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Poh A, Sammour A, Mathai J, Peverall J, Van Vliet C, Asadi K, Parakh S. Real-world challenges in undertaking NTRK fusion testing in non-small cell lung cancer. J Thorac Dis 2023; 15:3811-3817. [PMID: 37559603 PMCID: PMC10407491 DOI: 10.21037/jtd-23-113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/02/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND We performed a retrospective analysis to determine the incidence of neurotrophic tropomyosin-receptor kinase (NTRK) fusion in non-small cell lung cancer (NSCLC). METHODS Archival NSCLC tissues between 2018-2020 were screened by immunohistochemistry (IHC) with IHC-positive cases undergoing confirmatory molecular analysis. Correlative clinicopathologic parameters were collected. RESULTS Of 289 samples analyzed, 10 (3.5%) cases had NTRK expression on IHC. The median age of patients with NTRK-positivity on IHC was 74.9 (range, 44-88) years and 70% had a smoking history. The cohort included seven adenocarcinomas and one each squamous cell carcinoma, large-cell neuroendocrine and not otherwise specified histologies. PDL1 expression was ≤50% in five cases. Concurrent EGFR mutations were detected in three cases, with two cases also showing a PIK3CA E542K mutation and MET amplification, respectively. Due to insufficient tumor material, RNA-sequencing was undertaken in only one IHC-positive case, with the other nine cases analyzed by Fluorescent in-situ Hybridisation. A NTRK fusion, EML4-NTRK3 gene fusion was detected in one patient, a frequency of 0.35%. CONCLUSIONS NTRK fusions in NSCLC are rare. This study highlights real world diagnostic challenges regarding NTRK testing, such as requirements of adequate tumor tissue and appropriate testing methodologies.
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Affiliation(s)
- Ashleigh Poh
- Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, Victoria, Australia
- La Trobe University School of Cancer Medicine, Bundoora, Victoria, Australia
| | - Abdelaziz Sammour
- Department of Medical Oncology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Jared Mathai
- Department of Medical Oncology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Joanne Peverall
- PathWest, Department of Diagnostic Genomics, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Chris Van Vliet
- PathWest, Department of Anatomical Pathology, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Khashayar Asadi
- Department of Pathology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Sagun Parakh
- Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, Victoria, Australia
- La Trobe University School of Cancer Medicine, Bundoora, Victoria, Australia
- Department of Medical Oncology, Austin Hospital, Heidelberg, Victoria, Australia
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2
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Yap FH, Peverall J, Van Vliet C. Validation and assessment of HER2 FISH probe for endometrial serous carcinoma. Pathology 2023. [DOI: 10.1016/j.pathol.2022.12.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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3
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Ching D, Chiu SK, Van Vliet C, Jasim A. Primary ALK-Negative TP63-Rearranged Anaplastic Large Cell Lymphoma in the Bladder: Potential for Misdiagnosis. Int J Surg Pathol 2022:10668969221113481. [PMID: 35898185 DOI: 10.1177/10668969221113481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 76-year-old gentleman presented with persistent lower urinary tract symptoms. Multiple biopsies, radiological correlation and ancillary studies were required to achieve a diagnosis. The main differential diagnoses lies between urothelial carcinoma and anaplastic large cell lymphoma (ALCL), both of which are known to be positive for p63 and GATA3. An accurate diagnosis is crucial as the management is significantly different. To avoid misdiagnosis a comprehensive immunohistochemistry panel is necessary. Primary bladder lymphomas are rare. Our case represents the first case of primary ALK-negative TP63-rearranged ALCL. We reviewed the literature and discussed the potential pitfalls for misdiagnosis.
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Affiliation(s)
- Daniel Ching
- Department of Anatomical Pathology, Clinipath Pathology, Osborne Park, WA, Australia
| | - Sung-Kai Chiu
- Department of Haematology, St John of God Health Care Midland, WA, Australia
| | - Chris Van Vliet
- Department of Anatomical Pathology, 56375PathWest Laboratory Medicine WA, Nedlands, Australia
| | - Aws Jasim
- Department of Anatomical Pathology, 56375PathWest Laboratory Medicine WA, Nedlands, Australia
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4
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Harvey NT, Peverall J, Acott N, Mesbah Ardakani N, Leecy TN, Iacobelli J, McCallum D, Van Vliet C, Wood BA. Correlation of FISH and PRAME Immunohistochemistry in Ambiguous Superficial Cutaneous Melanocytic Proliferations. Am J Dermatopathol 2021; 43:913-920. [PMID: 33899766 DOI: 10.1097/dad.0000000000001951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Preferentially expressed antigen in melanoma (PRAME) is a tumor-associated repressor of retinoic acid signaling which is expressed in melanoma and has emerged as a potential biomarker for malignant behavior in melanocytic neoplasms. Although ancillary molecular techniques such as fluorescence in situ hybridization (FISH) are established techniques in the diagnosis of problematic cutaneous melanocytic proliferations, they are expensive, time-consuming, and require appropriate infrastructure, which places them out of reach of some laboratories. The advent of readily available commercial antibodies to PRAME has the potential to provide a more accessible alternative. The aim of this study was to determine whether immunohistochemistry for PRAME could serve as a surrogate for FISH analysis in a subgroup of challenging superficial melanocytic proliferations. Cases which had previously been submitted for FISH analysis were stained for PRAME and interpreted by a panel of at least 3 dermatopathologists is a blinded fashion. Of a study set of 55 cases, 42 (76%) showed a pattern of PRAME immunostaining which was concordant with the cytogenetic interpretation, with an unweighted kappa of 0.42 (representing mild-to-moderate agreement). Thus, although there was a correlation between positive immunohistochemistry for PRAME and abnormal findings on FISH analysis, in our view, the concordance was not sufficient to enable PRAME immunohistochemistry to act as a surrogate for FISH testing. Our findings reiterate the principle that interpretation of problematic superficial melanocytic proliferations requires a synthesis of all the available data, including clinical scenario, morphological features, immunohistochemistry, and ancillary molecular investigations.
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Affiliation(s)
- Nathan T Harvey
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
- Division of Pathology and Laboratory Medicine, Medical School, University of Western, Perth, Australia
| | - Joanne Peverall
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Perth, WA, Australia; and
| | - Nathan Acott
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
- College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
| | - Tamazin N Leecy
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
| | - Jean Iacobelli
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
| | - Dugald McCallum
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
| | - Chris Van Vliet
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
| | - Benjamin A Wood
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
- Division of Pathology and Laboratory Medicine, Medical School, University of Western, Perth, Australia
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5
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Mesbah Ardakani N, Singh S, Thomas C, Van Vliet C, Harvey NT, Calonje JE, Wood BA. Mitotically Active Nevus and Nevoid Melanoma: A Clinicopathological and Molecular Study. Am J Dermatopathol 2021; 43:182-190. [PMID: 32649342 DOI: 10.1097/dad.0000000000001721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
ABSTRACT The distinction between nevoid melanoma and a mitotically active nevus can be challenging at the microscopic level. In this study, we performed cytogenetic testing on a cohort of 25 mitotically active melanocytic proliferations resembling common melanocytic nevus from 25 patients. Based on cytogenetic findings, the lesions were classified as "nevoid melanoma" (n = 13) or "mitotically active nevus" (n = 12). Subsequently, we compared the clinicopathological features between these 2 groups. Nevoid melanomas occurred in older patients (P = 0.007); however, there were no significant differences in gender, size, or anatomical distribution between the 2 groups. Histologically, deep/marginal mitoses (P = 0.006), lack of maturation with depth (P = 0.036), and pseudo-maturation (P = 0.006) were significantly more common in nevoid melanomas. Immunohistochemically, complete loss of p16 was an important divisive feature (P = 0.0004), seen in 70% of nevoid melanomas, and highly correlated with loss of CDKN2A gene (chromosome 9p21). Our findings suggest that such reproducible immunomorphological differences can be of value in distinguishing nevoid melanoma from mitotically active nevus. Nevoid melanomas demonstrated a spectrum of chromosomal aberrations similar to those seen in common subtypes of melanoma, which can serve as a powerful adjunct diagnostic tool in morphologically challenging lesions.
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Affiliation(s)
- Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia ; and
| | - Shalinder Singh
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
| | - Carla Thomas
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
| | - Chris Van Vliet
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
| | - Nathan Tobias Harvey
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia
| | | | - Benjamin Andrew Wood
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia
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6
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Yap FHX, Amanuel B, Van Vliet C, Thomas M, Wong D. Malignant transformation of fibrous dysplasia into osteosarcoma confirmed with TP53 somatic mutation and mutational analysis of GNAS gene. Pathology 2020; 53:652-654. [PMID: 33272697 DOI: 10.1016/j.pathol.2020.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/16/2020] [Accepted: 08/24/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Francis H X Yap
- Department of Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia.
| | - Benhur Amanuel
- Department of Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia
| | - Chris Van Vliet
- Department of Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia
| | - Marc Thomas
- Department of Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia
| | - Daniel Wong
- Department of Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia; School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, WA, Australia
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Brown M, Jersmann H, Crowhurst T, Van Vliet C, Crouch G, Badiei A. A challenging diagnosis of malignant mesothelioma with osteosarcomatous differentiation metastasizing to bone. Respirol Case Rep 2020; 8:e00664. [PMID: 32995012 PMCID: PMC7507382 DOI: 10.1002/rcr2.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 11/29/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is an insidious primary neoplasm of the pleura that can be challenging to diagnose and is commonly considered to be only locally invasive. We present the case of a 74-year-old male who presented with clinical features of MPM but from whom pleural fluid and biopsies initially suggested benign pathology. He later developed diffuse bony metastases and re-examination of pleural biopsies using modern immunohistochemistry and molecular testing revealed a diagnosis of sarcomatoid and desmoplastic MPM with heterologous osteosarcomatous differentiation. This case not only demonstrates the rare potential of skeletal metastasis of MPM, but also highlights the importance of recognizing the utility of modern diagnostic tests and their potential to prevent the need for unnecessary invasive procedures. To our knowledge this is the first description of this rare histological sub-type presenting with skeletal metastases.
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Affiliation(s)
- Michael Brown
- Department of Thoracic MedicineRoyal Adelaide HospitalAdelaideAustralia
- Faculty of Health and Medical Sciences, Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
| | - Hubertus Jersmann
- Department of Thoracic MedicineRoyal Adelaide HospitalAdelaideAustralia
- Faculty of Health and Medical Sciences, Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
| | - Thomas Crowhurst
- Department of Thoracic MedicineRoyal Adelaide HospitalAdelaideAustralia
- Faculty of Health and Medical Sciences, Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
| | - Chris Van Vliet
- Department of Anatomical PathologyPathWest Laboratory Medicine, QEII Medical CentreNedlandsWestern AustraliaAustralia
| | - Gareth Crouch
- Department of Cardiothoracic SurgeryRoyal Adelaide HospitalAdelaideAustralia
| | - Arash Badiei
- Department of Thoracic MedicineRoyal Adelaide HospitalAdelaideAustralia
- Faculty of Health and Medical Sciences, Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
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8
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Chung K, Van Vliet C, de Boer B. Adult mesenchymal hamartoma of liver: A case report and discussion of associated molecular abnormalities. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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9
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Chin CK, Leslie C, Grove CS, Van Vliet C, Cheah CY. The Diagnostic, Prognostic, and Therapeutic Utility of Molecular Testing in a Patient with Waldenstrom's Macroglobulinemia. Int J Mol Sci 2017; 18:ijms18102038. [PMID: 28937595 PMCID: PMC5666720 DOI: 10.3390/ijms18102038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022] Open
Abstract
The application of molecular genomics and our understanding of its clinical implications in the diagnosis, prognostication and treatment of lymphoproliferative disorders has rapidly evolved over the past few years. Of particular importance are indolent B-cell malignancies where tumour cell survival and proliferation are commonly driven by mutations involving the B-cell receptor and downstream signalling pathways. In addition, the increasing number of novel therapies and targeted agents have provided clinicians with new therapeutic options with the aim of exploiting such mutations. In this case report, we highlight one such success story involving the diagnostic impact of the MYD88L265P mutation in Waldenstrom’s macroglobulinemia (WM), its prognostic implications and effect on choice of therapy in the era of novel therapies.
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Affiliation(s)
- Collin K Chin
- Department of Haematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine WA, Nedlands 6009, Australia.
| | - Connull Leslie
- Department of Anatomical Pathology, Pathwest Laboratory Medicine WA, Nedlands 6009, Australia.
| | - Carolyn S Grove
- Department of Haematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine WA, Nedlands 6009, Australia.
- Medical School, University of Western Australia, Crawley 6009, Australia.
| | - Chris Van Vliet
- Department of Anatomical Pathology, Pathwest Laboratory Medicine WA, Nedlands 6009, Australia.
| | - Chan Yoon Cheah
- Department of Haematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine WA, Nedlands 6009, Australia.
- Medical School, University of Western Australia, Crawley 6009, Australia.
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10
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Abstract
Granular cell tumour is a rare soft tissue tumour that can occur in any part of the body, but seldom in ocular adnexa. It usually behaves in a benign fashion. We report a case of a 54-year-old man with a well-demarcated, solitary, slow-growing orbital tumour which lead to significant ocular symptoms. The case was a diagnostic and therapeutic challenge due to its location and difficulty in obtaining tissue for a histological diagnosis. Surgical biopsy attempts were made but they all failed to uncover the true identity of the lesion. A definitive diagnosis was revealed with complete surgical excision of the tumour, which was challenging due to its size and close association with rectus muscle. This case has highlighted that orbital granular cell tumour may result in significant ocular symptoms. Adequate exposure to the anatomical site is the key to obtaining diagnosis and complete excision of a lesion.
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Affiliation(s)
- David Yang
- a Sir Charles Gairdner Hospital , Perth , Australia
| | | | | | | | - Adam Gajdatsy
- a Sir Charles Gairdner Hospital , Perth , Australia.,b Lions Eye Institute , Perth , Australia
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11
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Menon N, Forrest C, Van Vliet C, Thomas A. Loss of INI1/SMARCB1 expression in an aggressive sinonasal carcinoma: an institutional experience with a newly described entity. Pathology 2017. [DOI: 10.1016/j.pathol.2016.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Selinger C, Cooper W, Lum T, McNeil C, Morey A, Waring P, Amanuel B, Millward M, Peverall J, Van Vliet C, Christie M, Tran Y, Diakos C, Pavlakis N, Gill AJ, O'Toole S. EquivocalALKfluorescencein-situhybridization (FISH) cases may benefit from ancillaryALKFISH probe testing. Histopathology 2015; 67:654-63. [DOI: 10.1111/his.12708] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/29/2015] [Indexed: 01/27/2023]
Affiliation(s)
- Christina Selinger
- Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Camperdown NSW Australia
| | - Wendy Cooper
- Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Camperdown NSW Australia
- School of Medicine; University of Western Sydney; Campbelltown NSW Australia
- Sydney Medical School; University of Sydney; Sydney NSW Australia
| | - Trina Lum
- Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Camperdown NSW Australia
| | - Catriona McNeil
- Chris O'Brien Lifehouse and Royal Prince Alfred Hospital; Camperdown NSW Australia
| | - Adrienne Morey
- SydPath, Anatomical Pathology; St Vincent's Hospital; Darlinghurst NSW Australia
| | - Paul Waring
- Department of Pathology; University of Melbourne; Melbourne Vic. Australia
| | - Benhur Amanuel
- PathWest; Sir Charles Gairdner Hospital; Nedlands WA Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Nedlands WA Australia
| | - Michael Millward
- School of Medicine and Pharmacology; University of Western Australia; Nedlands WA Australia
- Department of Medical Oncology; Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - Joanne Peverall
- PathWest; Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - Chris Van Vliet
- PathWest; Sir Charles Gairdner Hospital; Nedlands WA Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Nedlands WA Australia
| | - Michael Christie
- Department of Pathology; University of Melbourne; Melbourne Vic. Australia
- Department of Anatomical Pathology and Medical Oncology; The Royal Melbourne Hospital; Parkville Vic. Australia
| | - Yen Tran
- Ballarat Base Hospital; Ballarat Vic. Australia
| | - Connie Diakos
- Royal North Shore Hospital; St Leonards NSW Australia
| | - Nick Pavlakis
- Royal North Shore Hospital; St Leonards NSW Australia
| | - Anthony J Gill
- Sydney Medical School; University of Sydney; Sydney NSW Australia
- Royal North Shore Hospital; St Leonards NSW Australia
- Cancer Diagnosis and Pathology Research Group; Kolling Institute of Medical Research; St Leonards NSW Australia
| | - Sandra O'Toole
- Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Camperdown NSW Australia
- The Kinghorn Cancer Centre; Garvan Institute of Medical Research; Darlinghurst NSW Australia
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