Ahmet Cetin

Haseki Training and Research Hospital, İstanbul, Istanbul, Turkey

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Publications (81)69.49 Total impact


  • No preview · Article · Sep 2014
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    ABSTRACT: The objective of this study was to examine demographic and clinicopathologic characteristics and to determine the effects of primary surgery, surgical staging and the extensiveness of staging. In a retrospective Turkish multicenter study, 539 patients, from 14 institutions, with borderline ovarian tumors were investigated. Some of the demographic, clinical and surgical characteristics of the cases were evaluated. The effect of type of surgery, surgical staging; complete or incomplete staging on survival rates were calculates by using Kaplan-Meier method. The median age at diagnosis was 40years (range 15-84) and 71.1% of patients were premenopausal. The most common histologic types were serous and mucinous. Majority of the the staged cases were in Stage IA (73.5%). 242 patients underwent conservative surgery. Recurrence rates were significantly higher in conservative surgery group (8.3% vs. 3%). Of all patients in this study, 294 (54.5%) have undergone surgical staging procedures. Of the patients who underwent surgical staging, 228 (77.6%) had comprehensive staging including lymphadectomy. Appendectomy was performed on 204 (37.8%) of the patients. The median follow-up time was 36months (range 1-120months). Five-year survival rate was 100% and median survival time was 120months. Surgical staging, lymph node sampling or dissection and appendectomy didn't cause any difference on survival. Comprehensive surgical staging, lymph node sampling or dissection and appendectomy are not beneficial in borderline ovarian tumors surgical management.
    No preview · Article · Sep 2013 · Gynecologic Oncology

  • No preview · Article · Feb 2013
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    ABSTRACT: Objective: This study aimed to examine the endocervical canal curettage (ECC) results of patients with atypical squamous cells of undetermined significance (ASC-US) or low-grade intraepithelial lesion (LSIL) and secondarily to explore the features of patients who are at greatest risk for endocervical involvement. Materials and methods: This is a retrospective analysis of 846 women who underwent ECC with ASC-US or LSIL on cervical cytology between January 2003 and April 2011. Records of demographic data and colposcopic impression were evaluated. Histopathological results of biopsies and ECC were classified into 2 categories as less than cervical intraepithelial lesion 2 (CIN 2) and CIN 2+ lesions for comparison. Multivariate analysis was performed using binary logistic regression analysis to identify predictors of ECC results. Results: CIN 1 lesions were detected in 8.9% of patients, and the rates of CIN 2 or 3 and invasive/microinvasive cancers in ECC were 3.8% and 0.7%, respectively. Cervical intraepithelial lesion 2 or worse lesions were detected in 1.6% (7/419) of the patients with normal colposcopic findings. There was no statistically significant difference in the rate of CIN 2+ lesion in endocervical canal between the patients with or without satisfactory colposcopic examination (4.4% vs 4.1% p = .69). A total of 1.7% of the patients who did not have cervical biopsy and also 1.1% of the patients who had less than CIN 2 biopsy results were diagnosed with CIN 2+ lesion by ECC despite the satisfactory colposcopy. Only a positive biopsy result for dysplasia was found to be an independent factor for the detection of a dysplastic lesion in endocervical canal (odds ratio = 0.06; 95% CI = 0.01-0.35; p = .02). Conclusions: Endocervical canal curettage had minimal diagnostic utility for the detection of CIN 2 or worse lesions in women with ASC-US or LSIL smear result and normal colposcopic findings. In addition to this, the presence or absence of CIN 2+ lesions diagnosed by means of endocervical curettage was independent of a satisfactory or unsatisfactory colposcopic examination.
    No preview · Article · Feb 2013 · Journal of Lower Genital Tract Disease
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    ABSTRACT: Objective To compare the diagnostic accuracy of endocervical curettage (ECC) and endocervical brushing (EB) in patients referred for colposcopic evaluation for low grade squamous intraepithelial lesion. Materials and methods A prospective, randomized, comparative trial was conducted in an Education and Research Hospital, Gynecologic Oncology Clinic. After exclusion of 40 subjects, 208 patients were randomly allocated into ECC (n = 104) and EB (n = 104) groups. A pathologist blinded to the specimen obtaining method evaluated all samples for the primary outcome of sampling adequacy. Secondary outcome measure was pain scores during the sampling was investigated by using visual analogue scale (VAS). Results Ten samples from the ECC group (9.6 %) and 12 samples from the brushing group (12 %) contained scanty endocervical specimen (p = 0.09). Evaluating samples for stroma; it was reported that brushing group had a statistically significantly higher percentage of specimens with no stroma (44 %) than ECC group (24 %) (p = 0.003). Mean and standard deviation of VAS scores during the ECC and EB procedures were 2.55 ± 1.12 and 1.99 ± 0.87, respectively (p < 0.001). Conclusion Endocervical brushing was proved to be as accurate with respect to diagnostic yield as ECC but less painful, evaluating the endocervical canal. It can be an alternative for evaluation of the cervical canal pathology in patients with low grade cytologic abnormalities but devoid of the misinterpretation of stromal invasion; ECC should be preferred in patients with a suspicion of invasive disease.
    Full-text · Article · Sep 2012 · Archives of Gynecology

  • No preview · Article · Jun 2012
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    ABSTRACT: To evaluate the feasibility of ovarian preservation at the time of operation in patients with clinical stage I endometrial carcinoma. The data of 499 consecutive patients with clinical stage 1 endometrial cancer operated between January 2001 and December 2011 were retrospectively reviewed. Clinical and pathologic information and the intraoperative inspection findings of ovaries were evaluated to find the factors associated with the coexisting ovarian malignancy. The mean age of patients was 56.8 ± 9.8 years. Coexisting ovarian tumors were detected in 38 patients (7.6 %), and 28 (5.6 %) of them were malignant (12 metastatic and 16 synchronous primaries). Most of the patients were postmenopausal (n = 371, 74.3 %) and 60 (12 %) of the patients were at the age of 45 years or less. Coexisting malignancy was detected in 9 % (n = 11) of the premenopausal patients and in 5 % (n = 3) of the patients aged 45 years or less. Multivariate analysis revealed that serosal invasion, tubal involvement, and positive abdominal cytology were independent risk factors for coexisting ovarian malignancy. The sensitivity, specificity, positive predictive value and negative predictive value of the intraoperative examination for the diagnosis of benign/normal ovary was 99.6, 78.8, 98.5 and 92.9 %, respectively. The incidence of coexisting ovarian malignancy in clinical stage I endometrial carcinoma is low. Although occult metastasis cannot be excluded at all, careful intraoperative inspection of ovaries seems valuable for the prediction of co-existing ovarian malignancy.
    No preview · Article · Jun 2012 · Archives of Gynecology
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    ABSTRACT: To compare the final diagnosis among pre- and postmenopausal women with low-grade squamous intraepithelial lesion (LGSIL) cervical smear results. Retrospective, comparative study. Departments of obstetrics and gynecology in two teaching and research hospitals. Data were evaluated on 712 women with LGSIL between April 2005 and April 2011. Results from 129 postmenopausal women with LGSIL were compared with 583 premenopausal women with a similar LGSIL result with respect to sociodemographic data and histopathology. Final clinicopathological diagnosis. The mean age of the pre- and postmenopausal women was 37.2 and 52.5 years, respectively, and lesions of cervical intraepithelial neoplasia grade 2 or worse were detected by biopsy and/or endocervical curettage in 13.6 and 9.3%, respectively. There was no significant difference between the final diagnosis among pre- and postmenopausal women with LGSIL cytology (relative risk 1.43; 95% confidence interval 0.82-2.48; p= 0.19). Invasive cervical cancer was detected in three premenopausal (0.5%) and two postmenopausal women (1.6%). Cervical pre-invasive and invasive disease rates were similar in pre- and postmenopausal women with LGSIL cytology. For this reason, LGSIL in postmenopausal women should be considered more seriously, and colposcopic evaluation may be as acceptable an option in the management of LGSIL in this group of patients as it is with premenopausal women.
    No preview · Article · May 2012 · Acta Obstetricia Et Gynecologica Scandinavica
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    ABSTRACT: To compare preoperative grading in endometrioid endometrial cancer with the final pathologic assessment of the hysterectomy specimen. The second objective of the study was to determine a high risk group who will be upgraded in the postoperative evaluation. A total of 335 patients with endometrioid endometrial cancer were retrospectively reviewed between June 2000 and January 2011. All pathology results were pre- and postoperatively reviewed at two institutions, and all patients underwent surgical therapy. Sensitivity, specificity, positive and negative predictive values and accuracy rates were calculated for all grades in the preoperative assessment. The mean age of the patients was 56.2±9.6 and the vast majority of the patients were postmenopausal (n=239, 71.3%). FIGO grade was determined to be greater in 75 patients in the final hysterectomy specimen. Fifty-five (32.9%) of the patients with preoperative grade 1 were found to be grade 2 and 3.6% of them were upgraded to grade 3. Fourteen of the patients with grade 2 (11.4%) were found to be grade 3. The accuracy rates of the preoperative grade assessment with endometrial sampling were 75.5%, 66.2% and 88.3% for grades 1, 2 and 3, respectively. There were no statistically significant differences in the preoperative demographic characteristics between patients with or without upgraded tumors. A high percentage of preoperatively diagnosed grade 1 tumors were upgraded in the postoperative evaluation. The patients who would have been upgraded after hysterectomy could not have been predicted preoperatively using the characteristic features.
    Full-text · Article · Mar 2012 · Journal of the Turkish German Gynecology Association
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    ABSTRACT: To identify clinicopathological risk factors for pelvic lymph node metastasis, and to evaluate the clinical validity of these factors in selecting patients who need pelvic lymph node dissection. The data of 466 patients who had lymphadenectomy for endometrioid adenocarcinoma of the endometrium between January 2002 and December 2010 were reviewed retrospectively. All patients underwent pelvic lymphadenectomy and 192 (41.2%) patients also underwent paraaortic lymphadenectomy. The median number of pelvic lymph node was 16 (range: 2-46) and of paraaortic lymph node was 5 (range: 2-16). 10.1% (47/466) of all patients had pelvic lymph node involvement and 7.8% (15/192) of the patients had paraaortic lymph node involvement (LNI). Pelvic LNI was significantly more common in the presence of higher grades of tumor, LVSI, deep myometrial invasion, positive peritoneal cytology and cervical involvement. The logistic regression analysis revealed that LVSI, cervical glandular invasion and cervical stromal invasion remained to be the independent risk factors for LNI. When the LVSI and/or cervical involvement were considered as high risk for pelvic lymph node metastasis, NPV and specificity were found to be 96.3% and 68.4%, respectively. LNI was correctly estimated in 323 women (69%), overestimated in 132 women (28%) and underestimated in 11 women (2%). LVSI, cervical glandular and stromal involvement were independent risk factors for pelvic LNI. These variables can be assessed pre- or intraoperatively with a high rate of accuracy, the model which uses these variables may be successfully used in the prediction of pelvic lymph node metastasis.
    No preview · Article · Feb 2012 · Gynecologic Oncology
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    ABSTRACT: Maffucci syndrome is a rare disorder associated with multiple enchondromatosis and soft tissue hemangiomas. An association of enchondromatosis and juvenile granulosa cell tumor (JGCT) at a young age has been previously reported. Four cases of Maffucci syndrome with JGCT were reported in the literature until 2009 and the eldest patients with Maffucci syndrome and JGCT was 21 years old. We report eldest patient with Maffucci syndrome who developed a JGCT in the literature.
    Preview · Article · Jan 2012 · Turk Jinekoloji ve Obstetrik Dernegi Dergisi
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    ABSTRACT: Aim: The aim of this study was to compare the surgical procedures for the treatment of stress urinary incontinence and to define which method is more effective and safe. Methods: Records of the patients who were treated for stress urinary incontinence between April 2003 and December 2010 were evaluated. Patients who underwent tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures, and Burch colposuspension were compared for evaluating the efficacy of the operation. Chisquare test and Fischer's Exact Test were used for categorical variables; continuous variables were analyzed by using student's t-test. A p value less than 0.05 was considered statistically significant. Results: Follow-up records of 97 patients were analyzed for this study. TVT was the most frequently used anti-incontinence procedure (n=39, 40.2%) followed by TOT (n=34, 35.1%) and Burch (n=24, 24.7%). The mean preoperative and postoperative International Consultation on Modular Questionnaire (ICIQ) scores were 16.4±2.01 and 4.68±5.6, respectively (p=0.0001). There was no significant difference between the operations according to subjective evaluation. The subjective cure/improvement rate for Burch was 87.5%, and was 74.3% and 88.2% for TVT and TOT, respectively. Conclusion: There were no significant differences between Burch, TVT and TOT for long-term efficacy. Surgical procedure should be chosen based on surgical experience and presence of additional surgical procedure.
    No preview · Article · Jan 2012
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    ABSTRACT: Objective: The aims of the study were to quantify the levels of anxiety associated with having received a low-grade abnormal smear result, identify factors associated with increased levels of anxiety. Material and methods: One hundred consecutive women referred for colposcopy for ASC-US result. Women in the study group completed prior to colposcopy the Hospital Anxiety and Depression Scale (HADS) which is a self-report inventory that consists of 14 items on two subscales. Socio-demographic and lifestyle factors associated with the psychosocial impact of the abnormal smear result were also assessed. Results: Having had children was a significant predictor of high anxiety scoring. Anxiety was significantly higher in women with low educational level. Women were educated 1-8 years were significantly more likely anxious. Conclusion: Interventions focus particularly on women's knowledge and understanding of smear results to reduce the adverse psychosocial impact of receiving an ASC-US cervical smear result.
    No preview · Article · Jan 2012
  • B.P. Göksedef · Y.R. Asma · M. Ekmez · A. Çetin
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    ABSTRACT: Ovarian hyperstimulation syndrome (OHSS) usually occurs up to %10 of women who use especially gonadotropins for artificial fertilization methods, becomes more intense with embryonic implantation and is associated with high miscarriage rate. Severe forms complicate 1% of IVF cycles and in the most marked cases, thromboembolic phenomena may occur as a result of hemoconcentration and coagulation disturbances. Severe OHSS is rare in case of spontaneous ovulation and always reported during pregnancy. We present a severe OHSS complicated with femoral, popliteal deep and superficial venous thrombosis in a 11 weeks pregnant women with spontaneous conception.
    No preview · Article · Jan 2012 · Turk Jinekoloji ve Obstetrik Dernegi Dergisi
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    ABSTRACT: We wished to determine the relationship between preoperative serum CA 125 levels and the risk of metastatic disease, recurrent disease, and death in women with endometrial cancer. We reviewed the records of women with endometrial adenocarcinoma of all stages who underwent primary surgery. We abstracted multiple data variables, including demographic characteristics, serum CA 125 levels, postoperative histopathology results, progression-free survival, and overall survival rates. The records of 97 women with endometrial carcinoma were analyzed. With a serum CA 125 cut-off level of 35 kU/L, the likelihood of disease-related death could be predicted with 70% sensitivity and 83% specificity; disease progression could be predicted with 60% sensitivity and 84% specificity; and lymph node metastasis could be predicted with 75% sensitivity and 84% specificity. There was a significant relationship between a serum CA 125 level ≥ 35 kU/L and depth of myometrial invasion, cervical stromal invasion, stage, frequency of recurrence, and disease-related death. Having deep myometrial invasion, cervical stromal involvement, positive peritoneal cytology, lymph node metastasis, disease recurrence, and disease-related death were each associated with significantly higher mean CA 125 levels. In women with serum CA 125 levels < 35 kU/L, five-year progression-free survival rates (88%) and overall survival rates (92%) were significantly better than in women with levels ≥ 35 kU/L (57% and 70%, respectively; P = 0.001 for both). Serum CA 125 levels and extension of disease are highly correlated in women with endometrioid endometrial cancer, and elevated CA 125 levels predict a higher risk of disease recurrence and death.
    Full-text · Article · Aug 2011 · Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC
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    ABSTRACT: Aim: We aimed to compare the components of metabolic syndrome in cases with various pregnancy complications and normal pregnancies. Materials and methods: Ninety two cases after 26. gestational week which were followed up in our clinic were included in the study. The rate of the presence of the factors of metabolic syndrome in 40 healthy pregnant women, 21 cases of gestational hypertention, 20 cases of gestational diabetes and 11 cases of preeclampsia were compared. Fasting serum cholesterol, triglyceride, LDL and HDL cholesterol levels were determined.The insulin resistance was calculated with HOMA-IR. Results: Mean levels of BMI were significantly higher in the group of pregnancy complications (GHT 33±5.1, preeclampsia 30.3 ±7.1, GDM 32.1±6.4, and controls 29.2±4.2 kg/m2; P=0.045). Mean leves of fasting serum glucose were also significantly higher in this group (GHT 80.5±16, preeclampsia 94.4±24, GDM 90.3±26, and controls 78.6±10 mg/dL; P=0.023). In the goups with complications mean levels of triglyceride were higher (GHT 267.7±61.5, preeclampsia 290.7±76.6, GDM 221.4± 81.3, and controls 218.3±45mg/dL; P=0.003). Mean levels of HDL did not show any significant difference. The rate of the cases with metabolic syndrome according either to the criteria of WHO (GHT %14.2, Preeclampsia %45.2, GDM %40, and controls %2.5; p=0.001) or NCEP-ATPIII (GHT %38, Preeclampsia %45.4, GDM %40, controls %0; p=0.001) was significantly higher in the groups of complications. Conclusions: We found that the criteria of metabolic syndrome and the rates of cases with MS were significantly higher in the groups of pregnancy complications compared with normal pregnancies. This finding indicates the relationship between both events. These cases have high risk for cardiovascular and metabolic diseases in later life.
    No preview · Article · Jan 2011
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    ABSTRACT: Objective: To determine the borderline ovarian tumors according to clinical features, treatment methods, recurrence and survival rates. Material and methods: Twenty-five cases were included to this study. Demographic and clinical findings, surgical methods, stage of disease, recurrences and survivals were revealed from hospital records. Data were analyzed with SPSS 13.0. Results: Mean age were 42.7±17.9. Most of the patients were in premenopausal (n=19, 76%). Mean tumor size were 13.44±9.37 cm (range 4-30 cm) and 16 of the patients had serous and 9 of them had musinous histologic type. Mean tumor size of serous and mucinous tumors were 9.44±6.78 cm, 20.56±9.4 cm, respectively and the difference was statisticallly significant (p=0.007). Tumor markers were elevated in 17 of the patients (68%) before the surgery. Twenty-two patients had frozen section (88%), accuracy rate of the frozen section was 90%. during surgery. Most of the patients were treated with total abdominal hysterectomy bilateral salpingo-oophorectomy (TAH-BSO) (n=12), 6 of the patients were treated with cystectomy and the others were treated with unilateral oophorectomy (USO) (n=7). Most of the cases were stage I (n=23, 92%). Recurrence of the disease was detected in 4 patients (16%) and 2 of them were treated with cystectomy and the others were treated with USO. No recurrence was detected in TAH-BSO group. Conclusions: Borderline tumors have perfect prognosis and most of the cases are premenopausal. The suggested treatment is surgical staging with TAH-BSO. Cystectomy might be chosen in young patients with fertilty desire, however, patients should be warned for high recurrence rates.
    No preview · Article · Jan 2011 · Turk Jinekoloji ve Obstetrik Dernegi Dergisi

  • No preview · Article · Jan 2011
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    ABSTRACT: Introduction: Struma ovarii is an ovarian tumor that consists predominantly thyroid tissue and accounts for only 2% of all mature teratomas. It is usually a benign condition - malignant transformation has been reported to occur in about 5% of all struma ovarii cases. Case: A 58-year-old postmenopausal woman attended our outpatient clinic for her annual gynecologic exam, on which a palpable ovary was incidentally found. Ultrasound and magnetic resonance imaging work-up showed two-centimeter solid mass on the right ovary. Laparoscopic salpingo-oophorectomy was performed; the histology report revealed a focus of thyroid papillary carcinoma in a struma ovarii. The patient underwent surgical staging procedure according to the ovarian cancer guideline. The tumor was in stage 1A, thus, no further treatment was indicated apart from follow-up. Conclusion: Malignant struma ovarii is a rare neoplasm of the ovary. Surgical staging should be included in the treatment, like in the other germ cell ovarian tumors.
    No preview · Article · Jan 2011
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    ABSTRACT: Objective: To determine the demographic, clinical, cytologic, colposcopic findings in women with postcoital bleeding Material and methods: Forty-eight premenopausal women with postcoital bleeding were referred to colposcopy unit between September 2009 and September 2010. Demographic features, cervical cytology results, colposcopic diagnosis and biopsy reports of cases were evaluated. Data were analyzed with SPSS 17.0. Results: The median age was 37 (23-49). Most of the cases did not use a contraceptive method (n=17, 35.4%) and were monogamous (n= 45, 93.8%) and multiparous (n=36, 75%). Cervical cytology identified 5 patients with ASCUS/LSIL, 2 with ASC-H and 3 with HSIL. Out of the 48 cases, 38 women had normal findings at colposcopy (79.2%) and 6 women had high grade cervical intraepithelial neoplasia (CIN 2/3) and invasive carsinoma (12.5%). Biopsy was taken from 39.6% of patients after colposcopic evaluation. Four cases were reported as CIN 1 (8.4%), 1 case as CIN 2 (2.1%), 1 case as CIN 3 (2.1%) and 2 cases as invasive carcinoma (4.2%) according to histopathologic evaluation. Conclusion: Even if, most of the cases with postcoital bleeding have benign lesions, colposcopy should be performed because of increased incidence of high grade CIN and invasive neoplasia.
    No preview · Article · Jan 2011 · Turk Jinekoloji ve Obstetrik Dernegi Dergisi