Accelerated partial breast irradiation (APBI) is a standard radiotherapy approach for patients with early-stage breast cancer. Various techniques can be employed to deliver APBI, with external beam radiotherapy (EBRT) and interstitial high-dose-rate brachytherapy (HDR-BT) using an Ir-192 source being the most commonly used in clinical practice. Purpose: To compare the oncological efficacy and cosmetic outcomes in breast cancer patients treated with postoperative APBI using either HDR-BT or EBRT. The primary efficacy endpoints were ipsilateral breast tumor recurrence-free survival (IBTR-FS) and recurrence-free survival (RFS). Materials and Methods: Between 2016 and 2022, 183 patients with рТ_1-2N₀M₀ breast cancer underwent APBI to the tumor bed after breast-conserving surgery. In the APBI-EBRT group (n = 85), irradiation was delivered in 10 fractions of 3.85 Gy (total equivalent dose   (α/β = 3) — 52 Gy). In the APBI-HDR-BT group (n = 98), we delivered 8 fractions of 4 Gy over 4 days (two fractions per day with >6-hour   intervals, total equivalent dose (α/β = 3) — 50 Gy). All patients met the GEC-ESTRO criteria for APBI. Cosmetic outcomes were assessed at 3 and 5 years post-treatment via a standardized telephone interview using six items from the BREAST-Q questionnaire. Responses were summed into a score (range: 6–18) and categorized as ‘excellent’, ‘good’, ‘satisfactory’, or ‘unsatisfactory’. Results: The median follow-up was 45 months in the APBI-EBRT group and 70 months in the APBI-HDR-BT group. The 3-year IBTR-FS was 100 % in both groups. The 3-year RFS was 97.6 % in the APBI-EBRT group and 98.0 % in the APBI-HDR-BT group (p = 1.0). In the   APBI-HDR-BT group, the 5-year IBTR-FS and RFS rates were 95.1 % and 93.9 %, respectively.   The 3-year cosmetic assessment revealed an ‘excellent’ result in 49 of 54 patients (90.7 %) in the APBI-EBRT group, while all 53 patients (100 %) in the APBI-HDR-BT group reported an ‘excellent’ result (p = 0.059). At the 5-year assessment, an ‘excellent’ cosmetic outcome was maintained in all patients in the APBI-HDR-BT group. Conclusion: Both APBI techniques (HDR-BT and EBRT) demonstrated comparably high efficacy in terms of local control after 3-year of follow-up. However, APBI delivered with HDR-BT showed a trend towards more favorable long-term cosmetic outcomes compared to APBI delivered with EBRT.

Purpose: To determine the diagnostic effectiveness of PET/CT with ⁶⁸Ga-FAPI in the detection and staging of metastases in patients with gastric cancer. Material and methods: The study included 57 patients with histologically confirmed gastric cancer. All patients underwent PET/CT with ⁶⁸Ga-FAPI and PET/CT with ¹⁸F-FDG. The diagnostic accuracy of the methods was compared based on sensitivity and specificity parameters in detecting distant metastatic lesions. Data assessment was conducted based on histologically verified disease and clinical follow-up data. Results: 57 patients underwent both ⁶⁸Ga-FAPI PET/CT and ¹⁸F-FDG PET/CT. In 5 patients (8.7 %), the treatment plan was changed from radical to palliative based on the 68Ga-FAPI PET/CT results. ⁶⁸Ga-FAPI PET/CT detected distant metastases in 29 patients (50.8 %), while with ¹⁸F-FDG, distant metastases were detected in 18 patients (31.5 %). The sensitivity of ⁶⁸Ga-FAPI PET/CT in detecting distant metastases was 100 %, with a specificity of 85.7 %, whereas for ¹⁸F-FDG, these values were 62 % and 90 %, respectively. Conclusion: PET/CT with ⁶⁸Ga-FAPI is a more effective diagnostic method for detecting distant metastases of gastric cancer than PET/ CT with ¹⁸F-FDG. The obtained results indicate the need to use PET/CT with ⁶⁸Ga-FAPI in clinical practice for more accurate diagnosis and treatment strategy selection in gastric cancer.

Introduction: Radium-223 (²²³Ra) therapy improves survival in patients with metastatic castration-resistant prostate cancer (mCRPC), but response monitoring is challenging due to the lack of classic PSA response. Standardized assessment methods based on imaging are needed. Objective: To develop and evaluate a comprehensive diagnostic algorithm for quantitative monitoring of the efficacy of ²²³Ra therapy based on SPECT/CT and bone scintigraphy data. Materials and Methods: A prospective single-center study included 114 mCRPC patients who received 2 to 6 injections of ²²³Ra. All patients underwent planar bone scintigraphy with automated Bone Scan Index (aBSI) calculation, quantitative SPECT/CT with   standardized uptake value (SUV_max, SUV_mean) and percent injected dose (%ID) calculation, PSMA-ligand PET/CT, assessment of biochemical markers (PSA, LDH, ALP) and clinical status. Results: In patients who completed the full course (6 injections, n = 64), a statistically significant decrease in all quantitative parameters was revealed: SUV_max (from 51.9 ± 16.4 to 30.5 ± 11.2; p < 0.001), SUV_mean (from 2.87 ± 0.63 to 2.43 ± 0.58; p = 0.021),   %ID (from 12.4 ± 3.1 to 10.8 ± 2.6; p = 0.037), aBSI (from 2.15 ± 0.38 to 1.70 ± 0.31; p = 0.005), as well as levels of PSA, LDH and ALP. Imaging parameters significantly correlated with ALP levels, pain syndrome, functional status, and the development of hematological toxicity. High baseline SUV_mean, %ID, and aBSI values were associated with an increased risk of myelosuppression. Conclusion: Quantitative SPECT/CT parameters (SUV_max, SUV_mean, %ID) and scintigraphy parameters (aBSI) are objective markers of the efficacy of ²²³Ra therapy, reflecting the dynamics of the metabolic activity of bone metastases and allowing to predict the development of hematological toxicity. A comprehensive multiparameter approach improves the accuracy of treatment response assessment.

Purpose: To determine the diagnostic performance of mammoscintigraphy (SMG) with the ^99mTc-methoxy-isobutyl-isonitrile (^99mTc-MIBI) when used for assessment of the response to neoadjuvant chemotherapy (NACT) in patients with triple-negative and HER2-positive breast cancer (BC). Materials and methods: This retrospective study included 93 patients with morphologically verified triple-negative and HER2-positive breast cancer who received NACT between 2011 and 2018. Mammoscintigraphy was performed before treatment, after 2–3 and/or after 4–6 cycles of NACT. Diagnostic conclusions of SMG were compared with the results of morphological examination after surgical treatment at the end of NACT. The degree of pathological response to NACT was evaluated according to the Miller-Payne classification. Results: Overall, the sensitivity and specificity of SMG in predicting of complete pathologic tumor response after the completion of NACT were 83 % and 92 %, respectively. In patients with triple-negative and HER2-positive BC, sensitivity and specificity were 87 % and 92 %; 78 % and 91 %, respectively. When a complete scintigraphic response (grade V) was achieved after 2–3 cycles of NACT, the specificity and positive predictive value of SMG reached 100 % for both aggressive BC subtypes. Conclusions: The obtained results indicate the high diagnostic potential of SMG in predicting complete pathological tumor response to the NACT. Exceptional specificity and positive predictive value of SMG in the middle of the NACT make it promising tool in selection of BC patients for surgery de-escalation/elimination.

Introduction: Accurate differential diagnosis of pancreatic cystic lesions is crucial for selecting the optimal management strategy and for timely identification of lesions with malignant potential. A key objective of radiology is the development and implementation of quantitative imaging approaches that can improve diagnostic performance and reduce reliance on subjective image interpretation. Purpose: To evaluate the value of magnetic resonance imaging (MRI) and MRI-based radiomic analysis for the differential diagnosis of pancreatic cystic neoplasms, and to develop machine-learning radiomic models for predicting the malignant potential of pancreatic cystic lesions. Materials and methods: In this retrospective study, MRI examinations of 67 patients with surgically and pathologically confirmed pancreatic cystic neoplasms were analyzed. Lesion segmentation and radiomic feature extraction were performed by a radiologist experienced in abdominal imaging. Seven supervised machine-learning models were trained. Model performance was assessed using area under the receiver operating characteristic curve (ROC-AUC), precision–recall AUC (PR-AUC), accuracy, sensitivity, specificity, and F1-score. The best-performing model was selected based on ROC-AUC. Model interpretability was evaluated using SHapley Additive exPlanations (SHAP). Results: The Random Forest classifier showed the best performance (ROC-AUC = 0.83), followed by LightGBM (ROC-AUC = 0.77). SHAP analysis highlighted the radiomic features with the greatest impact on the model outputs. Conclusion: MRI-based radiomics may support risk stratification of pancreatic cystic lesions. Further studies with larger cohorts are needed to confirm these findings and improve model generalizability.

The article presents two clinical cases of the local variant of Castleman’s disease in women aged 29 and 46. Both patients had no complaints, and pathological lesions in the abdominal cavity were revealed in routine US-examinations. In the first case, the preoperative contrast–enhanced CT scans with typical findings allowed us to make the correct diagnosis. In the second case, an atypical CT picture of the detected lesion did not allow us to specify the preoperative diagnosis. Both patients were successfully operated on, but in the second case with intraoperative technical difficulties. Based on the morphological examination of the removed lesions, the final diagnosis was made — Castleman’s disease (hyaline vascular type).

This article summarizes the results of modern scientific research on the use of three imaging methods for the diagnosis of breast cancer: dual-energy contrast spectral mammography (CESM), magnetic resonance imaging with contrast enhancement (MRI) and ultrasound with contrast (CEUS). The authors analyzed the diagnostic capabilities and overall effectiveness of these methods. Based on the analysis, it is concluded that further studies comparing CESM, MRI and CEUS in the same patient group are necessary. This will allow us to better understand how these methods affect treatment planning, therapy selection, and achieving positive clinical results.

Purpose: To evaluate the diagnostic informativeness and clinical efficiency of vacuum-assisted fine-needle aspiration biopsy (v-FNA) under ultrasound guidance in liver, pancreatic, and lymph node tumors, and to assess the feasibility of using small-diameter needles (20–25G) without compromising diagnostic accuracy. Materials and Methods: The study included 62 patients (32 men, 30 women) with suspected neoplastic lesions of the liver, pancreas, and lymph nodes. A total of 76 biopsies were performed under real-time ultrasound guidance using Chiba needles (20G, 22G, and 25G). Vacuum aspiration was performed under a constant negative pressure of −0.8 bar. Cytological preparations were stained by the May–Grünwald–Giemsa method and evaluated according to the WHO Classification of Tumours (5th Edition, 2022). Results: The overall rate of diagnostically adequate smears increased from 72.3 % with FNA to 89.5 % with v-FNA. The greatest improvement was observed in pancreatic and lymph node biopsies. Small-diameter needles (25G) yielded sufficient cellular material for reliable cytological diagnosis with minimal trauma. Concordance between cytological and histological diagnoses reached 85.7 %. Conclusions: Vacuum-assisted fine-needle aspiration biopsy under ultrasound control is a reliable, safe, and reproducible method of cytological diagnosis for intra-abdominal tumors. The use of controlled negative pressure allows for smaller needles without loss of   diagnostic yield, expanding clinical applicability and improving the overall quality of cytological evaluation.

Purpose: To assess the radiation exposure of personnel during biopsy of lung cancer patients under X-ray computed tomography control (CT) and to justify the need to implement specialized technologies to reduce and prevent radiation exposure to personnel. Materials and methods: Measurement of the radiation dose in the X-ray computed tomography beam on the surgeon’s hands, organs of vision and thyroid gland for all stages of puncture taking without taking into account the attenuation of radiation in the surgeon’s protective apron and taking it into account was carried out using a RadiaScan-801M dosimeter. The measurement of the equivalent dose in the surgeon’s head and neck area for all stages of biopsy taking, taking into account the apron on the patient and on the Alderson Rando anthropomorphic phantom, was carried out using two dosimeters: RadiaScan-801M and DKS-AT1123. Results: It has been shown that the maximum equivalent doses received by the surgeon during biopsy procedures were received by the hands, located within the scanning beam. The head and neck areas are significantly exposed to scattered X-ray radiation. The average equivalent dose and average dose rate for all biopsy stages were D = 1850 ± 874 μSv, Ḋ̅ = 21 ± 2 μSv/s. However, given the specific propagation of scattered X-rays during CT scanning due to tube rotation, radiation protective goggles cannot fully perform their function. The average equivalent dose in the head and neck area and average equivalent dose rate were D = 148.8 ± 116 μSv and Ḋ̅ = 1.5 ± 0.5 μSv/s, respectively. An additional simple method for reducing scattered radiation levels is proposed and validated, the effectiveness of which was demonstrated in a phantom experiment. Several ways to reduce radiation exposure through process automation are discussed. Conclusion: The obtained results indicate the need to find measures to make CT-guided biopsy procedures safer while minimizing radiation exposure to personnel

Introduction: Solitary fibrous tumor (SFT) — a rare mesenchymal tumor of fibroblastic origin. Solitary fibrous tumor is not a tumor of the pleura itself, unlike diffuse mesothelioma. The SFT was first described by E. Wagner in 1870. Non-specific clinical manifestations of solitary fibrous tumor complicate the diagnostic search and significantly expand the differential diagnostic range. Purpose: To demonstrate a rare case of solitary fibrous tumor of the pleura and to show, using a clinical case as an example, the difficulties of its diagnosis. Materials and methods: Multislice computed tomography (MSCT) of the chest organs performed to the patient with complaints of cough and shortness of breath during intense physical activity. Formation was detected with clear contours, a heterogeneous structure, located subpleurally was revealed. Results: The presented observation demonstrates non-specific radiological manifestations of a solitary fibrous tumor and illustrates the importance of correct interpretation of data and choice of diagnostic algorithm.

The main treatment methods for differentiated thyroid carcinoma are surgery and radioactive iodine ablation. In some cases, systemic therapy is useful. The use of external beam radiation therapy, especially stereotactic body radiation therapy applied with a curative intent, is highly debated. This article reports a rare clinical case of primary tumor treatment in a patient with inoperable differentiated thyroid carcinoma using stereotactic body radiation therapy and reviews the world data on the issue.

Purpose: To study the pharmacokinetics of ⁶⁸Ga‑FAP‑2286 in oncological and inflammatory diseases and to compare the diagnostic capabilities of ⁶⁸Ga‑FAP‑2286 and ⁶⁸Ga‑FAPI‑04, including in the context of its potential use for patient selection for 177Lu‑FAP‑2286 radionuclide therapy. Material and methods: PET/CT studies with ⁶⁸Ga‑FAP‑2286 and ⁶⁸Ga‑FAPI‑04 were performed on two patients: one with an oncological disease and one with an inflammatory process. The ⁶⁸Ga‑FAP‑2286 PET/CT scan was conducted in three phases — at 5 minutes, 60 minutes, and 180 minutes after radiopharmaceutical administration, followed by an assessment of the dynamics of SUV_max changes in the target regions. PET/CT scanning with ⁶⁸Ga‑FAPI‑04 was performed in a single step, 60 minutes post‑injection Conclusion: ⁶⁸Ga‑FAPI‑04 and ⁶⁸Ga‑FAP‑2286 have similar diagnostic characteristics. Differences in the pharmacokinetics of ⁶⁸Ga‑FAP‑2286 between tumorous and inflammatory changes were also identified.