This study aimed to compare the accuracy and reliability of Alvarado Score (AS) and Appendicitis Inflammatory Response Score (AIRS) in pregnant women undergoing surgery for acute appendicitis (AA). The files of 53 pregnant women with a diagnosis of AA who underwent surgery in our clinic between February 2014 and December 2018 were examined retrospectively. The patients were divided into 3 groups as follows: first trimester between 0 and 14 weeks, second trimester between 15 and 28 weeks, and third trimester between 29 and 42 weeks. The AS and AIRS values were calculated according to preoperative physical examination and laboratory results. The mean age of the patients was 28.58 (18–44) years. According to the pathology results, appendicitis was detected in 16 of 23 patients in the first trimester, in 22 of 25 patients in the second trimester, and in 2 of 5 patients in the third trimester. The AIRS was ≥ 9 in 9 patients and the AS was ≥ 7 in 19 of the 23 patients in the 1st trimester, while the AIRS was ≥ 9 in 11 patients and the AS was ≥ 7 in 19 of the 25 patients in the 2nd trimester. However, in the 3rd trimester, the AIRS was ≥ 9 in 2 patients and AS was ≥ 7 in 4 of the 5 patients. In conclusion, when the data obtained from the present study were evaluated, it was determined that both AS and AIRS are effective methods for diagnosing AA in pregnant women.

Background: Although LC-MS/MS is preferred as a reliable method, therapeutic enzyme drugs in the blood matrix may lead to false results. Objective: The purpose of this article is to experimentally investigate the effect of five different enzymes used in the treatment of metabolic diseases on blood immunosuppressant measurement. Methods: Five different enzyme drugs (galsulfase, alglucosidase alfa, imiglucerase, elosulfase alfa, laronidase) were added to control materials containing tacrolimus, everolimus, sirolimus, and cyclosporine A drugs. Measurements were performed using an LC-MS/MS instrument (Shimadzu 8040, Japan). The amount of deviations from the target values was calculated. Results: Blood Immunosuppressant levels significantly changed after the administration of enzyme drugs. Four different enzyme drugs led to false-positive results in the tacrolimus levels at a rate of 10.58% (95% CI, 9.83-11.32) to 37.28% (95% CI, 33.55-41.27). The highest deviations were observed with the administration of galsulfase and alglucosidase alpha in the sirolimus levels at rates of 336.54% (95% CI, 306.25-366.82) and 395.88% (95% CI, 360.25-431.50), respectively. Imiglucerase was the least effective enzyme for the sirolimus level (0.80% (95% CI, 0.71-0.89). Different deviations between the ratios of - 9.37% (95% CI, -10.40 - -8.33) and 8.33% (95% CI, 7.41-9.24) were determined at the cyclosporin A level. Conclusion: Galsulfase, alglucosidase alpha, imigluserase, elosulfase alpha and laronidase can significantly interfere with immunosuppressant measurements with LC-MS/MS. False immunosuppressant results associated with enzyme injection may result in immunosuppression failure, organ rejection. For the measurement of immunosuppressant levels, sampling should be done before the enzyme infusion. Clinicians should question the time of enzyme infusion and sampling when confounding results in immunosuppressant measurement.

Background and Objective: Reliable preoperative identification of lymph node metastasis in clinically node-negative (cN0) patients with locally advanced upper rectal cancer (LAURC) remains a major clinical challenge due to the limited sensitivity of imaging modalities. The HALP score—calculated from hemoglobin, albumin, lymphocyte, and platelet counts—has emerged as a promising marker reflecting systemic inflammation and nutritional status. This study aimed to investigate the association between preoperative HALP scores and histopathologically confirmed lymph node metastasis in cN0 LAURC patients and to assess its diagnostic performance.Methods: This retrospective study included 62 patients who underwent curative resection for cN0 LAURC between January 2020 and December 2023. HALP scores were computed using the formula: hemoglobin (g/L) × albumin (g/L) × lymphocyte count (/L) ÷ platelet count (/L), based on fasting blood samples collected within one week prior to surgery. Patients were stratified according to the presence or absence of pathological lymph node metastasis. ROC curve analysis was used to determine the optimal HALP cut-off value. Strict exclusion criteria were applied to minimize confounding from comorbidities affecting hematologic parameters.Results: Lymph node metastasis was confirmed in 21 patients (33.9%). Patients with metastasis had significantly lower HALP scores compared to those without (p = 0.007). ROC analysis identified a HALP cut-off value of 6.98, yielding a sensitivity of 73% and specificity of 81% (AUC = 0.695; 95% CI: 0.56–0.83; p = 0.013). No significant associations were observed between HALP score and TNM stage or demographic variables.Conclusion: The HALP score is significantly associated with pathological lymph node metastasis in cN0 LAURC patients and may serve as a simple, inexpensive, and clinically applicable biomarker to support preoperative staging. Further prospective studies with survival-based endpoints are warranted to validate its prognostic value.

Amaç: Bu çalışmanın amacı, preoperatif dönemde C-Reaktif Protein–Albümin–Lenfosit (CALLY) indeksinin meme kanserinde aksiller lenf nodu (ALN) metastazını ayırt etmedeki tanısal performansını değerlendirmektir.Materyal ve metod: Haziran 2023-Ocak 2025 arasında meme kanseri nedeniyle cerrahi uygulanan 59 ardışık kadın hasta retrospektif olarak incelendi. CALLY şu şekilde hesaplandı: (Albümin [g/dL] × Lenfosit [10⁹/L])/(CRP [mg/dL] × 10⁴). ROC analizi ile kesme değeri (≤1,9) belirlendi; hastalar düşük CALLY (Grup 1) ve yüksek CALLY (Grup 2) olarak sınıflandırıldı. CALLY’nin ALN pozitifliğini öngörmedeki duyarlılık/özgüllüğü hesaplandı ve klinikopatolojik değişkenler gruplar arasında karşılaştırıldı. Haziran 2023-Ocak 2025 arasında meme kanseri nedeniyle cerrahi uygulanan 59 ardışık kadın hasta retrospektif olarak incelendi. CALLY şu şekilde hesaplandı: (Albümin [g/dL] × Lenfosit [10⁹/L])/(CRP [mg/dL] × 10⁴). ROC analizi ile kesme değeri (≤1,9) belirlendi; hastalar düşük CALLY (Grup 1) ve yüksek CALLY (Grup 2) olarak sınıflandırıldı. CALLY’nin ALN pozitifliğini öngörmedeki duyarlılık/özgüllüğü hesaplandı ve klinikopatolojik değişkenler gruplar arasında karşılaştırıldı.Bulgular: Grup 1’de 28, Grup 2’de 31 hasta vardı. ROC analizi AUC=0,503; p=0,968 gösterdi. Kesme ≤1,9 için duyarlılık %43, özgüllük %53 olup klinik olarak anlamlı ayırt edicilik sağlamadı. Düşük CALLY grubunda albümin daha düşük, CRP daha yüksek ve lenfosit sayısı daha düşük saptandı (sırasıyla p<0,001; p=0,001; p=0,002). Sentinel lenf nodu biyopsisi oranları gruplar arasında benzerdi. CALLY ile metastatik ve toplam lenf nodu sayıları arasında anlamlı korelasyon izlenmedi.Sonuç: Bileşenleri tek tek istatistiksel farklılık gösterse de CALLY indeksi, bu kohortta ALN metastazını öngörmek için klinik olarak kullanışlı bir skorlama sistemi değildir. Bulgular, aksiller evrelemede tek başına inflamasyon temelli indekslere güvenilmemesi gerektiğine işaret eden negatif tanısal kanıt sunmaktadır.

Background: Sentinel lymph node biopsy (SLNB) is the standard axillary staging procedure in clinically node-negative breast cancer but remains invasive, non-therapeutic and increasingly questioned in contemporary de-escalation algorithms. After neoadjuvant chemotherapy (NACT), however, the safety of omitting SLNB solely on the basis of a negative axillary ultrasound (AUS) is uncertain, particularly across molecular subtypes with heterogeneous chemosensitivity. This study evaluated the diagnostic performance of preoperative AUS after NACT and explored clinicopathological and biological factors associated with SLNB positivity in ultrasound-negative axillae. Methods: In this single-centre retrospective cohort, 135 women with invasive breast cancer who received NACT followed by surgery (2022–2024) were analysed. To avoid spectrum bias, 77 patients with clipped, cytologically or histologically proven node-positive disease at baseline were excluded from the main analysis. All patients underwent preoperative AUS and definitive axillary staging. Ninety-six women with ultrasound-negative axillae who proceeded to SLNB constituted the primary study population. Oestrogen receptor (ER), progesterone receptor (PR), HER2, Ki-67 and immunohistochemistry-based molecular subtype were recorded. Receiver operating characteristic (ROC) analysis and uni/multivariable logistic regression were used as exploratory tools to identify factors associated with SLNB positivity. Results: In the overall cohort, AUS sensitivity, specificity, negative predictive value and false-negative rate for axillary metastasis were 47.8%, 90.9%, 62.5% and 52.2%, respectively. Among ultrasound-negative axillae, SLNB was positive in 37.5%. Compared with SLNB-negative patients, those with SLNB metastases more frequently harboured an intratumoural ductal carcinoma in situ (DCIS) component, showed higher ER/PR expression and lower Ki-67, and were predominantly luminal A or luminal B/HER2−, whereas AUS performance appeared more favourable in HER2-enriched and triple-negative tumours. ROC-derived cut-offs for ER (82.5%), PR (25.0%) and Ki-67 (17.5%) provided only moderate discrimination (area under the curve 0.68–0.70). In multivariable analysis, absence of a DCIS component and low PR expression were independently associated with reduced odds of SLNB positivity, suggesting that DCIS and high PR may act as indicators of residual nodal risk in ultrasound-negative axillae. All estimates are limited by sample size and wide confidence intervals and should be interpreted as hypothesis-generating. Conclusions: Preoperative AUS alone cannot reliably exclude sentinel lymph node metastasis after NACT, particularly in luminal A and luminal B/HER2− tumours with strong hormone receptor expression and a low proliferative index. Until prospective, biology-stratified trials confirm the safety of omission, SLNB should not be withheld solely on the basis of a negative AUS in these subtypes. Axillary management after NACT should systematically integrate both imaging findings and tumour biology when considering further de-escalation of surgery.