Background. Breast cancer (BC) is a heterogeneous disease, in which it is crucial not only to detect the tumor, but also to determine its biological characteristics to choose an optimal treatment strategy. Herein, we review existing literature on the subject and analyze own data.
Aim. To analyze clinical and morphological characteristics of rare histological types of BC.
Materials and methods. In this retrospective study, we analyzed the results of instrumental examination of 180 patients with mucinous BC treated in Sverdlovsk Regional Oncology Dispensary between 2020 and 2022. The mean age of the participants was 62.5 years. All patients underwent comprehensive examination, including digital mammography using the Fujifilm Amulet Innovality system, multiparametric ultrasound breast examination using the EPIQ 5 system (Phillips, Netherlands), and 1.5 T dynamic contrast-enhanced magnetic resonance imaging with a 16-channel – dedicated breast coil (GE Healthcare, USA).
Results and conclusion. The incidence of mucinous BC was 1.8 %. Other rare types of BC, such as occult, medullary, papillary, tubular, and cribriform cancer were observed in less than 1 % of cases, which is consistent with the available literature data. Mucinous tumors were primarily represented by luminal B histology (73.3 %); the Ki-67 proliferation index was usually 35 %. The most common radiological manifestation was a hyperdense formation with clear contours (85 %). Ultrasound examination usually revealed a hypoechoic formation with clear and irregular contours (92 %); however, 8 % of patients presented with isoechoic formations that can hardly be distinguished from the background. Magnetic resonance imaging showed the following patterns: mass (87.5 %) with a persistent type of contrast accumulation (56.2 %) (type I curve) or curve exhibiting a plateau (43.8 %) (type II curve). Contrast agent accumulation started from the first minutes and was >100 % in all patients. Limitation of diffusion was observed in 25 % of patients. Patients with mucinous BC were usually characterized by late manifestation; 3 patients additionally had other cancers, including colorectal cancer, mucoepidermal tumor of the salivary gland, pancreatic cancer. None of these patients had family history of cancer. Isolated findings of X-ray mammography, ultrasound, and magnetic resonance imaging suggested benign breast tumors and no cancer-specific features.
A multimodal approach enabled early detection of non-specific signs of rare forms of BC characterized by a specific clinical pattern with symptoms typical of this particular cancer from.

Background. Three-dimensional automated breast ultrasound (ABUS) is an innovative technology that allows global visualization of the breast and eliminates the operator-dependence of hand held ultrasound. Three-projection scanning during ABUS is provided by an ultra-long (15.4 cm) probe with a frequency of 14–16 MHz, and then the slices are reconstructed on a workstation. At the same time, high-frequency converters create high-resolution images. Through a special coronal projection, ABUS identifies variants of minimal, non-palpable breast cancer, including those with women with high mammographic breast density, which makes it a promising additional (supplemental screening) method of oncomammoscreening.
Aim. To assess the use of ABUS as a supplemental screening tool in women with high mammographic breast density.
Materials and methods. The study was conducted in 2018 at the N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia. As part of the study, 192 women underwent mammography, ABUS, and multiparametric ultrasound (B-mode, color Doppler, elatography) in standard manual mode.
Results. In the course of the study, in 192 patients, mammography revealed 42 cases of breast cancer, while using the AUS and manual ultrasound, additionally were identified 9 cases of breast cancer. Also, the ABUS showed high accuracy in assessment of the distribution of breast cancer – multifocal, multicentric and bilateral.
Conclusion. ABUS is a promising and highly effective diagnostic method in women with high mammographic breast density, with its advantages and disadvantages, which can be used in combination with mammography as a supplemental screening tool, especially in women at high risk of developing breast cancer.

Aim. To assess risk factors for breast cancer in a large population of women with benign breast dysplasia (BBD) followed up for a long time.
Materials and methods. This retrospective study included 504 women with BBD followed up for 10 years. Study participants were divided into two groups: 1) BBD patients who did not develop breast cancer within 10 years (n = 261); 2) BBD patients who developed breast cancer within 10 years (n = 243). We conducted comprehensive retrospective analysis of demographic, clinical, and laboratory characteristics, as well as treatment details for BBD. Patient age varied between 39 and 49 years. The ten-year follow-up interval was chosen to perform adequate comparison of the groups. The differences were considered significant at p <0.05.
Results. The main difference between the two groups was related to conservative treatment for BBD and its duration. Almost all (93.4 %) patients in the group without breast cancer received some conservative treatment for BBD for 78.0 ± 1.7 months, whereas among those who developed breast cancer, only 37.4 % received conservative therapy for 15.0 ± 0.8 months (p <0.001). Other significant risk factors for breast cancer in group 2 included obesity, gynecological pathology, long-term stress, and no surgical treatment for benign breast changes (p <0.001). The analysis of laboratory parameters demonstrated significantly higher levels of prolactin in patients who developed breast cancer (31 % versus 13 %; p <0.001).
Conclusion. Potential risk factors for breast cancer in BBD patients include overweight, benign gynecological diseases, elevated prolactin, and long-term stress. Timely diagnosis and treatment of BBD and elimination of the abovementioned factors can significantly reduce the probability of breast cancer.

Background. Breast cancer is the leading oncopathology of women. The routine radical surgery performed in this pathology includes lymph node dissection, which provokes development of postmastectomy syndrome. However, the removal of non-metastatic lymph nodes is not rational according to the subsequent disability of the patients. This can be avoided by using a sentinel lymph node (SLN) biopsy procedure. At this stage of oncology development, there are several ways to visualize SLN. The fluorescent method is among the most promising. This technique has been used for many years. However, it is not sufficiently implemented in clinical practice. There are still several questions about the procedure for its performance. In addition, it requires the introduction and improvement of domestic developments, including reducing financial costs.
Aim. To study the use of indocyanine green of domestic production (LLC Firm “FERMENT”, Russia) and the IC-GOR detection system (LLC “MedKomplekt”, Russia) for SLN biopsy in patients with early breast cancer.
Materials and methods. From February to September 2023, biopsy of SLN using indocyanine green (LLC Firm “FERMENT”, Russia) was performed in 53 patients with early breast cancer without clinically detectable lesion of regional lymph nodes. In all cases, according to the clinical examination, the patients had an operable stage of breast cancer (cT1–3N0M0). 5 mg of indocyanine green, dissolved in 4 ml of water for injection, was administered after sanitizing of the surgical field intradermally and subcutaneously at 2 points in the upper-outer quadrant of the breast along the edge of the areola in 40 patients (75.5 %) or paratumorally in 13 patients (24.5 %). An incision in the axilla about 4 cm long was made no earlier than 10–15 minutes after injection of indocyanine green (when visualizing the track 1 cm beyond its distal end to avoid crossing the lymph duct, after which the drug can flow into the wound). After imaging, all detected lymph nodes were removed for planned morphological examination. Standard lymph node dissection of 1 and 2 level was performed in all patients. Middle age of patients was 64.5 years (from 37 to 85 year). In 40 patients (75.5 %) modified radical mastectomy was performed, breast conserving surgery was done in 13 cases (24.5 %).
Results. SLN were visualized in 51 patients out of 53 (96.2 %). After the final morphological examination, the majority of patients in the group were ranged in the IA and IIA stages of the disease – 15 (28.3 %) and 28 (52.8 %), respectively. Metastasis in the SLN were found in 9 patients (17.0 %). Besides, in 3 cases (5.7 %) metastasis in the lymph nodes were found after lymph node dissection. In 4 cases (7.6 %) metastasis were found during lymph node dissection but were not detected in the removed SLN. Thus, in the study group 13 (24.5 %) patients had metastatic lymph node lesion despite negative clinical status. The total number of removed SLN in the study group was 169 (from 1 to 6), the average number of removed lymph nodes was 3.3. Any negative events, allergic and general reactions to indocyanine were not reported.
Conclusion. Our technique of contrasting SLN with indocyanine green is adequate and reproducible. The frequency of detection of SLN with this method is 96.2 %, with an acceptable level of false negative results is 7.6 %. Indocyanine green (LLC Firm “FERMENT”, Russia) and the LED fluoroscopic cancer detector IC-GOR (LLC “MedKomplekt”, Russia) can be recommended for performing a SLN biopsy.

Modern diagnostic methods with more accurate staging of the tumor process and effective high-tech treatment of breast cancer are very relevant, since this disease ranks first in the structure of cancer morbidity and mortality among women. Mapping of the signal lymph node is an alternative to axillary lymphatic dissection in patients with clinically intact regional lymph nodes (cN0). This allows patients to avoid such formidable, often and disabling complications of lymphatic dissection as prolonged postoperative lymphorrhea and lymphatic swelling of the upper extremity (lymphostasis). Radioisotope is the standard method of performing lymph node mapping, but recent years there have been more and more scientific studies and publications on the effectiveness of the non-toxic and non-radioisotope method in oncosurgery – fluorescent lymphography with indocyanine green.
This article analyzes the experience and results of performing a mapping signal lymph node by a fluorescent method with indocyanine green at an early staged breast cancer in the Botkin Hospital, Moscow.

Sentinel lymph node biopsy is an effective clarifying diagnostic method that is actively used in various malignancies, including breast cancer. The effectiveness of this method has led to a potential expansion of the standard indications for its use. This article is devoted to the study of the effectiveness of sentinel lymph node biopsy based on world literature data regarding the use of ycT4N0M0 in patients with breast cancer after neoadjuvant drug therapy.

At present, cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors such as palbociclib, ribociclib, and abemaciclib are widely used for the first-line treatment of locally advanced or metastatic breast cancer. However, direct comparisons of these treatment options in randomized studies have not been conducted.

Aim of the work is to gather and analyze published data on the comparative effectiveness of CDK4/6 inhibitors in combination with aromatase inhibitors in postmenopausal patients with HR+/HER2– locally advanced or metastatic breast cancer. A systematic review of publications presenting results from original studies on the impact of CDK4/6 inhibitor therapy in combination with aromatase inhibitors on the survival of patients was performed. Nineteen studies with original data on progression-free survival and overall survival were identified. None of the studies found significant differences between different CDK4/6 inhibitors and aromatase inhibitors in terms of progression-free survival. A statistically significant superiority of ribociclib over palbociclib in terms of overall survival was observed in a single matching-adjusted indirect comparison, while seven other studies of various types (real-world data studies, matching-adjusted indirect comparisons, and meta-analyses) did not find significant differences between the investigated drugs in terms of overall survival.

Currently, there is no compelling evidence of the superiority of one CDK4/6 inhibitor over others. The decision on the preference for a specific drug within the class can only be made after conducting direct randomized comparison trials, or accumulating sufficient real-world data on the use of palbociclib, ribociclib, and abemaciclib.

Mastalgia is the most common manifestation of mastopathy. Up to 70 % of women experiencing breast pain report a significant decrease in their quality of life; however, hormone therapy is not indicated and suitable for everyone. The main aim of a clinician in this case is to exclude cancer and choose appropriate treatment to manage pain. First-line therapy for such patients may not necessarily include medications.
The aim of this work was to identify the most effective non-pharmacological treatments for patients with mastalgia. We conducted a search of publications assessing various methods of mastalgia management in both Russian and foreign databases (PubMed, CyberLeninka, Elibrary, Google Scholar). We used the following key words: “mastalgia”, “cyclic mastalgia“, and “non-cyclic mastalgia“.
Visual demonstration of the fact the woman has no risk of breast cancer (after examination) and proper explanation can reduce complaints of mastalgia without any additional treatment. Recommendation to change a bra also brings a significant relief to the majority of women. Reduced consumption of methylxanthines and fats along with sufficient intake of fiber and liquid can be beneficial for patients. Dietary modifications with certain nutrients (such as indole-3-carbinol and trans-resveratrol) might significantly improve the quality of life of patients with mastalgia. Relaxation practices can also mitigate mastalgia.
Most patients with mastalgia can be managed without any medications if they are reassured about the absence of cancer risk, choose a well-fitting and supportive bra, have psychoemotional support, and modify their diet.

This review presents the evolution of adjuvant endocrine therapy for early hormone-dependent HER2-negative breast cancer, describes late relapse phenomenon, provides clinical rationale for escalation of treatment, analyzes the key stages of the metastatic cascade, and provides a scientific rationale for the introduction of CDK4/6 inhibitors into adjuvant treatment regimens. The main results of two large randomized studies of therapy including abemaciclib (MonarchE) and ribociclib (NATALEE) in patients with early stages of hormone-dependent HER2-negative breast cancer are presented; the oncological results of escalation of treatment and the safety of therapy are assessed.

Aim. To determine the advantages and disadvantages of laparoscopic (LS) and robot-assisted (RA) surgery in oncogynecological operations.
Materials and methods. 282 clinical cases were retrospectively analyzed. The patients were treated in oncogynecological department No. 70 of the CS.P. Botkin City Clinical Hospital, Moscow Healthcare Department for endometrial cancer of stages IA–II, cervical cancer in situ and IA1 stages or atypical endometrial hyperplasia in the period from February 2020 to September 2022, among them 74 patients were operated with Da Vinci robotic units (models Si and Xi) and 208 using laparoscopy. The standard volumes of surgical treatment, depending on the clinical diagnosis, were: hysterectomy, hysterectomy with pelvic lymphadenectomy, hysterectomy with pelvic and retroperitoneal lumbar lymphadenectomy. To compare the technical characteristics of minimally invasive operations and the condition of patients in the intra- and postoperative periods in each group, data on the duration of operations, body mass index, age, intra- and postoperative complications, as well as the number of postoperative hospital bed-days were analyzed.
Results. When comparing the average duration of operations by time, a statistically significant difference was obtained. Thus, LS hysterectomy was performed 43 minutes faster on average than RA (74.2 minutes versus 117 minutes) (p <0.001). When performing pelvic lymphadenectomy, the average duration of RA operations was 28 minutes longer than LS operations (142 minutes versus 170 minutes), and when adding the retroperitoneal lymphadenectomy stage, the average duration of RA operations was 128 minutes longer than LS operations.
Conclusion. At this stage of technology development in surgery, LS operations have a number of advantages over RA ones in numerous ways. LS operations demonstrate statistically significantly shorter execution time, fewer perioperative complications, as well as a more controlled environment in the operating field. In the long term, RA surgery has serious potential and is currently at an early stage of its development. A real and sober assessment of its characteristics will determine the right direction for the development of this technology in the future.

Background. The inclusion of lenvatinib in the immunotherapy regimen for patients with MSS/pMMR endometrial cancer (EC) is due to its ability to modulate the tumor microenvironment, which allows the use of pembrolizumab in low-immunogenic tumors. However, only 30 % of patients with advanced or metastatic EC have a clinical response when treated with pembrolizumab and lenvatinib. In this regard, there is an obvious need to identify biomarkers that allow accurate selection of candidates for this type of therapy.
Aim. To determine the predictive value of subpopulations of lymphocytes and macrophages, their expression of PD-1, expression of estrogen receptors, as well as vessel density in immunotargeted therapy for advanced or metastatic EC.
Materials and methods. An open-label non-randomized observational association study was performed, involving a total of 22 patients with advanced or metastatic MSS/pMMR EC treated with pembrolizumab and lenvatinib. Duration of clinical effectiveness was used as a parameter to stratify patients. Using TSA-associated multiplex immunofluorescence, the proportions of CD8+ T lymphocytes, CD20+ B lymphocytes, FoxP3+ T regulatory lymphocytes and CD163+macrophages in tumor samples before the start of immunotargeted therapy were analyzed.
Results. Three microenvironmental parameters were found to be associated with duration of clinical efficacy: the proportion of CD20+ B cells, the proportion of FoxP3+ T regulatory lymphocytes, and the ratio of CD8+/CD20+ lymphocytes in the tumor microenvironment. However, the CD8+/CD20+ lymphocyte ratio had the greatest predictive value; a value below 3.219 was associated with long clinical efficacy in patients with advanced or metastatic EC.
Conclusion. The ratio of cytotoxic and B-lymphocytes in the microenvironment is a reliable predictor marker of the duration of the period of clinical effectiveness of immunotargeting therapy in advanced or metastatic EC.

Standard treatment for advanced ovarian cancer (OC) consists of a combination of chemotherapy and cytoreductive surgery, but practice varies depending on the order of these 2 procedures: neoadjuvant chemotherapy followed by interval debulking surgery or primary cytoreduction followed by adjuvant chemotherapy. The aim of the work is to evaluate methods of treatment of OC of stages III, IV according to FIGO.
The literature review includes publications in English from the PubMed, CochraneLibrary and Google Scholar databases on the use of neoadjuvant therapy and primary cytoreduction in late stages of OC (FIGO III–IV). 6 randomized controlled trials, 8 meta-analyses, 8 systematic reviews, 1 case report were identified. Data from publications were distributed according to the criteria for assessing the effectiveness of the treatment: overall and relapse-free survival, perioperative complications, quality of life of patients and the grade of cytoreduction.
Neoadjuvant chemotherapy + interval debulking surgery is not inferior to primary debulking surgery + adjuvant chemotherapy in terms of survival outcomes in selected patients, but treatment with neoadjuvant chemotherapy + interval debulking surgery improves perioperative outcomes and optimal cytoreduction rates. It is needed to focus on finding optimal criteria for selecting patients in both groups in future studies of this issue. It is necessary to take into account X-ray, histological studies, the molecular subtype of the tumor, the patient’s condition, the qualifications of the surgical team, the drugs included in chemotherapy.

The problem of the occurrence of malignant neoplasms in women of reproductive age has not only medical, but also extremely important social significance, as it affects the demographic potential of the country as a whole.
The article presents an analysis of the current state of the problem of fertility and preservation of reproductive function in cancer patients. Currently, there are a sufficient number of methods of assisted reproductive technologies aimed at preserving fertility in women with cancer. Among them are the following: cryopreservation of embryos and oocytes, ovarian tissue, in vitro maturation of eggs, obtaining oocytes obtained by removing the ovaries with their subsequent maturation. In addition, auxiliary methods are also distinguished, the main purpose of which is ovarian protection: the use of gonadotropin-releasing hormone agonists, ovarian transposition, gonadal screening. Each method has its advantages and disadvantages. It should be noted that the very fact of the presence of oncological pathology makes its own adjustments to the use of each specific technique. It has been shown that in vitro maturation technology is the most optimal for the preservation and realization of reproductive function in cancer patients. One of its few disadvantages is the high cost and complexity of laboratory control and cultivation of oocytes, which undoubtedly requires highly qualified specialists and relevant experience.

Endometriosis is one of the most urgent problems of modern gynecology and reproductive medicine. About 40 % of women suffering from endometriosis of various localization are infertile. The use of drug therapy has not been proven to increase fertility. Currently, there is no consensus on the impact of surgical treatment on the effectiveness of assisted reproductive technologies.
This article presents a clinical case of modern approache to the use of assisted reproductive technologies for endometriosis-associated infertility. The tactics of managing women with endometriosis is determined by its localization, the age of the patient, ovarian reserve, the duration of infertility, the therapy and its effectiveness, the condition of the fallopian tubes, as well as spermogram parameters. The correctly chosen management strategy for this patient made it possible to achieve not only a clinical pregnancy, but also the birth of a healthy child.

 Hematocolpos is a rare pathological condition of the Female Reproductive System. This process is associated with vaginal obstruction and is characterized by a violation of the normal evacuation of secretions from the uterine cavity. This pathology is more often encountered by pediatric gynecologists who diagnose anomalies in the development of female genital organs. In peri- and postmenopausal women obstructive disorders are extremely rare and are associated with hormonal changes or previous interventions.
The article presents a rare clinical case of hematocolpos as a result of vaginal carcinoma in postmenopausal woman. 

Cervical cancer occupies one of the leading places in the structure of oncological diseases of the Female Reproductive System. In the treatment of this pathology, along with the surgical method of treatment, chemotherapy and radiation therapy are used. According to clinical guidelines, in the presence of cervical cancer stages IIB–IIIA, it is allowed to carry out 2–4 cycles of neoadjuvant chemotherapy in order to create conditions for the possibility of performing extended hysterectomy according to Meigs. Pregnancy during chemotherapy is unique and extremely rare.
The article presents a clinical case of pregnancy during chemotherapy (performed according to the scheme: taxanes and platinum-containing drugs) in a 27-year-old patient. According to the clinical picture and results of cervical biopsy, the diagnosis was made: invasive nonkeratinizing squamous cell carcinoma of the cervix IIB (cT2bNxM0) G2, right-sided parametric variant, nonspecific (with unspecified HPV status). Taking into account the presence of parametrial infiltration, the age of the patient, the oncological council prescribed from 2 to 4 cycles of chemotherapy according to the TC scheme (paclitaxel, carboplatin) with an interval assessment. After the second cycle of chemotherapy, an early pregnancy was diagnosed – a medical abortion was performed. Against the background of 3 cycles of chemotherapy, the conditions for surgical treatment were formed – surgical treatment was performed in the amount of extended hysterectomy according to Meigs (type III according to Piver/C2 Morrow) with transposition of the ovaries. The postoperative period was uneventful; the patient was discharged in a satisfactory condition.
The described case of pregnancy on the background of chemotherapy is of scientific and practical interest, initiating a discussion on the need to counsel such patients regarding reliable contraception, taking into account the eligibility criteria, which will avoid undesirable outcomes during cancer treatment.