This review provides a comparative evaluation of current techniques for marking axillary lymph nodes in breast cancer patients with initially positive axillary status (cN+) undergoing neoadjuvant systemic therapy. The main methods of localizing marked nodes are analyzed, including carbon suspension, wire localization, titanium clips, magnetic seeds (Magseed), radioactive seeds (I-125 RSL, MARI procedure), and radar localization (SAVI SCOUT), with a focus on identification rate, false-negative rate, safety, and cost-effectiveness. The implementation of targeted axillary dissection with selective removal of the pre-marked metastatic node has been shown to reduce the false-negative rate to 1.4–4.1 %. However, no single “gold standard” for marking currently exists, and the choice of technique depends on individual clinical, logistical, and economic factors. Further prospective studies are required to evaluate long-term oncological outcomes.
Background. The issue of selecting a surgical approach based on oncological safety remains relevant in the treatment of cervical cancer. Aim. To conduct a retrospective analysis of disease-free survival and overall survival in patients with early-stage cervical cancer treated using laparoscopic or open abdominal approaches. Materials and methods. A retrospective analysis of 93 patients with histologically confirmed stage IA2–IB1 cervical cancer was performed using data from the EMIAS information system. All patients underwent C1 / C2 radical hysterectomy according to the Querleu–Morrow classification. Patients were divided into two groups according to the surgical approach: laparoscopic (n = 39) and open abdominal (n = 54). Results. Disease-free survival was 92.3 % in the laparoscopic group and 88.9 % in the open abdominal group, with median follow-up periods of 47 and 40 months, respectively. Overall survival was 97.4 % in the laparoscopic group and 96.3 % in the open abdominal group. Conclusion. The surgical approach does not significantly affect oncological outcomes following radical hysterectomy.
The evolution of mastectomy for breast cancer is characterized by a shift from mutilating radical procedures to skin-sparing and nipple-sparing operations with immediate reconstruction and creation of a “hidden scar”. Preservation of the skin envelope and the projection skin flap over the tumor is regarded as a key step in reducing surgical trauma while maintaining oncologic safety. Data analysis indicates that when tumor depth exceeds 1.05 cm, the risk of involvement of the anterior leaf of the superficial fascia is minimal, which makes preservation of the projection skin flap feasible in most cases without worsening oncologic outcomes. Surgical access is shifting from traditional incisions toward aesthetically oriented zones, primarily peri-areolar and inframammary, allowing scar concealment within natural transition zones and skin folds. Comparison of these approaches underscores the importance of their anatomical and vascular characteristics for perfusion of skin – subcutaneous flaps and the incidence of nipple – areola complex ischemia and necrosis. The heterogeneity of the evidence base, the limited number of prospective comparative studies, and the paucity of data on the impact of access type and “hidden scar” techniques on quality of life and aesthetic satisfaction highlight the need to develop clinical criteria for selecting the optimal surgical access in mastectomy.
Background. Indocyanine green fluorescence mapping enables real-time assessment of both sentinel lymph nodes and superficial lymphatic drainage pathways of the breast. However, variations in their formation and the factors affecting the time to sentinel lymph node (SLN) visualization remain poorly understood. Aim. To describe patterns of superficial breast lymphatic drainage during fluorescence mapping, assess their relationship with tumor location, and identify factors associated with the time to SLN visualization. Materials and methods. This prospective single-center study included 52 patients with morphologically confirmed breast cancer staged as cT1–3N0M0. Indocyanine green was administered subdermally at four periareolar sites. Drainage direction, the number of active periareolar sectors, the pattern of lymphatic vessel formation, time to SLN visualization, anthropometric variables, and breast subcutaneous fat thickness were recorded. Statistical analysis included Spearman’s rank correlation, univariable and multivariable linear regression, and the Fisher–Freeman–Halton exact test. Results. Fluorescence identification of the SLN was successful in 51 (98.08 %) of 52 patients. An axillary drainage pattern was observed in 48 cases (92.31 %), while a combined axillary – parasternal pattern was found in 3 cases (5.77 %). No association between tumor location and drainage direction was detected in this cohort (p = 0.576); the analysis was limited by only three combined patterns across nine tumor-location categories. Two active periareolar sectors were the most frequent finding, occurring in 18 cases (35.29 %). Among 48 evaluated drainage components, the convergent pattern predominated in 23 cases (47.92 %). Mean visualization time was 13.42 ± 2.45 min with SPY Fluorescent Imaging System (SP2000) and 12.40 ± 1.78 min with SPY-PHI (Portable Handheld Imager) (p = 0.114). After adjustment for body mass index and subcutaneous fat thickness, SPY-PHI was associated with a shorter visualization time (B = –1.539; 95 % confidence interval –2.387…–0.691; p 0.001). Conclusion. Indocyanine green fluorescence mapping allows individual patterns of superficial breast lymphatic drainage to be identified. No association between drainage direction and tumor location was detected in this cohort, but the small number of combined patterns precludes a conclusion that no association exists. Higher body mass index was associated with a longer visualization time, whereas SPY-PHI use was associated with a shorter visualization time.
Background. Refractory ascites complicating advanced recurrent ovarian cancer (OC) leads to a marked deterioration in quality of life and an unfavorable oncological prognosis. The implementation of clinically effective approaches to ascites control remains an important objective in palliative gynecologic oncology. Aim. To evaluate the outcomes of implantable peritoneal port-system placement based on quality-of-life measures in patients with progressive OC within a prospective single-arm study. Materials and methods. A prospective single-arm study was conducted at the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine and included 75 patients with OC who underwent implantation of a peritoneal port system. The primary endpoint was the change in the total FACT-G (Functional Assessment of Cancer Therapy – General) score 30 days after implantation. Secondary endpoints included changes in the individual FACT-G domain scores: physical, social / family, emotional, and functional well-being, as well as the incidence of postoperative complications. Quality of life before and after the intervention was assessed using the validated FACT-G questionnaire. Results. The median total FACT-G score increased from 66 [65; 68.5] to 89 [88; 91] points. The median paired change was 23 points (95 % confidence interval 22–25; W = 0; p 0.001). A clinically meaningful improvement of at least 7 points was observed in all 75 patients (100 %; 95 % confidence interval 95.2–100). Statistically significant positive changes were found across all assessed domains. During the 30-day follow-up period, 1 (1.3 %) case of port system infection was recorded, requiring its removal. Conclusion. Implantation of peritoneal port systems was associated with substantial clinical benefit in patients with recurrent OC and clinically significant ascites. The procedure is technically straightforward, well tolerated, and is not associated with the clinically significant complications commonly observed with repeated paracentesis, which is particularly important in the provision of palliative care. However, the study was conducted without a control group, limiting the ability to establish a causal relationship between port-system implantation and improvement in quality of life.
