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ER-negative subset were HER2 enriched by intrinsic subtyping, and there were no luminal-A/B subtypes [5]. The greater likelihood of biological dependency on HER2-driven signaling in HER2-positive and ER-negative breast cancer may explain why longer trastuzumab therapy may have a differentially superior effect in ER-negative disease than in ER-positive disease. Our findings suggest that it may be possible to identify a subset of patients who would benefit from longer or shorter course of trastuzumab therapy based on the ER status. For a resource constrained setting, it may be possible to shorten the duration of trastuzumab therapy in patients with ER-positive status. An individual patient-level data meta-analysis of these three trials will provide greater power to conduct subgroup analysis. We recommend that the investigators of all the adjuvant trastuzumab duration trials contribute their trial data for a pooled analysis. It will benefit thousands of patients with HER2-positive breast cancer, especially women in the developing regions of the world.

Objective: To investigate the clinical and pathological characteristics of thyroid nodules, as well as to evaluate the significance of ultrasonographically detected thyroid calcification in the diagnosis of thyroid carcinomas. Methods: Retrospective data were studied from 1,051 consecutive patients who underwent a thyroidectomy in the Provincial Hospital of Fujian Medical University in South China between January 2003 and July 2006 for nodular thyroid disease. Complete sonographical information before surgery was only collected from 758 of the 1,051 patients. Results: Among the 1,051 patients, benign lesions were found in 857 (81.54%) patients, of whom 612 (71.41%) were nodular goiter; malignant lesions were found in 194 (18.46%) patients, in whom benign thyroid lesions were also found in 85 (43.81%) patients. A total of 48 patients suffered from microcarcinomas, of whom 37 patients had benign lesions; these 37 accounted for 43.53 and 77.08%, respectively, of the 85 malignant cases with benign lesions and the 48 cases with microcarcinomas. In the 758 patients who underwent thyroid ultrasonography before surgery, intrathyroidal calcifications were apparent in 243 patients (32.06%). The incidence of calcification was significantly higher in patients with thyroid carcinoma (54.17%) than in those with benign lesions (26.87%; p < 0.005). Detection of calcification in thyroid lesions by ultrasound had a sensitivity of 32.38% and a specificity of 87.35%, with an OR of 3.31 (95% CI, 2.24–4.63), positive likelihood ratio of 2.56, negative likelihood ratio of 0.77 and a κ value of 0.23. Conclusion: Thyroid carcinoma, especially microcarcinoma, often coexists with benign thyroid disease. Calcification detected by thyroid ultrasound represents a risk factor for malignancy, but is of limited use as a sole marker of malignancy.