[METHODOLOGIC PROBLEMS OF SENTINEL LYMPH NODE BIOPSY IN PATIENTS WITH BREAST CANCER].

The study included data on 168 patients with breast cancer, surgical treatment of whom was supplemented by axillary dissection (133 patients or 79.2%) or biopsy of sentinel lymph nodes (35 patients or 20.8%). The examination included ultrasound, planar scintigraphy of the breast and zones of regional lymph drainage. In 122 patients with primary breast cancer stage cT1-2N0M0 retrospective analysis of radionuclide imaging sentinel lymph node was performed. In 89 patients the introduction of colloidal radiopharmaceutical was carried out using a particle diameter of not more than 80-100 nm, in 33 patients study was conducted after administration of radiocolloid with a particle diameter of 200 to 1000 nm. Based on the data obtained by scintigraphy and ultrasonography of zones of regional lymph drainage there were offered two diagnostics models: the first, in which the presence of metastatic axillary lymph nodes was established when there were changes according to at least one of the diagnostic methods--scintigraphy or ultrasound; the second, in which the defeat of lymph nodes was determined only in the case of simultaneous detection of ultrasound and scintigraphic evidence of axillary lymph nodes. Sensitivity, specificity, and overall accuracy of the combination of ultrasound and planar scintigraphy axillary lymph nodes using the first model accounted for 82.7%, 67.7% and 74.4%, respectively. In the second model, the specificity was 94.6%, sensitivity--56%. Rapid transport of radiopharmaceuticals from the injection site, a high gradient of radiopharmaceuticals accumulation in sentinel lymph nodes, effective their visualization, approaching to 100%, were undoubted advantages of radiocolloids having a particle diameter up to 100 nm.

[The role of breast cancer stem cells in metastasis].

Cancer stem cells (CSCs) possess self-renewal and heterogeneous cancer cell lines formation. Numerous data confirm the existence of a model in which CSCs have an important role in cancer initiation, progression and clinical outcome. Analysis of CSCs role in metastasis, in contrast, remains mainly conceptual and hypothetical. Recent data are summarized in this review which support the CSCs theory as a source of breast cancer metastatic lesions with noting the key role of the microenvironment.

[Adjuvant chemotherapy for breast cancer: search for new ways of planning].

A decision regarding adjuvant chemotherapy in early (operable) breast cancer in the past was made entirely on the basis of clinical and pathological features. However with the growing awareness of tumor biology and the possibility of the genomic analysis to determine the molecular subtypes of breast cancer it is getting real to identify patients whose tumors are resistant to chemotherapy or vice versa benefit from its addition. Despite the fact that genomic analysis allows some patients avoiding chemotherapy (especially patients with localized breast cancer), such studies do not indicate the most appropriate chemotherapy regimens. Therefore treatment decisions should be based on a combination of biological features of the tumor, its stage and signs that characterize the patient such as age and tolerance to the side effects of therapy.

[Effectiveness of mammary scintigraphy for determining the results of neoadjuvant polychemotherapy in breast cancer].

Analysis of mammoscintigraphy is presented to assess the effectiveness of neoadjuvant polychemotherapy for locally advanced breast cancer. In 90% of patients there is defined conformity of scintigraphy data on the effectiveness of performed polychemotherapy to the results of histologic examination of the postoperative material. The sensitivity of scintigraphy in assessing the effectiveness of neoadjuvant polychemoterapy was 83.3%, specificity--87.9%, accuracy--86.3%, predictive value of positive and negative results-78.9% and 90.1%, respectively. Mammoscintigraphy is an effective method to control the response of locally advanced breast cancer to neoadjuvant polychemotherapy.

[Markers of effectiveness of preoperative taxane-based chemotherapy for locally advanced breast cancer].

The absolute sensitivity signs of breast cancer to the drug have not yet been developed. Data from clinical trials on the study of experimental laboratory predictive markers of chemosensitivity: TOP2alpha (topoisomerase 2-alpha), beta-tubulin (subunit of dimeric protein tubulin), and BRCA1 (breast cancer 1) are contradictory and not numerous. Analysis of the results by the end of the clinical trial will allow examining the correlation between the effectiveness of preoperative taxane-chemotherapy and the level of experimental and standard molecular markets that is important for development of algorithm of treatment tactics for patients with locally advanced breast cancer.

[Use of Taxotere in neoadjuvant therapy of breast cancer].

Wide-range research in the efficacy of neoadjuvant therapy of breast cancer has been conducted worldwide for over two decades. Promising end results have been reported on completion of clinical and pathomorpologic response. It has become a standard practice in managing relatively operable and inoperable breast cancer. However, preoperative chemotherapy in operable disease is still a subject of discussion. For many years anthracycline-based treatment has remained a therapy of choice in the neoadjuvant setting. Higher efficacy of its combined use with taxotere and anthracycline was demonstrated. It was followed by higher rates of complete pathomorphologic response and survival. Besides, regimens using taxotere and target therapies are being investigated. Tentative results suggest that better survival may be achieved due to decreased toxicity profiles.

[Phase II clinical trial of neoadjuvant hormone therapy in comparison with chemotherapy of patients with breast cancer].

Data are presented on a randomized study (stage II) which was undertaken to assess the efficacy of neoadjuvant chemotherapy (doxorubicin+paclitaxel) vis-a-vis endocrine therapy with aromatase inhibitors (anastrazole or exemestane) in postmenopausal women with ER-positive and/or PgR-positive tumors. Preoperative neoadjuvant chemotherapy was well tolerated and showed similar rates of overall response as compared with the latter regimen.

[Inflammatory breast carcinoma and prognosticators of efficacy of primary chemotherapy].

The efficacy of primary chemotherapy for inflammatory breast carcinoma (IBC) was studied vis-a-vis certain symptoms characterizing patient's status and biological features of tumor. It was shown that such factors as estrogen (ER) and progesterone (PR) receptor status and malignancy grade of tumor can be used to predict the efficacy. Negative ER/PR status plus high malignancy grade involved higher frequency of complete pathomorphological responses. Worst prognosis was in patients under 35 years of age, with ductal BC and negative ER/PR status of tumor.