Description: We evaluated the impact of staging procedures to detect asymptomatic distant metastases (DM) in the management of women with operable invasive breast cancer (BC, entire cohort: n = 866). Out of 472 patients with lymph node (LN)-negative disease (pN0), DM were found in four cases (detection rate: 0.8%). All four patients presented with established risk factors: hormone receptor (HR)-negative status, HER2-positive status, n = 3; ‘triple-negative’ disease, n = 1. Considering the subgroup of LN-negative patients whose tumors showed the risk factor ‘negative HR status’ ( n = 66), the detection rate of DM was 6%. The detection rates of DM in higher pN categories were as follows: pN1:1.7%; pN2:9.5%; pN3:13.5%. We generally support the international guidelines, including those published by the European Society for Medical Oncology (ESMO) which emphasize that patients with early-stage BC do not profit from radiological staging for the detection of DM and recommend refraining from this. However, we would expand these guidelines and propose that screening should be carried out in node-negative patients whose tumors show established tumor-related risk factors (e.g. HR-negative and HER2-positive status), since in this particular subcohort, the detection rate of DM is with 6% similarly high as that of patients with four to nine positive LNs.

Description: The temporal and magmatic evolution of central Snake River Plain (SRP; Idaho, USA) olivine tholeiites erupted within the past 4 m.y. is evaluated here. This investigation correlates and merges both geochemical and paleomagnetic measurements to constrain the volcanic history recovered from the 340 m Regional Aquifer Systems Analysis (RASA) test well located near Wendell, Idaho. Only a handful of studies have accomplished this task of shedding light on the chemical stratigraphy of the SRP and the petrogenesis of basalts with depth, and therefore through time. Paleomagnetic relationships suggest that time breaks between individual lava flows represent a few years to decades, time breaks between flow groups represent at least a couple of hundred years or possibly much longer, while significant hiatuses in volcanism, revealed by thick sediment packages or polarity reversals (both are evidenced in this well), are inferred to last thousands to tens of thousands of years. Major element geochemistry from 52 basaltic lava flows demonstrates near primitive compositions (i.e., ~10 wt% MgO) and tholeiitic iron enrichment trends, similar to lavas from the eastern SRP. Trace element concentrations are similar to those of ocean island basalts, with enriched Ba and Pb, and light rare earth element (REE)/heavy REE ratios similar to those of many Neogene volcanics of the western Cordillera. When combined, we identify a total of 11 flow groups, which we also classify as fractionation or recharge on the basis of decreasing or increasing MgO weight percent with depth. Taking into consideration these trends, we review the potential recharge, fractionation, and assimilation processes that characterize much of SRP olivine tholeiite, and conclude that assimilation, in combination with fractional crystallization, is the dominant petrogenesis for the basalts in the central SRP. Although fractionation of Wendell parent magmas was accompanied by assimilation of crustal material, this could not have been assimilation of ancient cratonic crust. The geochemical cycles observed in this well are inferred to represent fractionation and recharge of basaltic magma from a series of sill-like layered mafic intrusions located in the middle crust, similar to what has been proposed for the processes that control the eruptive history of basalts in the eastern SRP.