Vol 6, No 1 (2026)

Triple negative breast cancer remains the subtype of breast cancer with the highest rates of recurrence and mortality. Research in the field of tumor biology has led to identification of subgroups of patients with specific molecular features, which has led to the development and approval of many new targeted treatments for this disease.

This review considers current options for the treatment of locally advanced forms of breast cancer at the neoadjuvant stage – the use of carboplatin, targeted therapy with vascular endothelial growth factor inhibitors and immunotherapy. It discusses the practical problems and unanswered questions that arise in connection with the approval of neoadjuvant immunotherapy, and describes the approach used in the clinical practice to use various treatment options and the possibility of combining them to achieve the best early and long-term results.

Aim. To study the role of SLNB in patients with primary operable breast cancer (T_1–2N₀/N_0–1) in restaging depending on the involvement of regional lymph flow (N status).

Materials and methods. The retrospective study included 956 women with ductal/lobular stage I–IIB breast cancer. The median age was 54 [45; 63] years. According to the TNM clinical staging system, the patients predominantly had stage IA and IIA cancer. In 94 % of patients, no involvement of the SLN was detected. N+ status was registered in 6 % of patients. Histologically, breast cancer was predominantly represented by invasive ductal carcinoma in 87.5 % of the patients. Depending on the molecular subtype, luminal B HER2neu negative breast cancer was found in 38.2 % of the patients and luminal A subtype in 29.6 %. Moderately differentiated breast cancer was found in 63.5 % of the patients.

Results. Median follow-up of the patients was 70.6 [60.0; 82.0] months. Depending on the involvement of the SLN, the following sentinel lymph node biopsy showed the following results: in 77.5 % of the patients, cN₀ was confirmed histologically (pN₀); in 2.7 %, SLN involvement was staged both clinically and pathologically (cN₁–pN₁); in 2.8 %, de-escalation of staging was detected (cN₁–pN₀); and in 0.6 %, SLNB revealed larger volume of damage to the regional lymph collector (cN₁–pN_2–3). 20 % of the patients underwent neoadjuvant chemotherapy (NACT). Among patients with cN₁, SLN involvement (pN₁) was significantly more often detected histologically in the group after NACT, 6.8 % versus 1.7 % (p = 0.0001), respectively. In 2.8 % with cN₁–pN₀, NACT efficacy was significantly higher (12.1 % versus 0.5 %, p = 0.00001). Also, in 16.3 % of the patients, pN₁ was significantly more common in the group without NACT (18.5 % versus 7.4 %, p = 0.0002).

Conclusion. Conducting SLNB restaged the involvement of the regional lymph collector of T_1–2N₀/N_0–1 patients in 189 (19.8 %) cases. According to the results of SLNB, in 528 (55.2 %) patients with breast cancer, it was possible to refuse lymphadenectomy.

The use of ¹⁸F-fluorodeoxyglucose positron emission tomography (PET-СT) to determine the initial stage and assess response to treatment in aggressive lymphomas is considered the standard. Evaluation of bone marrow infiltration in PET-CT with ¹⁸F-fluorodeoxyglucose usually allows to distinguish normal regenerating bone marrow after chemotherapy by its characteristic absorption.

A 54-year-old patient was diagnosed with diffuse large B-cell lymphoma with focal lesions in the lymph nodes and bone marrow with osteodestruction of the lytic type. Therapy at the A.F. Tsyb Medical Radiological Research Center consisted of 6 cycles of R-EPOCH with intrathecal administration of drugs for the prevention of neuroleukemia (dexamethasone + cytarabine + methotrexate), completed in December 2022. On intermediate PET-CT after 2 cycles, the glycolysis intensity was completely normalized. During the observation in February 2023, PET-CT showed an increase in the level of metabolism in one of the foci of osteodestruction in the pelvic bones. A guided biopsy of the lesion in March 2023 was performed, morphological conclusion: absence of signs of diffuse large B-cell lymphoma, elements of hematopoiesis of the bone marrow. In June 2023, repeated PET-CT showed continuing increase in contrast accumulation in the previously identified foci. Trephine biopsy in July 2023 showed a picture of hematopoietic foci in the bone marrow, a sign of remission. PET-CT scan in December 2023 showed a decrease in the intensity of glycolysis in the foci in the pelvic bones confirming remission of the disease.

In the era of rituximab, false-positive PET-CT results are detected with greater frequency, therefore, their assessment and correct interpretation, as well as additional clarification using other available techniques, are necessary in modern clinical practice to choose tactics for further therapy.

Choristoma is a region of normally formed tissue located in an abnormal location. Ectopic liver is a rare clinical condition characterized by the presence of hepatic tissue outside the anatomical and topographical location of the organ. Despite its low incidence, this condition requires special attention due to challenges of diagnosis and selection of the optimal treatment approach.

The article presents a clinical case of successful diagnosis and treatment of a patient with pain syndrome in the upper abdominal cavity caused by inflammation of an accessory liver lobe.

Background. Epidemiological studies aggregating data on newly diagnosed multiple myeloma (MM) from real-world clinical practice allow to analyze various clinical and laboratory parameters characterizing general trends in MM diagnosis, treatment outcomes, and life expectancy.

Aim. To determine overall survival rates in patients with newly diagnosed MM and to examine factors influencing survival in a population-based study.

Materials and methods. A total of 3,184 patients with a newly diagnosed MM from 40 regions of Russia were enrolled in a multicenter prospective study from January 2, 2015, to October 4, 2018. Complete registration of newly diagnosed cases was conducted at each of the 44 participating centers. Information on clinical and laboratory parameters, antitumor therapy regimens administered to patients, including autologous transplantation, was analyzed.

Results. The median age of MM patients in Russia was 63 years. It was shown that 39 % of the patients belonged to the older age group 66–90 years, and the percentage of patients under 55 years was 22 %. Only 9 % of patients underwent bone marrow cytogenetic testing. The proportion of patients with kidney damage was 26 %, while 5 % of patients were dialysis dependent. It was shown that 78 % of patients were diagnosed with stage 3 according to Durie–Salmon system, and in 52 % of cases, stage III according to International Staging System was diagnosed. Induction therapy included the use of bortezomib in 94 % of cases, the VCD regimen (bortezomib + dexamethasone + cyclophosphamide) was mainly used, lenalidomide was prescribed extremely rarely – in 1 % of cases. The proportion of patients under 65 years of age who received at least one autologous hematopoietic stem cell transplant was only 18 %. With autologous hematopoietic stem cell transplantation, the median overall survival was 107 months, and in the case of maintenance therapy with lenalidomide, it increased to 129 months. Five-year overall survival of the entire group of patients was 40 %. In a multivariate analysis, independent predictors of worse overall survival were Durie–Salmon stage III, substage B, profound anemia (hemoglobin ≤80 g/L), albumin ≤30 g/L, and hypercalcemia (≥3 mmol/L).

Conclusion. This multicenter prospective study of the epidemiological and clinical parameters of newly diagnosed multiple myeloma is unique in Russia in terms of coverage and follow-up duration (over 10 years). Analysis of treatment data for newly diagnosed multiple myeloma identified key issues in diagnosis and treatment.