Cristian Ioan Bordea

Background: Melanoma remains a leading cause of cancer-related mortality, with early detection being the primary determinant of survival. The emergence of MLLMs offers a potential paradigm shift in accessible screening. However, the diagnostic reliability and safety of these general-purpose models in oncology remain insufficiently characterized. Methods: This study performed a head-to-head comparison of GPT-5, Gemini 3, and Grok 4 to evaluate their efficacy as first-level screening tools for cutaneous melanoma. A retrospective analysis was conducted using a balanced dataset of 100 clinical images (50 histopathologically confirmed benign, 50 malignant) from the ISIC archive. Results: Gemini 3 achieved the highest overall accuracy (71%) and specificity (94%), while Grok 4 demonstrated the highest sensitivity (52%). All models exhibited a critical deficit in sensitivity, missing approximately half of the malignant lesions. Statistical testing revealed no significant performance differences between the models (p > 0.05). Notably, Gemini 3 exhibited severe overconfidence, maintaining a high CI (84.62%) even during false-negative predictions, whereas GPT-5 and Grok 4 showed better calibration with a significant drop in confidence upon incorrect diagnosis. Conclusions: While current MLLMs possess a foundational capacity for dermatological analysis, their unacceptably low sensitivity and potential for overconfident misdiagnosis render them unsafe as standalone screening tools. At present, MLLMs should only be utilized as complementary tools under strict clinical supervision.

Sentinel lymph node biopsy (SLNB) has transformed the management of cutaneous melanoma, emerging as a cornerstone in evaluating regional lymphatic spread while minimizing surgical morbidity. From its theoretical foundation laid by Cabanas to its refinement and clinical validation through landmark trials, SLNB has evolved into a standard of care with significant prognostic value. This review traces the historical trajectory of SLNB, analyzes current guidelines and controversies and explores future directions. Novel imaging technologies, such as indocyanine green fluorescence and augmented reality-assisted mapping, promise to enhance accuracy and reduce invasiveness. Furthermore, the advent of effective systemic therapies and neoadjuvant protocols is reshaping the therapeutic landscape, potentially redefining the role of SLNB in melanoma management. As precision medicine advances, SLNB remains an essential procedure, with its utility continually redefined by technological innovation and evolving oncologic strategies.

The incidence and mortality of cervical cancer are high in Romania compared to other European countries, particularly for locally advanced cervical cancer cases, which are predominant at the time of diagnosis. Widely accepted therapeutic guidelines indicate that the treatment for locally advanced cervical cancer consists of concurrent chemoradiotherapy (total dose 85–90 Gy at point A), with surgery not being necessary as it does not lead to improved survival and results in significant additional morbidity. In Romania, the treatment for locally advanced cervical cancer differs, involving lower-dose chemoradiotherapy (total dose 60–65 Gy at point A), followed by surgery, which, under these circumstances, ensures better local control. In this regard, we attempted to evaluate the role and necessity of surgery in Romania, considering that in our study, residual lesions were found in 55.84% of cases on resected specimens, especially in cases with unfavorable histology (adenocarcinoma and adenosquamous carcinoma). This type of surgery was associated with significant morbidity (28.22%) in our study. The recurrence rate was 24.21% for operated-on patients compared to 62% for non-operated-on patients receiving suboptimal concurrent chemotherapy alone. In conclusion, in Romania, surgery will continue to play a predominant role until radiotherapy achieves the desired effectiveness for local control.

The incidence and mortality of cervical cancer are high in Romania compared to other European countries, particularly for locally advanced cervical cancer cases, which are predominant at the time of diagnosis. Widely accepted therapeutic guidelines indicate that the treatment for locally advanced cervical cancer consists of concurrent chemoradiotherapy (total dose 85-90Gy at point A), with surgery not being necessary as it does not lead to improved survival and results in significant additional morbidity. In Romania, the treatment for locally advanced cervical cancer differs, involving lower-dose chemotherapy (total dose 60-65Gy at point A), followed by surgery which, under these circumstances, ensures better local control. In this regard, we attempted to evaluate the role and necessity of surgery in Romania, considering that in our study, residual lesions were found in 55.84% of cases on resected specimens, especially in cases with unfavorable histology (adenocarcinoma and adenosquamous carcinoma). This type of surgery was associated with significant morbidity (28.22%) in our study. The recurrence rate was 24.21% for operated patients compared to 62% for non-operated patients receiving suboptimal concurrent chemotherapy alone. In conclusion, In Romania, surgery will continue to play a predominant role until radiotherapy achieves the desired effectiveness for local control.

During pregnancy, hormonal and immune adaptations are vital for supporting the genetically distinct fetus during elevated infection risks. The global prevalence of HPV necessitates its consideration during pregnancy. Despite a seemingly mild immune response, historical gestational viral infections underscore its significance. Acknowledging the established HPV infection risks during pregnancy, our review explores the unfolding immunological changes in pregnant women with HPV. Our analysis aims to uncover strategies for safely modulating the immune system, mitigating adverse pregnancy consequences, and enhancing maternal and child health. This comprehensive narrative review delves into the existing knowledge and studies on this topic.

(1) Introduction: Sentinel lymph node biopsy (SLNB) is widely used in breast cancer patients who undergo neoadjuvant chemotherapy (NAC), replacing axillary lymph node dissection. While commonly accepted for cN0 patients, its role in cN1/2 patients remains controversial. Our study aims to investigate the role of SLNB in BC patients who underwent prior NAC and compare our results to those of other studies presented in the literature. (2) Materials and methods: Our retrospective study included 102 breast cancer patients who received NAC before ^99mTc-albumin Nanocolloid SLN mapping and SLNB was performed, completed or not with axillary dissection. A review based on the PRISMA statement was also carried out, encompassing 20 studies. (3) Results: The lymphoscintigraphy performed after the administration of NAC presented an identification rate (IR) of 93.13%. IR for SLNB was 94.11%, with a false-negative rate (FNR) of 7.4%. After a median follow-up of 31.3 months, we obtained a distant disease-free survival rate of 98%. The results obtained by other groups were similar to those of our study, presenting IR in the range 80.8–96.8%, with FNR varying from 0 to 22%. (4) Conclusions: on conclusion, SLNB can accurately determine the lymph node status, with an acceptable FNR and maintain its expected prognostic role with low recurrence rates, and our results are comparable to those obtained by other studies.

(1) Background: The aim of our study was to determine whether monitoring cardiac function through RNV and cardiac biomarkers could predict the cardiac impact of combined therapy with trastuzumab, pertuzumab and docetaxel, which are regularly used nowadays to treat HER2-positive breast cancer. (2) Methods: This prospective monocentric study included 22 patients, diagnosed with HER2-positive breast cancer, who had their LVEFs and cardiac biomarkers evaluated both at the beginning of their treatment and after 6 months. Among all of the enrolled patients, two blood specimens were collected to assess circulating cardiac biomarkers. RNV was performed in each patient after “in vivo” radiolabeling of the erythrocytes. The obtained results were then statistically correlated. (3) Results: The average LVEF decrease between the two time points was approximately 4%. Of the five biomarkers we considered in this paper, only NT-proBNP correlated with the LVEF values obtained both in the baseline study and after 6 months of follow-up (r = −0.615 for T0 and r = −0.751 for T1, respectively). ST2/IL-33R proved statistically significant at the T1 time point (r = −0.547). (4) Conclusions: A combination of LVEF, NT-proBNP and ST2/IL-33R assessment may be useful for early detection of cardiac impairment in breast cancer patients treated with trastuzumab, pertuzumab and docetaxel.

Identification and biopsy of the sentinel lymph node (SLN) in early-stage breast cancer (T1-T2N0) has become the standard method in the surgical treatment of the axilla, due to its accuracy in the evaluation of axillary lymph node status,thus avoiding extensive axillary lymph node dissection inpatients with negative SLN. The aim of our study is to highlight the role of 99mTc-nanocolloid lymphoscintigraphy in the preoperative lymphatic mapping, especially for SLN localizations outside the axilla, as well as the benefits of this technique in the accurate staging of breast cancer. 430 patients (age 31-81 years) with breast cancer (T1-T2N0 stage) were included in the study group, who underwent lymphoscintigraphy in order to identify the sentinel lymph node in the Nuclear Medicine Department of "€œProf. Dr. Al. Trestioreanu"€ Institute of Oncology, Bucharest,between October 2008 - July 2014. Radiocolloid (99mTc-nanocolloid)was injected using peritumoral or periareolar intradermal technique, doses between 20-37 MBq (0.3-0.5 ml volume), followed by static and dynamic post-injection acquisitions.Intraoperative identification of the SLN was performed using a gamma-probe, guided by the skin marker performed preoperatively after completion of lymphoscintigraphy. 697 sentinel lymph nodes were identified through imaging techniques in 427 patients (99%). Of them, 364 patients had axillary localization of the SLN, while 48 patients(11%) had non-axillary (pectoral, internal mammary, supraclavicular,intra-mammary) localization and 15 patients (3%)had multiple localization (axillary and non-axillary).Intraoperative histopathological exam revealed lymphatic invasion in 74 SLN (12% macrometastases and 88% micrometastases). The identification and biopsy of the sentinel lymph node in stages I and IIA is a useful routine for accurate breast cancer staging, suited for axillary lymphatic drainage, as well as for unusual non-axillary SLN localization, guiding the clinician for further postoperative management of these patients.