Vol 16, No 1 (2020)

Biopsy of signal (sentinel) lymph nodes (LN) has been performed at the N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia, for almost 20 years. In the first few years, contrast-visual method (1 % blue isosulfan and triphenyl methane control) was used in 640 patients with early (T1–2N0M0) breast cancer. In 150 patients from this cohort, standard axillary dissection was performed irrespectively of the results of signal (sentinel) biopsy. The rate of false positive responses varied between 4.6 and 6.6 %. Since 2012, radioisotope method of visualization of signal LN with intratumor administration of ^99mТс-technephyte colloid particles has been used (in 708 patients with T1–3N0M0 breast cancer). This type of signal LN biopsy had the following diagnostic characteristics: sensitivity was 58.9 %, specificity was 96.2 %, diagnostic accuracy was 87.1 %.

In parallel with this study, in 2016 a study of diagnostic accuracy and safety of biopsy of axillary LN after neoadjuvant systemic therapy was started. The study included 263 patients with T1N1–3M0, T2–3N0–3M0, T4N0–1M0 breast cancer. To evaluate clinical status of axillary LN, ultrasound, single-photon emission computed tomography, mammography at baseline and after completion of neoadjuvant chemotherapy ± targeted therapy (trastuzumab) were performed. In some patients, in the recent years a double method of signal LN labeling (radioisotope and fluorescent methods) was used.

In patients with baseline cN⁺-status, the rate of false positive signal LN biopsy conclusions was 13.6 %, in patients with baseline cN0-status it was 7.7 %.

The study of double contrast of axillary LN and targeted label of metastatic LN prior to neoadjuvant systemic therapy continues. In total, various modifications of biopsy of signal LN were performed in 2,000 patients with breast cancer.

The study protocol was approved by the biomedical ethics committee of N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia.

All patients gave written informed consent to participate in the study.

The use of CDK4/6 inhibitors in combination with endocrine therapy (aromatase inhibitors and fulvestrant) allowed us to radically change our understanding of opportunities in the treatment of hormone-positive HER2-negative advanced breast cancer and determine optimal therapy sequencing. The results of randomized clinical trials and over 5-years accumulated international experience in the use of CDK4/6 inhibitors in real clinical practice prove that the use of combinations with CDK4/6 inhibitors can achieve significant efficacy results and increase the survival rates when prescribed in 1 and 2 lines of treatment.

In this paper, we present the results of a survey conducted in July–October 2019 among 48 oncologists in Moscow, that were asked to choose, in their opinion, the most preferable patient’s profile and molecular and biological features of hormone-positive HER2-negative advanced breast cancer, in which the use of combination therapy with CDK4/6 inhibitors will provide the greatest benefit.

Conflict of interest. MD M.A. Mukhina is the medical director of oncology in the Eurasia and Baltic region of Pfizer Innovations Company

The aim of the study is to evaluate the role and prognostic significance of magnetic resonance imaging (MRI) perfusion methods in prognosis of disease course and outcome based on evaluation of the perifocal infiltration zone in pelvic disorders in women.

Materials and methods. Retrospective analysis of pelvic MRI data obtained using MRI system with induced magnetic field of 1.5 T was performed. The study included 530 protocols of pelvic scans in women. Two equal groups (n = 265) of patients with oncological and nononcological pathologies of pelvic organs were formed; after application of propensity score matching, each group contained 165 patients. All examination protocols included dynamic contrast enhancement. The obtained data were statistically analyzed using the Stata 13 software.

Results. In the study, types of dynamic curves obtained using dynamic contrast enhancement from the perifocal infiltration zone were analyzed. There was no data showing a correlation between the type of dynamic curve from the zone of perifocal changes and disease prognosis or possibility of differential diagnosis.

Conclusions. Evaluation of the perifocal infiltration zone per MRI results with intravenous contrast does not affect prognostic accuracy of the method (p >0.05); contrast can be used only for differential diagnosis or evaluation of local advancement of the process.