Pathologic complete response (pCR) after neoadjuvant systemic therapy (NAST) of early breast cancer (EBC) has been recognized as a good prognostic factor in the treatment of breast cancer because of its significant correlation with long-term disease outcome. Based on this correlation, pCR has been accepted by health authorities (FDA, EMA) as a surrogate endpoint in clinical trials for accelerated drug approval. Moreover, in recent years, we have observed a tendency to treat pCR in routine clinical practice as a primary therapeutic target rather than just one of the pieces of information obtained from clinical trials. These trends in routine clinical practice are the result of recommendations in treatment guidelines, such as the ESMO recommendation “…to deliver all planned (neoadjuvant) treatment without unnecessary breaks, i.e. without dividing it into preoperative and postoperative periods, irrespective of the magnitude of tumor response”, because “…this will increase the probability of achieving pCR, which is a proven factor for a good prognosis…”. We hypothesize that the above recommendations and trends in routine clinical practice are the consequences of misunderstanding regarding the concept of pCR, which has led to a shift in its importance from a prognostic factor to a desired treatment outcome. The origin of this misunderstanding could be a strong subconscious incentive to achieve pCR, as patients who achieved pCR after NAST had a better long-term outcome compared with those who did not. In this paper, we attempt to prove our hypothesis. We performed a comprehensive analysis of the therapeutic effects of NAST and adjuvant systemic therapy (AST) in EBC to determine whether pCR, as a phenomenon that can only be achieved at NAST, improves prognosis per se. We used published papers as a source of data, which had a decisive influence on the formation of the modern attitude towards EBC therapy. We were unable to find any evidence supporting the use of pCR as a desired therapeutic goal because NAST (reinforced by pCR) was never demonstrated to be superior to AST in any context.

Background/Objectives: Acute Pancreatitis (AP) is an unpredictable inflammatory disease associated with high morbidity and significant mortality, particularly in severe forms. Early death is primarily linked to Systemic Inflammatory Response Syndrome (SIRS) and Multi-Organ Failure (MOF). The objective of this study was to identify objective clinical and laboratory predictors of early and one-year mortality in AP patients and to evaluate the prognostic accuracy of commonly used severity scoring systems. Methods: This prospective, observational study enrolled 50 adult patients admitted to the Intensive Care Unit (ICU) at the University Hospital Center Bežaniska Kosa. Patients with chronic pancreatitis, trauma-induced AP, or late presentation were excluded. Severity scores (APACHE II, BISAP, Ranson, Pancreas) and biomarkers (C-reactive protein, Procalcitonin) were collected at admission (0 h) and dynamically at 48 h, 72 h and day 7. Endpoints were early (in-hospital) and one-year mortality. Results: Overall mortality was 16% (n = 8). Mortality was significantly associated with sepsis/septic shock (p < 0.001), severe AP (p = 0.001), prolonged mechanical ventilation, and ICU stay. At admission, APACHE II (AUROC 0.813) and BISAP (AUROC 0.807) showed good accuracy. Reassessment at 48 h markedly improved prediction: APACHE II achieved excellent value (AUROC 0.917), and the Ranson score became a strong predictor (p < 0.001). Procalcitonin (PCT) was identified as a significant and superior predictor of mortality from 48 h onwards (p < 0.001), outperforming CRP. One-year survival was significantly shorter among patients with sepsis, septic shock, severe AP, and prolonged ICU stay. Conclusions: Dynamic assessment using clinical scoring systems, particularly APACHE II and BISAP within the first 48 h, provides reliable mortality prediction in acute pancreatitis. The presence of sepsis, severe disease, and the need for prolonged organ support are key mortality determinants. Serial PCT monitoring offers sensitive, incremental value for risk stratification and guiding intensive care decisions in both short- and long-term outcomes.

Breast cancer is the most frequent cancer among women worldwide. Cancer cells primarily spread through the lymphatic vessels, with axillary lymph node status being one of the most reliable prognostic factors in breast cancer patients. Axillary lymph node staging in breast cancer patients was initially performed by axillary lymph node dissection. Sentinel lymph node biopsy is the standard of care in clinically and radiologically negative axilla. According to the current guidelines, double contrast is a recommended procedure for identifying the sentinel lymph node. Nowadays, several new tracers are in clinical practice with a high identification rate and low false negative results. Due to technological and resource limitations, many medical centers worldwide lack the facilities to apply new radioactive tracers. The use of blue dye alone is a reliable and effective diagnostic and surgical technique, offering a high identification rate and low false-negative results.

Background: We present a detailed description and the preliminary results of our original technique for non-invasive three-dimensional tumor localization in the breast, which was created as an alternative to standard invasive tumor marking before neoadjuvant systemic therapy (NAST), aiming to enable adequate surgery after complete tumor regression. Methods: A detailed description of the technique is provided in the main text. The technique’s feasibility and precision were assessed in a single-arm, prospective study based on the histological parameters of the adequacy and rationality of the excision of completely regressed tumor beds. Results: Out of 94 recruited patients, 15 (16%) were deemed unsuitable, mainly due to the tumors’ inadequate ultrasound visibility. Among the 79 processed patients, 31 (39%) had complete clinical regression after NAST and were operated on using our technique. The histological parameters of surgical precision (signs of tumor regression: 24/31; microscopic cancer residues: 7/31) were verified in all excised specimens (100% precision). There were no positive margins in seven cases with microscopic residues, indicating our technique’s capacity to enable oncologically safe post-NAST surgery. Conclusions: The proposed technique is feasible and satisfactorily accurate in determining the location of regressed tumors, thus representing an alternative to invasive tumor marking, especially in surgical centers lacking trained staff and equipment for invasive marking. The technique’s limitations are mainly related to the inadequate ultrasound visibility of the tumor.

Introduction/Objective. Subclinical inflammation is increasingly recognized as a driver of postoperative pain, yet its role in breast tumour surgery is not fully defined. The objective was to determine whether preoperative C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) predict acute postoperative pain (APSP); to examine how surgical extent influences the peri-operative inflammatory response; and to explore the relation between intra-operative fentanyl and pain intensity. Methods. In a prospective single-centre cohort, 101 adults scheduled for breast surgery were stratified into four groups: mastectomy (M, n = 25), tumourectomy (T, n = 28), tumourectomy plus axillary dissection (T+A, n = 20), and benign excision (C, n = 28). Venous blood was drawn on admission (T0) and at 24 h (T24) for CRP and ESR. Pain was assessed with an 11-point Numerical Rating Scale 30 min after recovery and at 24 h; the highest 24-h score (max-APSP) was the primary pain outcome. Results. Pre-operative CRP correlated with max-APSP (p = 0.043), whereas ESR did not (p = 0.11). Baseline CRP and ESR, and their 24-h increments, rose stepwise with surgical magnitude, peaking after mastectomy (baseline CRP 7.1 ± 1.9 mg/L; T24 27.5 ± 3.6 mg•L/¹; both p < 0.01 vs. other groups). Intra-operative fentanyl correlated with CRP at 24 h (r = 0.33, p = 0.001) and with max-APSP (r = 0.28, p = 0.005). Despite these biological gradients, mean max-APSP remained mild to moderate across groups. Conclusion. Pre-surgical systemic inflammation, reflected by CRP, independently predicts early pain after breast tumour surgery. Surgical magnitude amplifies inflammatory markers, and greater fentanyl exposure parallels both inflammation and pain. Routine perioperative CRP may help identify high-risk patients for targeted anti-inflammatory and opioid-sparing analgesic strategies to reduce acute pain and potentially mitigate chronic pain development.

Background/Objectives: Predicting sentinel lymph node (SLN) involvement in breast cancer can reduce unnecessary axillary lymph node dissections (ALND) and facilitate clinical decision-making. This study aimed to: (i) identify independent predictors for SLN metastasis, and (ii) assess the predictive performance of the MSKCC nomogram for SLN positivity in early-stage breast cancer patients. Methods: A retrospective cohort study spanning a six-year period was conducted at a tertiary care oncology department in Belgrade, Serbia. The study included 684 consecutive patients with histologically confirmed primary breast carcinoma, without distant metastasis, who underwent surgical treatment with sentinel lymph node biopsy (SLNB). Results: Out of 684 patients, 198 (29%) were SLN-positive. Among the positive cases, 178 (89.9%) had one positive SLN, 19 (9.6%) had two, and 1 (0.5%) had three. Multivariate logistic regression revealed that lymphovascular invasion and tumor sizes >20 mm significantly increased the risk for SLN involvement. Patients with SLN metastasis had significantly higher MSKCC-predicted probabilities compared to SLN-negative patients (52.1 ± 18.5% vs. 33.1 ± 16.9%, p < 0.001). The area under the receiver operating characteristic curve (AUC) for the nomogram was 0.778 (95% CI: 0.738–0.818; p < 0.001). The nomogram demonstrated acceptable discrimination, with an AUC of 0.778 (95% CI: 0.738–0.818). However, calibration-in-the-large was −0.526 (95% CI: −0.709 to −0.342), indicating systematic overestimation of absolute risk. The calibration slope was 1.152 (95% CI: 0.921–1.383), and the Brier score was 0.174. Conclusions: Lymphovascular invasion and primary tumor size >20 mm are the only independent predictors of SLN metastasis. Furthermore, The MSKCC nomogram demonstrated acceptable discrimination but systematically overestimated absolute SLN-metastasis risk. Recalibration and further validation are required before clinical application in this population.