Comparison of Breast Density Between Synthesized Versus Standard Digital Mammography

PURPOSE

To evaluate perceptual difference in breast density classification using synthesized mammography (SM) compared with standard or full-field digital mammography (FFDM) for screening.

MATERIALS AND METHODS

This institutional review board-approved, retrospective, multireader study evaluated breast density on 200 patients who underwent baseline screening mammogram during which both SM and FFDM were obtained contemporaneously from June 1, 2016, through November 30, 2016. Qualitative breast density was independently assigned by seven readers initially evaluating FFDM alone. Then, in a separate session, these same readers assigned breast density using synthetic views alone on the same 200 patients. The readers were again blinded to each other's assignment. Qualitative density assessment was based on BI-RADS fifth edition. Interreader agreement was evaluated with κ statistic using 95% confidence intervals. Testing for homogeneity in paired proportions was performed using McNemar's test with a level of significance of .05.

RESULTS

For patients across the SM and standard 2-D data set, diagnostic testing with McNemar's test with P = 0.32 demonstrates that the minimal density transitions across FFDM and SM are not statistically significant density shifts. Taking clinical significance into account, only 8 of 200 (4%) patients had clinically significant transition (dense versus not dense). There was substantial interreader agreement with overall κ in FFDM of 0.71 (minimum 0.53, maximum 0.81) and overall SM κ average of 0.63 (minimum 0.56, maximum 0.87).

CONCLUSION

Overall subjective breast density assignment by radiologists on SM is similar to density assignment on standard 2-D mammogram.

Pathological Stage I Endometrial Carcinoma: The Role for Adjuvant Radiotherapy

Background

In order to assess the efficacy of adjuvant radiotherapy in the treatment of pathological stage I endometrial carcinoma, we performed a retrospective analysis of 158 patients with this diagnosis who after surgery were either treated with radiation therapy or only followed from January 1980 through December 1987.

Methods

Patients were divided into two prognostic categories, high and low risk, on the basis of three known predictors of survival: histology, differentiation, and depth of myometrial invasion. All patients underwent total abdominal hysterectomy and bilateral salpingooophorectomy but only the high risk group received radiotherapy as well.

Results

After a median follow up time of 59 months the survival rates of the two groups were similar. The 5-year disease-free survival of the surgery alone group was 92 % compared to 89 % for the postoperative radiotherapy group. Side effects of treatment were minimal.

Conclusions

Postoperative radiation therapy for high risk pathological stage I endometrial carcinoma is an effective adjuvant therapy and confers an excellent prognosis.

Composition of Anopheline (Diptera: Culicidae) Community and Its Seasonal Variation in Three Environments of the City of Puerto Iguazú, Misiones, Argentina

In order to extend the knowledge of the composition of the anopheline community and the seasonal variation related to anthropogenic modifications in the city of Puerto Iguazú, adult females were captured between 2009 and 2012. Samples were collected in three environments with different degrees of anthropogenic modification: urban, periurban, and wild. Alpha diversity was evaluated as the 'true' diversity of the species in each environment. Among environments, range-abundance curves were used to compare the composition, abundance, and uniformity of species and cluster analysis was used to analyze the similarities and differences. The temporal distribution was analyzed and the relative abundance of the species captured was correlated with meteorological variables. A total of 4,565 females, belonging to seven species: Anopheles albitarsis s.s. (Lynch-Arribálzaga), Anopheles argyritarsis (Robineau-Desvoidy), Anopheles deaneorum (Rosa-Freitas), Anopheles fluminensis (Root), Anopheles mediopunctatus (Theobald), Anopheles strodei s.l. (Root), and Anopheles triannulatus s.l. (Neiva and Pinto) were captured. The wild environment showed higher abundance, diversity, and greater uniformity reflected on the less sharp area of the range-abundance curve. Species richness was the same in the wild and periurban environments. Higher abundances were observed in summer during the months with higher temperatures. Although the wild environment showed greater Anopheles abundances and diversity, specific richness and species complementarity were similar among the three environments studied. Thus, the periurban environment would turn into a transition zone of great epidemiological importance due to the introduction of people in this environment, which represents a potential risk of malaria transmission in the area.

Results from the Super Cryogenic Dark Matter Search Experiment at Soudan

We report the result of a blinded search for weakly interacting massive particles (WIMPs) using the majority of the SuperCDMS Soudan data set. With an exposure of 1690 kg d, a single candidate event is observed, consistent with expected backgrounds. This analysis (combined with previous Ge results) sets an upper limit on the spin-independent WIMP-nucleon cross section of 1.4×10^{-44} (1.0×10^{-44})  cm^{2} at 46  GeV/c^{2}. These results set the strongest limits for WIMP-germanium-nucleus interactions for masses >12  GeV/c^{2}.

Patients with isolated prolonged in vitro bleeding time

In patients with isolated prolonged in vitro bleeding time there is no standardised treatment concept. With this study we characterized the extent of bleeding symptoms.

Patients, methods All diagnoses known to cause prolonged in vitro bleeding time (PFA-100) (epinephrine-cartridge >160 s, ADP-cartridge > 120 s) have been excluded, such as platelet function disorders, effects of medications, nutrition or von Willebrand disease. 75 patients (77%, n = 58 women; 23%, n = 17 men, median age 46 (16–81) years were included. All bleeding symptoms have been stored in a databank with help of a comprehensive questionnaire.

Results 78% (n = 54) of all patients reported of having had an operation, 69.8% (n = 37) of them described postoperative bleedings (p = 0.0373). 13.5% (n = 5) of the 54 could remember having been randomly treated by the administration of a transfusion and only 2.7% (n = 1) were treated by substitution of von Willebrand factor. 71% (n = 51) patients indicated haematoma (p = 0.8116). About 33.8% (n = 24) patients had gum bleeding and 40.8% (n = 29, p = 0.7808) patients reported bleeding after the dentist. 41.4% (n = 29) patients suffered under frequent epistaxis (p = 0.0212). There was no correlation between prolonged epinephrine bleeding time to VWF : Ag (rho = 0.16) nor to VWF : RCo (rho = 0.12) nor between prolonged epinephrine and ADP bleeding time (rho = 0.01) nor to ROTEM® analysis.

Conclusion Patients with isolated prolonged PFA are mainly women and can be affected by all kinds of bleedings while haematoma is the main symptom. VWD might not be causal

A mononuclear iron carbonyl complex [Fe(μ-bdt)(CO)2(PTA)2] with bulky phosphine ligands: a model for the [FeFe] hydrogenase enzyme active site with an inverted redox potential

A mononuclear hexa-coordinated iron carbonyl complex [Fe(μ-bdt)(CO)₂(PTA)₂] 1 (bdt = 1,2-benzenedithiolate; PTA = 1,3,5-triaza-7-phosphaadamantane) with two bulky phosphine ligands in the trans position was synthesized and characterized by X-ray structural analysis coulometry data, FTIR, electrochemistry and electronic structure calculations. The complex undergoes a facilitated two-electron reduction 1/1^2- and shows an inverted one-electron reduction for 1/1^- at higher potentials. Electrochemical investigations of 1 are compared to the closely related [Fe(bdt)(CO)₂(PMe₃)₂] compound. A mechanistic suggestion for the hydrogen evolution reaction upon proton reduction from acid media is derived. The stability of 1 in both weak and strong acids is monitored by cyclic voltammetry.

Distribution of receptor tyrosine kinase (RTK) nsSNPs in breast cancer (BC) patients (pts) using next-generation sequencing (NGS)

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Background: Non-synonymous SNPs (nsSNPs) discovered by NGS occurring in RTKs’ conserved topology in pts with BC may promote oncogenic signaling and hence may be actionable. Methods: We analyzed BC pts for nsSNPs in 29 RTKs identified by tumor profiling with NGS from Caris during 2013-2015. Mutations were classified by location including the tyrosine kinase domain (TKD), extracellular domain (ECD), transmembrane domain (TM), juxtamembrane domain (JM) and carboxy-terminal (CT) regions. nsSNPs underwent in silico analysis using PolyPhen-2 (Harvard) to determine pathogenicity. Results: 79 pts were identified with a median age of 58 years (range 32-83); 99% female; 60% white, 38% black and 2% other. 77 pts were classifiable with 8 (10%) triple-positive, 35 (46%) ER+/PR+/HER2- (ER/PR+), 10 (13%) ER-/PR-/HER2+ (HER2+) and 24 (31%) triple-negative. 78 nsSNPs and 1 Caris-reported pathogenic substitution of ERBB3 (TKD S846I) were found. 52/79 (66%) pts had ≥1 RTK nsSNP (range 0-4); 28/29 RTKs had ≥1 nsSNP with median of 2 (range 0-15). In 28 pts (35%), 40% of nsSNPs were predicted to be damaging (pnsSNP) and 3 pts had 2 pnsSNPs. 17/29 RTKs had pnsSNPs, median 1 (range 0-9). The most commonly mutated RTKs were ROS1 (9/15 variants were pnsSNPs), ALK (3/4), EPHA5 (3/3), FLT4 (2/5), cKIT (2/4) and ERBB4 (2/3). ROS1 and ALK nsSNPs were most-frequently seen in ER/PR+ (9/15 pnsSNPs), triple-positive (3/3) and HER2+ (0/2) pts; no triple-negative pts had such variants. 100% triple-positive pts (6/8 pnsSNP), 69% ER/PR+ (18/35), 60% HER2+ (2/10) and 58% triple-negative (3/24) had RTK nsSNP. nsSNP were spread in all 5 RTK regions: 58% localized to the ECD (20/45 pnsSNPs), 17% TKD (8/13), 9% CT (2/7), 9% TM (1/7) and 8% JM (1/6) lesions were found. Of 9 ROS1 pnsSNPs, 7 were ECD, 1 CT and 1 TKD. Conclusions: 35% of BC pts had pnsSNP in RTKs across various phenotypes including frequent mutations in potentially actionable genes such as ROS1 and ALK. 26% of ER/PR+ pts had pnsSNPs in ROS1 or ALK. nsSNPs in the ECD or TKD were most likely to be damaging.

Localization of non-receptor tyrosine kinase (nRTK) variants in solid tumor patients using next-generation sequencing (NGS)

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Background: Non-synonymous SNPs (nsSNPs) in nRTKs may serve as oncologic targets and predictive biomarkers, with significant lesions described in various nRTK regions including the tyrosine kinase domain (TKD). NGS allows the entire coding sequence to be evaluated, facilitating the identification of novel lesions. Methods: We searched all nsSNPs in 14 nRTKs in the tumors of patients (pts) at our institution that received NGS with Caris from 2013-2015 with a diagnosis of advanced breast, colon or lung cancer. Substitutions were classified as either within or extra-TKD; in the case of JAK1-3, pseudokinase domain lesions were also identified. In order to predict the pathogenicity of nsSNPs, in silico analysis with PolyPhen-2 (Harvard) was completed. Results: 356 pts (79 breast, 110 colon and 165 lung (156 NSCLC, 11 small cell)) were identified with a median age of 61 years (range 26-86); 58% female; 62% white, 35% black. 245 variants were found, with 200 nsSNPs and 45 known pathologic mutations (Pmut); Pmut were PIK3CA (21 breast, 13 colon, 5 NSCLC) and AKT1 (6 breast). 169/356 (47%) pts had ≥1 nRTK lesion (0-8). 52/200 (26%) nsSNPs were predicted-damaging (pnsSNPs) with in silico analysis among 49 pts (6 breast, 13 colon and 30 NSCLC). pnsSNPs were found in 14/14 nRTKs with median 3 (1-10). The most frequently mutated nRTKs in breast were SRC (2/2 variants were pnsSNPs) and ABL2 (1/5); in colon ABL1 (5/10), JAK3 (3/27) and CDK12 (2/8); and in NSCLC JAK3 (6/20), BTK (5/8), ABL1 (3/12), JAK2 (3/11), CDK12 (3/9) and JAK1 (3/3). Of 180 nsSNPs with in silico results, 68% were extra-TKD (29/122 variants were pnsSNPs), 23% within the TKD (13/42) and 9% in pseudokinase domains of JAK1-3 (10/16). Notably, 8/10 pseudokinase domain pnsSNPs were in NSCLC pts (3 JAK1, 2 JAK2 and 3 JAK3). Conclusions: > 13% solid tumors held an nRTK nsSNP that was predicted-damaging by in silico analysis, with 69% of these mutations occurring outside of the TKD-proper. Further work is needed to determine how these pnsSNPs affect function and if they are clinically actionable.

Safety and antitumor activity of the anti-PD-1 antibody pembrolizumab in patients with recurrent carcinoma of the anal canal

Background

Safety and efficacy of pembrolizumab, a humanized programmed death 1 monoclonal antibody, was assessed in KEYNOTE-028, a multicohort, phase Ib trial for patients with programmed death ligand 1 (PD-L1)-positive advanced solid tumors. We report results for the cohort of patients with advanced anal carcinoma.

Patients and methods

Patients with PD-L1-positive tumors (≥1%) received intravenous pembrolizumab 10 mg/kg once every 2 weeks for up to 2 years or until confirmed progression or unacceptable toxicity. Response was assessed every 8 weeks for the first 6 months and every 12 weeks thereafter per Response Evaluation Criteria In Solid Tumors, version 1.1. Primary endpoints were safety and overall response rate per investigator review. Secondary endpoints included progression-free survival, overall survival, and response duration. Data cutoff date was 1 July 2015.

Results

Of the 43 patients with advanced anal carcinoma evaluable for PD-L1 expression, 32 (74%) had PD-L1-positive tumors as assessed with the 22C3 prototype assay, of whom 25 were enrolled between April and September 2014. Sixteen patients (64%) experienced treatment-related adverse events; the most common ones were diarrhea and fatigue in four patients (16%) each and nausea in three patients (12%). There were no treatment-related deaths or discontinuations as of the data cutoff date. Among the 24 patients with squamous cell carcinoma histology, four had confirmed partial response, for an overall response rate of 17% [95% confidence interval (CI), 5%-37%) and 10 (42%) had confirmed stable disease, for a disease control rate of 58%. One additional patient with non-squamous histology had confirmed stable disease.

Conclusion

In this population of patients with PD-L1-positive advanced squamous cell anal carcinoma, pembrolizumab demonstrated a manageable safety profile and encouraging antitumor activity. These data support further study of pembrolizumab for this patient population.

ClinicalTrials.gov

NCT02054806.

Diversity of anopheline mosquitoes (Diptera: Culicidae) and classification based on the characteristics of the habitats where they were collected in Puerto Iguazú, Misiones, Argentina

In order to extend the knowledge of anopheline diversity and their habitats in three environments with different degrees of anthropic intervention in Puerto Iguazú, Misiones, anopheline larvae were collected and classified on the basis of similarities of their habitats. Spatio-temporal abundance was determined and larval diversity and complementarity index were calculated. Rank-abundance curves were performed to compare the composition, abundance, and species evenness among environments. A total of 783 larvae, belonging to six species: Anopheles argyritarsis, An. fluminensis, An. mediopunctatus, An. punctimacula, An. strodei s.l., and An. triannulatus s.l., were collected. A cluster analysis and a principal component analysis detected two groups; exposure to sunlight and type of habitat were the characteristics that explained the grouping of species. Higher abundances of anopheline larvae were observed during autumn and spring. The greatest richness was recorded in wild and peri-urban environments and the effective number of species was greater in the wild. Anopheles punctimacula and An. triannulatus s.l. are secondary vectors of malaria in other South American countries and both species were found in the three environments, so that deforestation poses a potential risk for malaria transmission as it contributes to the proliferation of larval habitats for these mosquitoes.