Vol 27, No 4 (2022)

BACKGROUND: The International Serous Fluid Cytopathology Reporting System (TIS RSFC) was proposed in 2020 to standardize cytological reports and include information on perceived risk of malignancy in reports. It is necessary to analyze the use of TIS RSFC to determine the principles of rational practical implementation and possible improvement of this classification.

AIM: To assess the possibility and results of the application of TIS RSFC (2020) in the cytodiagnosis of pleural effusions using the organizational technologies and resources of a regional oncological dispensary.

METHODS: This observational, retrospective, crossover study carried out a comparative analysis of reports following cytological examination of pleural effusion with clinical and anamnestic information, histological, immunohistochemical results of 1507 patients of the Altai Regional Oncological Dispensary (Barnaul) from 2019 to 2021. The microscope slides were prepared by the traditional smear method, as well as by liquid cytology methods. Papanicolaou and Pappenheim staining methods were used. In certain cases, immunocytochemical tests were performed additionally.

RESULTS: The following numbers of cytological reports corresponding to the TIS RSFC categories were formulated: non-diagnostic material, C I — 11 (0.7%); absence of malignant tumor cells, C II — 946 (62.8%); atypia of unknown significance, C III — 61 (4.0%); suspicion of a malignant process, C IV — 13 (0.9%); malignant process, C V — 476 (31.6%). Within category C V there were 37 (7.8%) cases of the primary tumor — mesothelioma; 398 (83.6%) cases of metastatic tumors, including 41 (8.6%) cases of non-epithelial tumors. Immunocytochemical tests of pleural fluid were performed in 273 (18.1%) cases. Risk of malignancy was 9.1% (1/11) for C I; 1.2% (11/946) — for C II; 59.0% (36/61) — for C III; 84.6% (11/13) — for C IV, and 100% — (476/476) for C V. Cytodiagnosis with immunocytochemistry in unclear cases was characterized by a sensitivity of 92.5%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 88.5%, and an accuracy of 96.6%.

CONCLUSIONS: The application of TIS RSFC (2020) in cytological tests of pleural fluid does not cause difficulties for specialists in cytological laboratory. If the required diagnostic accuracy of cytological tests is available, this system makes it possible to characterize the risk of malignancy and thus guide the oncologist in the case management. The liquid-based cytology and the addition of traditional cytological techniques with immunocytochemical tests increase the cytodiagnostic sensitivity.

BACKGROUND: The study of remote effects of radiation exposure on tumor-related morbidity in population remains a matter of great social significance in Altai Krai.

AIM: To investigate the incidence rate for malignant neoplasms of respiratory tract and thoracic organs in the remote period in the male population born in 1932–1949 and located in the zone of influence of the first nuclear test.

METHODS: This retrospective cohort study was based on the analysis of anonymized data and surgical records on morphologically verified cases of primary malignant neoplasms in a male cohort for the period from 2007 to 2016. In this paper, we studied a cohort fixed by the date of the first nuclear test, with a total of 6383 male individuals. The main (exposed) cohort included 2291 men, while the control (non-exposed) cohort included 4092 men who lived in rural communities of the region that were not affected during the first nuclear test. The cohort included 156 cases of morphologically verified diagnosis of primary malignant neoplasms of the respiratory tract and thoracic organs (codes C30–C39 according to the International Classification of Diseases). Person-time incidence rate (PtR), standard error (mPtR) and confidence intervals (95% CI) were calculated. The incidence of respiratory and thoracic malignant neoplasms, structure and relative risk (RR) were assessed. Statistical processing of the data was performed using licensed Microsoft Office 2016 software.

RESULTS: The number of person-years spent at risk for respiratory and thoracic malignancies in the male population in the main cohort was 16 731 person-years, and in the control cohort — 30 747 person-years. In the main cohort, PtR was 436.32×10⁵ person-years, with an mPtR of 51.07 and 95% CI of 334.18–538.45; in the control cohort the PtR was 269.95×10⁵ person-years with an mPtR of 29.63 and 95% CI of 210.68–329.21. The leading localizations of malignant neoplasms of the respiratory and thoracic organs in men in the main and control cohorts were bronchial and lung malignancies and laryngeal malignancies.

CONCLUSIONS: An increased relative risk of respiratory and thoracic malignant neoplasms manifesting in the remote period in the male population born and living in rural areas of Altai Krai during the first nuclear test conducted at the Semipalatinsk test site was revealed: RR=1.616, 95% CI 1.180–2.214, with the standard error of relative risk equal to 0.160.

BACKGROUND: This article offers detailed information about the surgical treatment of pancreatic cancer, based on the experience of the abdominal department of Samara Regional Clinical Oncological Dispensary (Samara, Russian Federation). This allows readers to familiarize themselves with the achievements and innovations in this field, to get information about constantly improving surgical methods and their effectiveness. Such information can help not only patients, but also medical professionals, including surgeons, to improve the quality and effectiveness of operations. The article also includes an overview of the main methods of diagnosing pancreatic cancer, which can help specialists identify the disease at an early stage and improve their working methods. It provides up-to-date information on the diagnosis, treatment and prognosis of pancreatic cancer, which can help improve treatment outcomes and prolong the survival of patients suffering from this disease.

AIM: Analysis of the state of oncological care for patients with pancreatic cancer in the Samara region over the past 5 years.

METHODS: The results of treatment of 236 patients with pancreatic cancer operated in the department of abdominal oncology of the Samara Regional Clinical Oncology Dispensary in the period from 2018 were studied.

RESULTS: According to the results of treatment, pancreatic cancer stage IA was established in 9.74% of patients (n=23), stage IV — in 5.89% (n=14), stage IIA — 12.71% (n=30), stage IIB — in 12.71% (n=30); stage III — in 23.30% (n=55), stage IV — in 35.59% (n=84) of patients. Of the 76 patients with initially unresectable tumors, 12 received neoadjuvant chemotherapy according to the FOLFIRINOX scheme, which allowed them to perform radical surgery. The average age of the patients was 62.2 years. The overall survival rate in the entire group of patients was 20 months. It is interesting to note that in the group of patients with stage III, the 1-year survival rate was 20.53%, which is lower than in the group of patients with stage IV (25.59%). Most likely, this is due to postoperative complications and mortality in patients with stage III who underwent radical treatment (while patients with stage IV underwent gentle palliative surgery).

CONCLUSIONS: Pancreatic cancer is a complex disease that requires an interdisciplinary approach to achieve the necessary diagnosis and develop optimal treatment tactics. Radical surgery is disabling, but remains the only treatment option for pancreatic cancer, which determines the patient’s life prognosis. The results of gastropancreatoduodenal resection are characterized by a significant frequency of postoperative complications (34.38%), with a high rate of postoperative mortality (20.93%). Unsatisfactory results of surgical treatment of pancreatic cancer indicate the need to develop more effective methods of complex treatment. The lack of verification of pancreatic cancer at the prehospital stage in the majority of patients (84.6%) does not allow chemotherapy treatment in the neoadjuvant mode for locally advanced forms, which dooms patients to diagnostic surgery. As a result, valuable time is lost, which calls into question the well-being of such patients. The development of new, more effective diagnostic methods at the outpatient stage will solve this problem.