Objective: This study aimed to determine clinical and pathological factors that identify a pathological complete response (pCR) in breast cancer patients undergoing neoadjuvant chemotherapy (NAC). Material and Methods: A retrospective, single-center study was conducted in women over the age of 18 who had been diagnosed with pathologically confirmed invasive breast cancer and who had received NAC between July 2016 and October 2021. Patient demographics, clinical, radiological, treatment, and pathological data were reviewed from the electronic hospital records. The primary outcome of interest was pCR, defined as the absence of residual invasive breast cancer in both the breast and axillary lymph nodes. Multivariable logistic regression analysis was used to identify factors associated with pCR. Results: A total of 119 patients were included in the analysis. The distribution of age was 54.5 ± 11.5 years. pCR was observed in 33 (27.7%) patients. pCR for breast tissue was observed in 43 (36.1%) patients. There was no statistically significant relation between the clinical stage and pCR. Age, age at first labor, extent of disease in the breast, NAC completeness, clinical tumor size (cT) stage, clinical lymph node (cN) stage, and molecular subtype were analyzed in a multivariable model. Analysis showed that molecular subtype was the only independent factor related to pCR. pCR rates across molecular subtypes were: 8.7% in luminal-A, 10.8% in luminal-B, 54.5% in human epidermal growth factor receptor 2 (HER-2)-positive, 42.4% in luminal-B (HER-2 positive) and 46.7% in triple-negative. There was no statistically significant difference between luminal-A and luminal-B subgroups (odds ratio 1.15, 95% confidence interval, 0.19-9.35, p= 0.881). Despite the limited number of patients in HER2-positive and triple-negative groups, both demonstrated statistically significant higher odds compared to reference group. Conclusion: The presented study underscores the relevance of molecular subtypes in determining the response to neoadjuvant chemotherapy in breast cancer patients. Particularly HER2-positive and triple-negative subtypes may demonstrate more favorable response rates.

Background and Objectives: Gallstone ileus (GI) is a rare mechanical intestinal obstruction resulting from gallstone impaction through a bilioenteric fistula, accounting for 1–4% of mechanical intestinal obstructions. This study aimed to evaluate the clinical approach, surgical management, and outcomes in a cohort of surgically treated GI patients. Materials and Methods: A retrospective cohort analysis of 12 patients diagnosed with GI and treated surgically between January 2018 and December 2024 was conducted. Data collected included demographics, clinical presentation, imaging findings, surgical approach, and postoperative outcomes. Descriptive statistics were used due to small sample size. Results: All patients presented with abdominal pain and vomiting, with delayed admission (mean 3.83 ± 2.08 days). Rigler’s triad was identified on CT in 91.7% of cases. The distal ileum (66.7%) was the most common site of obstruction, with a mean stone size of 3.19 ± 0.6 cm. Surgical management included enterolithotomy alone (66.7%, n = 8) and one-stage procedures (33.3%, n = 4). Laparoscopic approaches were employed successfully in 41.7% of cases (n = 5) without the need for conversion. Postoperative complications occurred in 41.7% of patients, with 8.3% mortality (n = 1). One recurrence was observed during a median (IQR) follow-up period of 33.00 (7.00–66.00) months. Conclusions: GI management should be individualized based on patient risk factors. In our cohort, enterolithotomy alone was the most common approach for high-risk elderly patients, while one-stage procedures were performed in stable patients with residual gallstones. Laparoscopic approaches were utilized in selected hemodynamically stable patients with appropriate surgical expertise. Our experience suggests that minimally invasive techniques can be successfully achieved in this traditionally challenging condition with careful patient selection.

Ductal carcinoma in situ (DCIS) is a heterogeneous precursor lesion with variable invasive potential. Current predictive parameters for invasion risk offer limited utility for personalized assessment. This study aims to evaluate artificial intelligence (AI)-assisted mammography analysis as a tool for predicting invasion risk in DCIS patients. In this retrospective cohort study, 74 patients with pathologically proven DCIS by preoperative biopsy were analyzed using a deep learning-based AI system (Transpara version 1.7.4). The AI system classified patients into low-risk and high-risk groups, which were validated against postoperative histopathological findings. Statistical analysis included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy calculations. Invasion was detected in 19 (25.7%) patients, with 18 (94.7%) classified as high-risk by the AI system. The model demonstrated 94.7% sensitivity, 45.5% specificity, 37.5% PPV, and 96.2% NPV. In patients aged ≥ 50 years and those with lesions ≥ 3 cm, the NPV reached 100%. A significant relationship was found between necrosis and invasion (p = 0.004). The high NPV suggests AI-assisted mammography analysis could serve as an effective rule-out tool for invasion in DCIS patients, potentially identifying candidates for less aggressive surgical treatment. Further validation in larger, multi-center studies is necessary to confirm these findings.

Background: Wire localization for nonpalpable breast lesions and pre-neoadjuvant chemotherapy (NAC) clips can lead to complications including wire migration, pneumothorax, and organ injury. This study evaluates the clinical efficacy and safety of a novel 3D-printed screw mechanism designed to prevent wire migration. Methods: This retrospective descriptive study included 104 patients with nonpalpable breast lesions and pre-NAC clips who underwent wire localization between March 2023 and August 2024. A screw mechanism was designed and manufactured using 3D printing technology with polylactic acid (PLA) material (4 g per device). The device features a 21.7 mm base diameter and elliptical wire hole (2.5 × 4 mm). Wire stability and complications were assessed through imaging and clinical follow-up. Results: The median age was 47 years (range: 33–82) and median BMI was 24.7 (17.9–40.8). Lesions were primarily located in the upper outer quadrant (49.9%). Among 68 patients receiving NAC, 44.1% achieved pathological complete response (ypT0N0). The screw mechanism successfully prevented wire migration during patient transport from radiology to operating room in all 104 cases (0% migration rate, 95% CI: 0-3.6%). No complications including pneumothorax, organ injury, or skin reactions were observed. The device was easily removed by simple unscrewing on the operating table before surgical skin preparation. Median device application time was 2–4 h. Conclusion: The 3D-printed screw mechanism effectively prevents wire migration and demonstrates excellent safety profile. Its simple design and ease of application make it a practical solution for improving patient safety during breast lesion localization procedures. Trial registration: Not applicable. This retrospective study did not require trial registration.

Aims: Distinguishing complicated from uncomplicated acute appendicitis before surgery has important implications for surgical planning and patient counseling. This study aims to evaluate and compare the diagnostic value of inflammatory biomarkers and liver function tests in differentiating complicated from uncomplicated acute appendicitis, and to determine whether their combined use improves predictive performance over inflammatory markers alone.Methods: A total of 722 appendectomy patients from a single institution were retrospectively analyzed. Based on operative findings and histopathological reports, patients were classified as complicated (gangrenous, perforated, abscess) or uncomplicated. Preoperative white blood cell count (WBC), neutrophil, lymphocyte, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), gamma-glutamyl transferase (GGT), total bilirubin, direct bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were analyzed. Diagnostic performance was evaluated using ROC analysis, logistic regression, and DeLong test model comparison.Results: Of 722 patients, 637 (88.2%) had uncomplicated and 85 (11.8%) had complicated appendicitis. CRP (p

Background/Aims: Treatment of perihilar cholangiocarcinoma (PHCC) and intrahepatic cholangiocarcinoma (IHCC) is a challenging issue. We aimed to investigate the clinical characteristics of both tumors and the outcome of our treatment policy. Material and Methods: We retrospectively analyzed data of 117 patients who were diagnosed with PHCC or IHCC between January 2007 and September 2023. Postoperative outcomes and the effects of prognostic factors on overall survival (OS) were investigated. Results: Surgical resection was performed on 47 patients (PHCC, n = 33 and IHCC, n = 14). Preoperative biliary drainage was applied in 32 of 33 cases with PHCC and 2 of 14 cases with IHCC. The mortality rate was 8.5% (n = 4). The complication rate was 68.1%. The R0 resection rate was 73% in PHCC. The mean OS time of PHCC cases that underwent R0 resection was 26.5 ± 24.8 months. The mean OS time of patients who underwent resection for IHCC was 28.7 ± 35.5 months. The OS was poorly affected by high CA19-9 levels (≥37 U/mL) (P = .005), the presence of lymphovascular invasion (P = .049), positive surgical margins after resection (P < .001), and the development of postoperative acute renal failure (P = .078). The OS of patients receiving adjuvant chemotherapy was significantly longer (P = .071). CA19-9 levels of more than 37 U/mL (P = .027) and positive surgical margin (P < .001) were independent factors for poor OS. Conclusion: Surgical resection is the mainstay of multidisciplinary treatment for PHCC and IHCC. In advanced stages of IHCC, the combination of loco-regional therapies and repeat surgery, along with the enhanced efficacy of systemic chemotherapy, plays a significant role in a patient’s survival. Cite this article as: Gundogdu A, Anil Kodalak T, Kucukaslan H, et al. Multidisciplinary approach to perihilar and intrahepatic cholangiocarcinoma: A single-center experience. Turk J Gastroenterol. 2025;36(1):34-44.