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Background: One of the most important factors in breast cancer (BC) mortality is treatment delay. The primary goal of this survey was to identify factors affecting the total delay time (TDT) in Turkish BC patients. Methods: A total of 1031 patients with BC were surveyed using a uniform questionnaire. The time between discovering the first symptom and signing up for the first medical visit (patient delay time; PDT) and the time between the first medical visit and the start of therapy (system delay time; SDT) were modelled separately with multilevel regression. Results: The mean PDT, SDT and TDT were 4.8, 10.5 and 13.8 weeks, respectively. In all, 42% of the patients had a TDT >12 weeks. Longer PDT was significantly correlated with disregarding symptoms and having age of between 30 and 39 years. Shorter PDT was characteristic of patients who: had stronger self-examination habits, received more support from family and friends and had at least secondary education. Predictors of longer SDT included disregard of symptoms, distrust in success of therapy and medical system and having PDT in excess of 4 weeks. Shorter SDT was linked to the age of >60 years. Patients who were diagnosed during a periodic check-up or opportunistic mammography displayed shorter SDT compared with those who had symptomatic BC and their first medical examination was by a surgeon. Conclusion: TDT in Turkey is long and remains a major problem. Delays can be reduced by increasing BC awareness, implementing organized population-based screening programmes and founding cancer centres.

460C ontrast-enhanced magnetic resonance imaging (MRI) is a complementary imaging technique that is increasingly used in the surgical treatment planning of breast cancer. Contrast-enhanced MRI has a sensitivity of 40%-100% in detecting ductal carcinoma in situ (DCIS) and up to 100% sensitivity in detecting invasive breast cancer (1, 2). In many studies, MRI had a higher accuracy than mammography (MMG) and ultrasonography (US) in detecting multiple malignant foci, in defining the actual size and spread of a solitary tumor, and in diagnosing contralateral synchronous breast cancer (3-5).Many studies have indicated various detection rates of MRI (16%-37%) for occult multiple lesions. The detection rate for a larger spread of the cancer is as high as 34% (1,5,6).Larger extension of local disease affects not only the surgical and systemic treatment but also the axillary lymph node approach for staging leading to a direct full axillary dissection instead of sentinel node excision (5, 7).Our objective in this prospective study was to investigate 1) the rate at which additional evidence is obtained with a pre-operative MRI and 2) how often the MRI findings change the surgical plan in patients for whom physical examination, MMG, and US findings make them candidates for breast-conserving surgery. Materials and methodsThe study was approved by the Ethics Committee of the Ege University School of Medicine. Retrospective analyses were performed on the prospectively obtained information. All of the patients were asked to read and sign informed consent prior to the MRI examination.Contrast-enhanced breast MRIs were performed on 69 female patients undergoing physical examination, MMG, and US between August 2006 and December 2008. These patients exhibited evidence of breast cancer based on clinical and radiologic findings and were candidates for breastconserving surgery.Inclusion criteria were as follows: 1) Cytologically or histopathologically (fine-needle aspiration biopsy, Tru-cut excisional or incisional biopsy) proven breast cancer, 2) In accordance with the TNM classification used for malignant tu- All of the enrolled patients were believed to be candidates for breast conservation on the basis of physical examination, mammography, and ultrasonography. The patients were reevaluated with the MRI examination as to whether they were still candidates for breast conservation therapy. RESULTSThe MRI findings changed the previous management plans in 19.1% of the 68 patients. With respect to the surgical approach, no statistically significant difference was observed between the histopathology groups (P = 0.403). In terms of the breast parenchymal pattern, however, surgical planning was changed in 53.8% of the patients who exhibited a dense pattern, which was significantly different from the rates of the other groups (P = 0.006). The sensitivity, specificity, positive predictive value, and negative predictive value of the MRI for additional malignant lesion detection and identification were 85%, 98%, 92%, and 96%, respectively. The...

According to the results of our study, we conclude that perioareolar intradermal injection of Tc-99m tin colloid combined with peritumoral intraparenchymal injection of blue dye is an accurate and easy method of locating the sentinel node with very high detection rates. It is recommended that the combination of all methods such as lymphoscintigraphy, blue dye, and gamma probe application will increase the success rate of SLN detection in patients with breast cancer.