Çelik, Levent; Arıbal, ErkinMeme kanseri sık görülen ve ülkemizde kadınlarda en sık ölüme neden olan kanserdir. Meme kanseri taraması için Türkiye'de oluşturulmuş bir rehber yoktur. Batı ülkelerinde 1960 yılların sonlarına doğru başlayan mamografi tarama çalışmaları ile meme kanseri erken tanısı için randomize kontrollü 8 çalışma yapılmış ve bu çalışmalarda ve daha sonra uygulamaya geçilen tarama programlarında mamografi taramanın meme kanserinden ölümleri düşürdüğü gözlenmiştir. Literatürdeki bilgiler ve batı ülkelerindeki uygulamalar değerlendirildiğinde 40 yaş üstü kadınlarda yıllık mamografi taraması en etkin yöntem olarak görülmektedir. Ancak ulusal tarama programları o ülkenin kaynakları doğrultusunda ve optimum yararın sağlanması için planlanmış programlar olup bu rehber ile birebir örtüşmeyebilir. Bu rehber Türk Radyoloji Derneği Meme Radyolojisi Grubu adına oluşturulmuştur ve bilimsel veriler ön planda tutularak sağlıklı kadınlarda ve riskli kadınlarda me me kanseri taraması için gerekli öneriler verilmiştir.Yayın TURKISH RADIOLOGIC SOCIETY BREAST IMAGING GROUP STANDARTS FOR BREAST CANCER SCREENING(Aves, 2012) Aribal, E.; Tunçbilek, Nermin; Çelik, LeventBreast cancer is common in Turkey and the most common cause of death from cancer in women. There is not a written guide in Turkey for breast cancer screening. The first trials about mamographic screening were started in 1960's in the Western countries. The results of 8 randomised controlled trials and screening programs in these countries showed that early detection of breast cancer has reduced breast cancer mortality. The information from these experiences and knowledge in the literature show that annual mammography screening in women over the age of 40 is the most effective method. However, in national screening programs, the aim to ensure optimal benefit in respect of the resources of the country, may cause the need for different screening policies which may not correspond exactly with this guide. This guide was created on behalf of the Turkish Society of Radiology Breast Radiology Group, and recommendations for screening of healthy women and women at risk for breast cancer were established in the light of scientific data.
