Over the past two decades, the surgical treatment of breast cancer (BC) has changed from standard radical mastectomies to organ-preserving and reconstructive plastic surgeries using endovideosurgical and robotic technologies.  Robot-assisted radical subcutaneous mastectomy, as a minimally invasive method of surgical treatment  of BC in the early stages, is recognized as safe and effective.

The results of robot-assisted radical subcutaneous mastectomy and radical subcutaneous mastectomy with endoprosthesis in 27 patients with histologically verified BC are presented. A comparative assessment of postoperative complications of robot-assisted radical subcutaneous mastectomy with endoprosthesis and radical subcutaneous mastectomy with endoprosthesis was performed. It was found that the postoperative period in robotic interventions is more favorable, which confirms the low need for analgesics, the absence of signs of the formation of hematomas of the surgical wound, as well as a decrease in the frequency of inflammatory infiltrates and gray soft tissues in the area of the postoperative suture. Performing a robot-assisted radical subcutaneous mastectomy with endoprosthesis can significantly improve the surgical and aesthetic results of BC treatment in the early stages of this disease.

Background. Breast cancer (BC) can be unifocal, multifocal, multicentric (MCBC) and bilateral according to number and localization of tumors. MCBC has different clinical and biological characteristics compared to unifocal BC, for example, a higher risk of lymph node involvement, a more aggressive natural history and a worse prognosis. Therefore, accurate diagnosis and detection of MCBC is one of the main tasks of imaging.

Objective: to compare diagnostic accuracy of contrast enhanced spectral mammography (CESM) and digital mammography (DM) in the diagnosis of MCBC.

Materials and methods. The study included 438 women with suspected BC. The results of DM and CESM were compared with the results of a pathomorphological study performed after surgery or biopsy to assess the effectiveness of imaging modalities. DM was performed for all women using a Senographe DS (GE, USA) unit. CESM was performed after intravenous injection of non-ionic contrast agents using injector with breast compression in the craniocaudal and mediolateral projections. The study was performed for both glands regardless of the location of the suspicious lesion in order to timely diagnose clinically asymptomatic bilateral cancer. The final diagnosis was made based on the results of the pathomorphological examination. MCBC was diagnosed when two or more tumors at a distance of 3 cm or more from each other were detected. Visualization of additional grouped calcifications of malignant type occupying a small portion of breast tissue (more than 15 pieces per 1 sq. cm) was considered as another mammographic sign of MCBC.

Results. According to the pathomorphological examination BC was diagnosed in 154 (35 %) women out of 438 examined patients. MCBC was identified in 25 (16 %) of 154 patients. CESM was more effective than DM in detecting MCBC with sensitivity of 88.0 % vs 48.0 % (p = 0.002), accuracy of 92.2 % vs 90.9 %, negative predictive value of 97.6 % vs 90.8 % (p = 0.02), respectively. But the specificity was significantly higher in DM than in CESM – 99.2 % vs 93.0 % (p = 0.009), respectively, and the positive predictive value did not differ significantly (p = 0.12).

Conclusion. CESM is a more sensitive method for diagnosing MCBC compared to DM with sensitivity of 88.0 % vs 48.0 %. The high negative predictive value of CESM (97.6 %) confirms the fact that this modality is an effective method for planning surgery and radiation therapy.

Retrospective analysis of the usage of fine needle aspiration breast cytolology has been represented in the present work. The potentialities of cytological diagnostics according to Yokohama system with characteristics of C1–C5 categories were estimated. The results of cytological conclusions of 4778 patients with breast lesions who had been examined in the Altay oncological dispensary during the year were studied.  Fine needle aspiration breast cytology was used of outpatients in 89.6 % cases. The largest number of patients  with pathological changes in the breast was noted in category C2 with benign processes (75.7 % of all cases). Difficult cases for cytological study, where the method could not guarantee the accuracy of the diagnosis, belong to the C3 and C4 categories (1.9 % of all cases). The cytological conclusion recommended the compulsory usage of the core biopsy. Malignant tumors were identified in 853 (19.9 %) patients with an indication of the histological type of tumors.

Thus, the cytological technique (as a part of Triple test) should be chosen for outpatients with breast diseases using the Yokohama writing system (C1–C5 categories) of fine needle aspiration cytology.

Background. The role of neoadjuvant chemotherapy (NACT) in luminal HER2-negative breast cancer (BC) remains highly controversial due to the lack of reliable predictors of drug therapy efficacy.

Objective: to evaluate the effectiveness of NACT in patients with aggressive luminal HER2-negative BC and to compare modern systems for assessing the pathomorphological response.

Materials and methods. The tumor response to NACT regimens was assessed in 64 patients with aggressive luminal HER2-negative BC stage II–III.  The median age of women was 46.5 years (range 31–76 years), 76.6 % had primary operable stages (cT1–3N0–1), locally advanced BC (cT4,  cN2–3) – 23.4 % patients. The characteristics of BC were as follows: invasive ductal carcinoma (76.6 %), grade G₂ and G₃–54.7 % and 45.3 %, Ki-67 ranged from 20 % to 98 %, median 45 %. The ER expression level was low (1–10 %, ERlow) in 12.5 % and was more than 10 % in 87.5 % of cases. HER2 status corresponded to 0, 1+ and 2+ in the absence of gene amplification – in 50.0 %, 35.9 % and 14.1 % of patients, respectively. The rate of TILs <10 %, 10–20 % and >20 % was in 71.4 %, 10.7 % and 17.9 % of cases. After NACT with the inclusion of anthracyclines and taxanes ± platinum combinations (in BRCA mutated status), the patients underwent radical surgery (mastectomy or breast-conserving surgery) with an assessment of the pathological response.

Results. 15.6 % of patients  had a complete pathomorphological response (pCR) to treatment, which corresponded to the RCB-0 class and the pathomorphological stage ypT0N0. Residual tumor load with incomplete response was very significant – class RCB-I was noted in only 7.8 %, and RCB-II and RCB-III – in 39.1 % and 37.5 %, respectively. An increase in the size of the residual tumor and the number of affected lymph nodes were associated with an increase in the RCB class. Predictors of pCR achievement in luminal HER2-negative cancer were: grade G₃, rare histological forms of BC (medullary, metaplastic), rate of TILs ≥30 %, low ER expression, and HER2 0 status.

Conclusion. Assessment of Ki-67, tumor grade, ER and HER2 rate, and TILs before starting NACT will  help identify a group of high sensitivity to chemotherapy and optimize the treatment strategy in aggressive luminal HER2-negative  BC.

Background. Triple negative breast cancer has no specific treatment sites for chemotherapy and is unfavorable in terms of prognosis. One of the drugs widely used in this cohort of patients is eribulin, which in addition to its antimitotic effect has an effect on the tumor microenvironment. The search for biological criteria that will allow predicting the effectiveness of the drug is assumed relevant since it will help to select patients who may receive the most benefit from certain therapy regimens.

Objective: identification of immunological predictors of the therapeutic effectiveness of eribulin in patients with locally advanced or metastatic triple-negative breast cancer.

Materials and methods. The study included 20 patients with locally advanced and metastatic triple negative breast cancer. 50 % had a short-term response (progression-free survival <3 months) to eribulin therapy, and 50 % had a long-term response (progression-free survival >6 months). Seven-color immunofluorescence was used to determine the subpopulation composition of tumor-infiltrating lymphocytes and their PD1 expression. Image acquisition and analysis were performed using the Vectra® 3.0 system and InForm® software (Akoya Biosciences, USA).

Results. It has been shown that the ratio of the number of PD1-negative to PD1-positive CD20+ B-lymphocytes less than 5.5 associated with the long-term effectiveness of eribulin in patients with locally advanced or metastatic triple negative breast cancer.

Conclusion. The results showed that the ratio of the number of PD1-negative to PD1-positive CD20+ B-lymphocytes can be considered as a possible marker to predict the effectiveness of eribulin in patients with breast cancer.

As a consequence of the advances in systemic neoadjuvant therapy of breast cancer is the de-escalation of surgical treatment.  The study of a limited number of axillary lymph nodes after neoadjuvant therapy and refusal of lymphadenectomy in the absence of metastatic lesions is becoming more common. The published studies have proven the informativeness and safety of standard techniques of sentinel lymph node biopsy after neoadjuvant treatment for cN0 patients. For group cN1 and regression of metastases after neoadjuvant treatment, standard sentinel lymph node biopsy techniques have failed. The use of combined methods of double detection and an increase in the number of examined lymph nodes to 3 and more increased the detection rate of sentinel node biopsy after neoadjuvant therapy and reduced false-negative rate. Long-term results, questions of methodology lymph nodes evaluation, radiation therapy in this group of patients require further investigation.

Background. The survival rate of patients with ovarian malignancies depends on the prevalence of the tumor process, the volume of surgical treatment, and the size of the residual tumor. At the first stage, an «aggressive» surgical tactic of removing all macroscopically determined tumor foci with subsequent antitumor drug therapy is recommended. However, the results of treatment remain unsatisfactory, which dictates the need to search for new methods of treatment.

Objective: to evaluate the effectiveness of implantable port systems for intraperitoneal chemotherapy administration in the treatment of patients with advanced stages of ovarian cancer.

Materials and methods. 37 cases of stage IIIC ovarian cancer were studied for the period 2018–2019. At the first stage of treatment, a cytoreductive operation was performed. At the second stage, the patients were randomly randomized into three groups: group 1 (n = 9) – installation of a port system + hyperthermic intraperitoneal chemoperfusion followed by intraperitoneal chemotherapy; group 2 (n = 11) – hyperthermic intraperitoneal chemoperfusion followed by systemic intravenous chemotherapy; group 3 (n = 17) – control group, intravenous administration of antitumor drugs. The observation period is 27 months. In the study groups, the indicators of age distribution, the degree of malignancy of the neoplasm, the volume of the residual tumor, and the relapse-free survival were analyzed.

Results. Trends towards differences in progression-free survival were found in all study groups. In group 1, there was no relapse in all patients. In group 2, relapses amounted to 18.2 %, in group 3–23.5 %. G₃ ovarian cancer (6 (66.7 %) and 6 (54.5 %) cases, respectively) prevailed in groups 1 and 2; G₁ ovarian cancer (9 (52.9 %) cases) prevailed in group 3. Discussion. Features of the chemical composition and method of administration of the drug increase the effectiveness of local exposure to tumor cells. The introduction  of cytostatic agents into the abdominal cavity leads to minimal systemic toxicity, which exceeds the results of standard intravenous therapy.

Conclusion. An advantage in the relapse-free survival of patients after hyperthermic intraperitoneal chemoperfusion in combination with an implantable port system was found in comparison with standard methods of treatment.

Background. In the NCCN guidelines published in 2020, chemoradiation treatment with adjuvant chemotherapy for patients with stage FIGO III cervical cancer was considered counter-productive. Long-term outcomes of treatment for patients with locally advanced disease (IIIC) are still not satisfactory. The desire to change the current situation resulted in the studying of the effectiveness of adjuvant chemotherapy in cervical cancer patients with regional lymph nodes metastases.

Objective: to evaluate the effectiveness of the combination of neoadjuvant chemoradiation plus adjuvant chemotherapy in patients with FIGO stage III cervical cancer (T1–2N1M0).

Materials and methods. The main group included 119 patients  who received chemoradiation followed by adjuvant chemotherapy with cisplatin from 2015 to 2018. The comparison group included 66 patients who received the same combination treatment between 2015 and 2018, however, without adjuvant chemotherapy. Adjuvant chemotherapy did not result in a quality of life reduction. Also, acceptable toxicity was achieved.

Results. The follow-up period for patients included in our research was 3 years or more. Recurrences occurred in 32 (27 %) patients in the main group and 31 (47 %) patients in the comparison group. During the first year of follow-up, recurrences occurred in 8 % in the main group and 43 % in a comparison group of patients respectively. There was a difference in the localization of recurrent events. Importantly, no cases of local recurrences were detected.

Conclusion. Disease recurrences more often developed in patients of reproductive age and squamous histological type of tumor. Mostly, the progression of the disease was manifested by metastases in the paraaortic lymph nodes. Almost half of all progression cases (48 %) in the comparison group appeared to be hematogenic metastasis. Most often the lungs and bones damage was detected.

Arterial chemoembolization is an X-ray surgical method that is used for recurrent pelvic tumors complicated by bleeding. It combines occlusion of tumor vessels and local chemotherapy, for which a cytostatic and drug-saturated microspheres are used. To obtain a result, two conditions must be met: carefully close all tumor afferents, treat the maximum tumor volume with saturated microspheres.

The aim of the work: to define the key points of preoperative planning for recurrent pelvic tumors in women in order to achieve reliable hemostasis and cytoreduction.

An analysis of 17 women with recurrent tumors complicated by tumor bleeding is presented. The first group consisted of 7 patients in whom the uterus was not removed, the second group consisted of 10 patients with removed uterus. For preoperative planning, magnetic resonance imaging of pelvis and selective angiography of the branches of the anterior and posterior trunk of the internal iliac artery were used. The sources of blood supply to the tumor were different and depended on the localization of the process in the upper, middle, and lower levels of pelvis. Multidisciplinary planning made it possible to achieve reliable hemostasis in all cases, to prevent complications from the pelvic organs.

Ovarian cancer is one of the most malignant and aggressive tumors of the female reproductive system. Late diagnosis is one of the most significant problems: more than two-thirds of cases are detected only at stage III–IV. Ovarian cancer is characterized by a unique metastatic process. Implantation is the earliest and most common way of metastasis. It is often accompanied by fluid accumulation in the abdominal cavity, known as ascites. We report a case of low-grade serous ovarian carcinoma with a large heterogeneity of tumor cells in the ascitic fluid detected using multicolor flow cytometry. We demonstrated the advantages and benefits of this method in the diagnosis of ovarian cancer. Multicolor flow cytometry opens new horizons for liquid biopsy in oncology.