Discrepancies Between Pathological Tumor Responses and Estimations of Complete Response by Magnetic Resonance Imaging After Neoadjuvant Chemotherapy Differ by Breast Cancer Subtype.

INTRODUCTION: The influence of breast cancer (BC) subtype in discrepancies between pathologic complete response (pCR) and complete response by magnetic resonance imaging (MRI-CR) after neoadjuvant chemotherapy (NAC) have not been discussed well. We evaluated the association between BC subtype and pCR or only residual in situ lesion without invasive cancer (pCR/in situ+) in patients with MRI-CR (positive predictive value [PPV]). MATERIAL AND METHODS: From the data of 716 patients with primary BC who were diagnosed with invasive cancer and treated with NAC and then surgery from January 2009 to May 2014 at St. Luke's International Hospital, 180 patients were determined to have MRI-CR by retrospective chart review. BC subtypes at baseline were classified into 6 subtypes, as strong estrogen receptor (ER++), moderately positive ER (ER+), negative ER (ER-), and HER2 status expression. RESULTS: Three subtypes had PPV (pCR) ≥ 50%: ER-/HER2+ (56.3%, 27/48), ER-/HER2- (57.6%, 34/59), and ER+/HER2+ (56.2%, 9/16). However, PPV (pCR) for the ER++/HER2- and ER++/HER2+ subtypes was < 30%; notably, only 12.0% (3/25) for the ER++/HER2- subtype, which was significantly low (P < .001) compared with ER++/HER2- and other subtypes. PPV (pCR/in situ+) was significantly low at 20.0% in the ER++/HER2- subtype (P < .001 compared with other subtypes). PPV (pCR/in situ+) in other subtypes was collectively greater than 60%, and was 91.7% in the ER-/HER2+ subtype. CONCLUSION: We should interpret carefully MRI-CR of NAC to evaluate residual disease for ER++/HER2- BC.

Overcalling low-risk findings: grouped amorphous calcifications found at screening mammography associated with minimal cancer risk.

BACKGROUND: Because of the increasing availability of screening mammography and spread of information about its benefits, the incidence of early breast cancer has been increasing in Japan. However, screening mammography can result in overdiagnoses or false positives, causing in some subjects undergoing unnecessary invasive procedures. The current mammography guidelines recommend further investigation of subjects with grouped amorphous calcifications; this recommendation may have resulted in overdiagnoses or false positives. METHODS: We retrospectively reviewed the charts of patients who had undergone screening mammography in the screening unit of our institution from January 2011 to December 2012 and been found to have grouped amorphous calcifications. Of the 233 such cases, 17 had been lost to follow-up, whereas whether the lesions were actually benign or malignant had been determined in the remaining 216 (92.7%). RESULTS: Six (2.8%) of 216 subjects with grouped amorphous calcifications were diagnosed as having malignancy and the remaining 210 (97.2%) as having benign lesions. Four of the six cases (1.9%) with malignancy had ductal carcinoma in situ and two (0.9%) 3 and 4 mm diameter invasive cancers of luminal type and nuclear grade 1. CONCLUSIONS: Grouped amorphous calcifications identified on screening mammography contribute minimally to detection of breast cancer and are not thought to be associated with any identifiable improvement in prognosis; present recommendations concerning this finding may result in false positives and overdiagnoses.

Spring migration routes of mallards (Anas platyrhynchos) that winter in Japan, determined from satellite telemetry.

Wild birds, in particular waterfowl, are common reservoirs of low pathogenic avian influenza viruses, and infected individuals could spread the viruses during migrations. We used satellite telemetry to track the spring migration of the mallard ducks ( Anas platyrhynchos ) that winter in Japan. We studied their migration routes, distribution of stopover and breeding sites, and timing of migration movements. We tracked 23 mallards from four different wintering sites. Nine of the 23 mallards reached presumable breeding sites, where migration terminated. The migration routes of the birds greatly differed not only among the wintering sites but also within the same wintering site, although the general feature of the routes was shared among birds within the same wintering site. The mallards used several stopover sites, and they typically stayed for a long period (about one to four weeks) at a site between migration intervals of two to three days. Stopover sites were located in northeast Japan, the eastern coastline of South Korea and North Korea, and the interior of Far Eastern Russia. Mallards from three different wintering sites used a stopover area near the middle part of the Ussuri river in Russia. The terminal sites, which were presumably also breeding sites, were distributed widely over northeast Asia and Far Eastern Russia. These results suggest that mallards that winter in Japan originate from breeding areas widely distributed across eastern Asia. Mallards could potentially transmit avian influenza viruses between Japan and a broad region of northeastern Asia.