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Teng X, Li X, Xu S, Zhang J, Hartmann K, Laible M, Hipfel R, Bai Y, Ba X, Wu Z, Wirtz RM, Liu S, Ugur S. Abstract P4-02-12: Comparison of RT-qPCR with consensus immunohistochemistry by three pathologists for ER, PR, HER2 and Ki-67 in Chinese breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-02-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
During the diagnostic work-up of breast carcinomas, immunohistochemistry (IHC) is the currently used method for assessing the expression of estrogen- (ER) and progesterone-receptors (PR), human epidermal growth factor receptor 2 (HER2) as well as of Ki-67 as a marker of tumor cell proliferation. In this study, we analyzed the concordance of these four breast cancer biomarkers between the RT-qPCR- and IHC-based (evaluated by three independent pathologists) determinations.
Methods
The expression of ER/ESR1, PR/PGR, HER2/ERBB2 and Ki-67/MKI67 was determined in 269 FFPE breast cancer samples with tumor content >20% from Chinese patients. For IHC, the samples were freshly cut, stained and assessed by three independent pathologists using the same scoring methods in a blinded fashion (positivity defined as: ER/PR ≥1%, HER2 >2+ and Ki-67 ≥20%). Measurement of the markers on the mRNA level was done on total RNA extracts prepared from whole tissue sections from the same FFPE blocks using the CE-marked RT-qPCR based IVD MammaTyper® on a Cobas® z480 qPCR cycler. IHC assessments of the three pathologists were compared to each other with regard to concordance of positive/negative results. Subsequently, agreement of RT-qPCR and IHC results for each marker and in samples in which the three pathologists had a consensus positive/negative IHC result was determined. Furthermore, we compared the MammaTyper® assessments from a subset of whole FFPE sections to data obtained from paired samples enriched for invasive carcinoma via macrodissection.
Results
From the 269 samples, 256 were available for final analysis. When excluding cases with discordant IHC callings between the three pathologists (6.0% for ER; 7.4% PR; 4.1% Her2; 17.1% Ki-67)) the concordance to the RT-qPCR determination and consensus IHC-based analysis displayed an excellent agreement for ER (OPA: 95.4%, PPA: 97.5%, NPA: 91.5%, Kappa: 0.897), PR (OPA: 91.1%, PPA: 89.6%, NPA: 93.1%, Kappa: 0.820) and HER2 (OPA: 97.1%, PPA: 91.9%, NPA: 100.0%, Kappa: 0.936). For cancer MKI67 mRNA and Ki-67 protein expression, a lower but still good concordance was found (OPA: 90.1%, PPA: 91.8%, NPA: 83.3%, Kappa: 0.707). In addition, we could demonstrate an excellent agreement of quantitative RT-qPCR measurements between whole surface and paired tumor-enriched samples in 99 Chinese breast cancer patients with R2 of 0.927 for ER, 0.926 for PR, 0.923 for HER2 and 0.908 for KI67. Even under highly standardized IHC scoring conditions, the discordance rates in the RT-qPCR marker callings with 0.0% for ESR1, 5.0% for PGR, 3.0% for ERBB2, 13.1% for MKI67 were lower than disagreements by three pathologists on the identical slide.
Conclusion
Standardized determination of the breast cancer biomarkers ER, PR, HER2 and Ki-67 on the mRNA level shows high concordance to a consensus IHC determined by three experienced pathologists indicating that RT-qPCR may be a valid alternative for determining the four breast cancer biomarkers. In line with previous research we could show on a large set of samples that macrodissection is not required for reliable assessment of the four breast cancer markers in clinical FFPE samples.
Citation Format: Teng X, Li X, Xu S, Zhang J, Hartmann K, Laible M, Hipfel R, Bai Y, Ba X, Wu Z, Wirtz RM, Liu S, Ugur S. Comparison of RT-qPCR with consensus immunohistochemistry by three pathologists for ER, PR, HER2 and Ki-67 in Chinese breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-02-12.
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Affiliation(s)
- X Teng
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - X Li
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - S Xu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - J Zhang
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - K Hartmann
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - M Laible
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - R Hipfel
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - Y Bai
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - X Ba
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - Z Wu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - RM Wirtz
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - S Liu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - S Ugur
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
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Lehr HA, Aulmann S, Etzrodt A, Laible M, Hartmann K, Gürtler C, Wirtz RM, Sahin U, Varga Z. Abstract P2-07-08: Standardized prediction of Oncotype DX® risk classes by local RT-qPCR. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-07-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recent results from the prospective validation of the Oncotype DX® recurrence score (RS) have underlined the clinical validity of the assay for the prediction of chemotherapy benefit in ER+/HER2- early stage breast cancer patients. Due to health economic restrictions, some patients have no easy access to the test. A pre-selection of tumor samples may help identify patients with a high likelihood to be spared chemotherapy. Histology and semi-quantitative IHC are hence used to select samples for Oncotype testing, but these suffer from intra- and inter-observer variability, especially for Ki-67 which is a main factor in most RS prediction algorithms. We have established and validated a tool for the prediction of RS risk classes (TAILORx cutoff RS ≤25) based on highly standardized, reproducible and locally performed RT-qPCR measurements of ERBB2, ESR1, PGR and MKI67 mRNA using the CE-marked IVD MammaTyper®.
Methods: Total RNA was extracted from whole surface 10μm sections from FFPE breast cancer samples with a known RS result and a tumor cell content ≥20%. ERBB2, ESR1, PGR and MKI67 mRNA expression was measured by RT-qPCR on a CFX96 qPCR cycler using the MammaTyper® kit. A prediction model for an RS ≤25 result was established using multivariable logistic regression. Based on this model and the training data two cutoffs for confident prediction of low chemotherapy benefit patients in a clinical setting were established at 95% and 97.5% specificity. The model and the cutoffs were then fixed and validated in a second, separate set of breast cancer samples. ROC analysis was used to characterize predictive power of the continuous values resulting from the prediction model. Positive and negative predictive values for detection of an RS ≤25 result were also determined on the validation samples using the two pre-defined cutoffs.
Results: The sample set for training of the prediction model encompassed 202 samples including 29 samples (14.4%) with an RS >25. In an initial multivariable model with all four markers, PGR and MKI67 were the strongest predictors while the influence of ESR in the model was lower, but still significant. ERBB2 was no significant predictor in this set of ERBB2 negative samples and was therefore excluded from the final model which was based on three markers only. This three marker model achieved an AUC of 0.920 (95% CI: 0.871-0.968) in the training samples. When applying the fixed model from the training dataset to a second separately collected set of 104 samples containing 20 samples (19.2%) with an RS >25, an AUC of 0.883 (95% CI: 0.810-0.955) was documented. When further applying the two predefined cutoffs established in the training set, 45 and 36 of the 104 validation samples (43.3% and 34.6%) had a predicted low chemotherapy benefit result (RS ≤25). Even with the less stringent cutoff, not a single one of the RS >25 cases from the validation cohort was falsely predicted as RS ≤25 sample.
Conclusion: We have established a highly reliable method for prediction of Oncotype DX® low chemotherapy benefit results based on local and cost effective mRNA measurements. This method enables local pathologies to pre-assess routine samples using a highly precise molecular tool and thereby reserve the Oncotype DX® test for cases with ambiguous cancer biology.
Citation Format: Lehr H-A, Aulmann S, Etzrodt A, Laible M, Hartmann K, Gürtler C, Wirtz RM, Sahin U, Varga Z. Standardized prediction of Oncotype DX® risk classes by local RT-qPCR [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-08.
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Affiliation(s)
- H-A Lehr
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - S Aulmann
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - A Etzrodt
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - M Laible
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - K Hartmann
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - C Gürtler
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - RM Wirtz
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - U Sahin
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - Z Varga
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
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Fasching P, Laible M, Weber K, Wirtz R, Denkert C, Schlombs K, Schmatloch S, Camara O, Lück H, Huober J, Karn T, van Mackelenbergh M, Marme F, Müller V, Schem C, Stickeler E, Sahin U, Loibl S, Untch M. Evaluation of the MammaTyper® as a molecular predictor for pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) and outcome in patients with different breast cancer (BC) subtypes. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.222] [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: 11/12/2022] Open
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Fasching P, Laible M, Weber K, Wirtz R, Denkert C, Schlombs K, Schmatloch S, Camara O, Lück H, Huober J, Karn T, van Mackelenbergh M, Marme F, Müller V, Schem C, Stickeler E, Sahin U, Loibl S, Untch M. Validation of the MammaTyper® pathological complete response (pCR)-score as a predictor for response after neoadjuvant chemotherapy (NACT) in patients with early breast cancer (BC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.166] [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: 11/15/2022] Open
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Kuner R, Laible M, Gangi-Maurici S, Walter C, Bender C, Schaefer G, Klocker H, Oed M, Bukur V, Sahin U. PO-324 Detection of high-risk prostate cancer biomarkers by RNA sequencing and qPCR method. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.354] [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: 11/04/2022] Open
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Vollherbst DF, Ulfert C, Neuberger U, Herweh C, Laible M, Nagel S, Bendszus M, Möhlenbruch MA. Endovascular Treatment of Dural Arteriovenous Fistulas Using Transarterial Liquid Embolization in Combination with Transvenous Balloon-Assisted Protection of the Venous Sinus. AJNR Am J Neuroradiol 2018; 39:1296-1302. [PMID: 29724762 DOI: 10.3174/ajnr.a5651] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/05/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Sinus-preserving endovascular embolization was described as a promising treatment technique for dural arteriovenous fistulas. Our aim was to report our single-center experience in patients with dural arteriovenous fistulas who were treated with transarterial liquid embolization in combination with transvenous balloon-assisted protection of the affected venous sinus. MATERIALS AND METHODS A retrospective analysis of a prospectively collected data base was performed. Demographic and clinical data, angiographic features of the dural arteriovenous fistulas, procedural parameters, complications, treatment success, follow-up imaging, and clinical outcome were assessed. RESULTS Twenty-two patients were treated in 25 procedures. All patients were symptomatic, of whom 81.8% presented with tinnitus; 9.1%, with ocular symptoms; and 9.1%, with headache. Most fistulas were located at the transverse and/or sigmoid sinus. The most frequent fistula type was Cognard IIa+b (40.9%), followed by Cognard I (31.8%) and Cognard IIa (27.3%)/Borden I (59.1%), followed by Borden II (40.9%). The affected sinus could be preserved in all except for 1 patient in whom it was sacrificed in a second treatment procedure by coil embolization. The overall complete occlusion rate was 86.4%. The overall complication rate was 20%, with transient and permanent morbidity and mortality of 8%, 0%, and 0%, respectively. After a mean follow-up of 18 months, most patients (68.2%) achieved complete symptom remission, 27.3% showed symptom relief, and 4.6% had stable symptoms. CONCLUSIONS Transarterial liquid embolization of dural arteriovenous fistulas in combination with transvenous balloon-assisted protection of the venous sinus is feasible and safe and offers high rates of occlusion and of symptom remission.
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Affiliation(s)
- D F Vollherbst
- From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.)
| | - C Ulfert
- From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.)
| | - U Neuberger
- From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.)
| | - C Herweh
- From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.)
| | - M Laible
- Neurology (M.L., S.N.), Heidelberg University Hospital, Heidelberg, Germany
| | - S Nagel
- Neurology (M.L., S.N.), Heidelberg University Hospital, Heidelberg, Germany
| | - M Bendszus
- From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.)
| | - M A Möhlenbruch
- From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.)
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Laible M, Schueler S, Veltkamp R. Response to the letter by Safiri et al. Acta Neurol Scand 2018; 137:371. [PMID: 29392721 DOI: 10.1111/ane.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Laible
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - S Schueler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - R Veltkamp
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Stroke Medicine, Imperial College London, London, UK
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Lehr HA, Aulmann S, Laible M, Etzrodt A, Hartmann K, Gürtler C, Sahin U, Varga Z. Abstract P1-06-11: Prediction of oncotype DX® results based on local gene expression measurements by MammaTyper®. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-06-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Oncotype DX® recurrence score (RS) has emerged as a recommended risk classifier for patients with ER+/HER2- early-stage breast cancer. While RS is one of the most rigorously studied risk scores, it is also one of the most expensive tests, thus remaining beyond reach for a many patients.
The necessity for an affordable method for estimating risk of recurrence has motivated investigations on the correlation between RS and traditional parameters such as IHC for ER, PR and Ki67. However, semi-quantitative IHC lacks standardization across different laboratories especially for Ki67.
In this study we therefore investigated whether the standardized assessment of HER2, ER, PR, and Ki67 on mRNA level could better serve for prediction of low risk RS cases.
Methods: ERBB2, ESR1, PGR and MKI67 mRNA expression was measured by RT-qPCR in extracts from FFPE breast cancer samples using the MammaTyper® test. Complete data for RS, IHC, grading and mRNA measurement was available for 198 samples. Tumor subtypes according to St Gallen surrogate definition from 2013 were assigned based on binary mRNA marker classification (pos/neg) according to pre-defined cut-offs. Subtype results were compared to RS risk classes based on commercial and TAILORx-trial cut-offs. RS low risk classification (RS ≤25) based on four IHC markers and grading was estimated using the online tool breastrecurrenceestimator.onc.jhmi.edu and compared to observed RS classes.
Finally, the prediction of continuous RS values by mRNA or semi-quantitative IHC measurement was compared by linear regression and subsequent ROC analysis of prediction models.
Results: The distribution of RS risk classes in the set of samples with full data was 21% RS 0-10, 39% RS 11-17, 27% RS 18-25, 7% RS 26-30 and 7% RS >30. MammaTyper® called 38% (76) of the samples as Luminal A-like. From these samples 70% and 99% had RS values below 18 and 25 respectively. Only 1 MammaTyper® Luminal A-like sample had an RS >30.
Estimation of RS according to the online tool resulted in classification of 61% (121) of the samples as low risk (RS ≤25). Of these 74% and 98% of samples had observed RS values below 18 and between 18 and 25 respectively. 2 and 1 samples called as low risk by the online tool had an RS of 26-30 and >30 and, respectively.
In linear regression analysis of IHC against RS only PR and Ki67 were significant predictors (p-values <0.0001 and 0.0128) while when using mRNA values ESR1, PGR and MKI67 were found as predictors of RS in the multivariate model (all p-values <0.0001). On a training set (67% of samples) the IHC based prediction model was correlated to the observed RS with an R2 of 0.305 whereas the mRNA based model achieved an R2 of 0.489. When the models were applied to training and validation dataset (33% of samples) for prediction of an RS >25 result, the IHC based model had AUCs of 0.887 and 0.836, respectively, while the mRNA based model achieved AUCs of 0.909 and 0.899, respectively.
Conclusion: mRNA based prediction of RS was considerably better than prediction based on IHC. As Ki67 IHC standardization is reaching its limits, local gene expression measurements with their high degree of standardization could serve as a safer way for prediction of Oncotype low risk results.
Citation Format: Lehr H-A, Aulmann S, Laible M, Etzrodt A, Hartmann K, Gürtler C, Sahin U, Varga Z. Prediction of oncotype DX® results based on local gene expression measurements by MammaTyper® [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-06-11.
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Affiliation(s)
- H-A Lehr
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - S Aulmann
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - M Laible
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - A Etzrodt
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - K Hartmann
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - C Gürtler
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - U Sahin
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Z Varga
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
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Laible M, Hartmann K, Gürtler C, Anzeneder T, Weber S, Keller T, Sahin U. Abstract P3-08-14: Prediction of distant recurrence in low risk early breast cancer by RT-qPCR based subtyping using MammaTyper®. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-08-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Estrogen receptor (ER/ESR1), progesterone receptor (PR/PGR) and epidermal growth factor receptor 2 (HER2/ERBB2) are routinely assessed by immunohistochemistry (IHC) during workup of breast cancer samples. The routine use of Ki67 (MKI67) IHC assessment in the context of breast cancer subtyping, however, remains controversial, due to poor reproducibility and lack of standardization.
The MammaTyper® test is an in-vitro diagnostic (IVD) test which measures the expression status of the four breast cancer biomarkers ERBB2, ESR1, PGR and MKI67 on the mRNA level via reverse transcription-quantitative PCR (RT-qPCR) and has demonstrated a high degree of reproducibility in the assessment of the four markers.
In this retrospective analysis we assessed the prognostic power of molecular subtyping by MammaTyper® in archived samples from low risk early breast cancers treated with adjuvant endocrine therapy only.
Methods:
ER+/HER2- (according to initial diagnosis) FFPE breast cancer samples from patients treated with adjuvant endocrine therapy only were obtained from 6 different centers. Tumor cellularity was assessed by H&E staining and RNA was extracted from samples with a tumor cell content of ≥20% using a bead-based RNA purification kit (RNXtract®). Total RNA was then used as input for MammaTyper® RT-qPCR. Expression values were classified as positive or negative for each marker based on predefined cutoff values. Tumor subtypes were assigned to each sample based on the combination of binary (pos/neg) single marker expression status according the St Gallen surrogate subtype definition. Distant disease free survival of Luminal A-like samples vs. samples with other subtypes was assessed by Kaplan Meier analysis and Cox regression using SAS version 9.4.
Results:
The final analysis included 319 samples with sufficient tumor cellularity and RNA content for reliable analysis. The rate of distant recurrence in the analyzed set was 8.5%. Median follow up was 7.8 years. The MammaTyper® test called 60% (192) of samples as Luminal-A-like (4.7% (9) distant events), 37% (119) as Luminal B-like (HER2 negative) (13.4% (16) distant events), 1.3% (4) as Triple negative (ductal) (25% (1) distant events), 0.6% (2) as “not defined according to St Gallen” (ESR1-/PGR+) (50% (1) distant events) and 0.6% (2) as Luminal B-like (HER2 positive) (no distant events).
When comparing Luminal A-like samples with the samples of the other subtypes in survival analysis, Luminal A-like samples had a significantly better distant disease free survival when assessing samples from patients with pN0 status (278) (p=0.0177, HR=0.344 (95% CI 0.137-0.866), pN1 status (0-3 affected nodes) (314) (p=0.0153, HR=0.374 (95% CI 0.163-0.855) as well as for all samples (p=0.0032, HR=0.319 (95% CI 0.143-0.711).
Conclusion:
Determination of HER2, ER, PR and Ki67 mRNA levels allows molecular subtyping according to the St Gallen surrogate subtype definition. Low risk of distant recurrence could be confirmed for the MammaTyper® Luminal A-like samples suggesting that for this patient group endocrine treatment alone may be sufficient. The high degree of standardization of mRNA measurement may drive the use of the Ki67/MKI67 biomarker in routine breast cancer pathology.
Citation Format: Laible M, Hartmann K, Gürtler C, Anzeneder T, Weber S, Keller T, Sahin U. Prediction of distant recurrence in low risk early breast cancer by RT-qPCR based subtyping using MammaTyper® [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-08-14.
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Affiliation(s)
- M Laible
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - K Hartmann
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - C Gürtler
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - T Anzeneder
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - S Weber
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - T Keller
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - U Sahin
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
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Laible M, Horstmann S, Möhlenbruch M, Schueler S, Rizos T, Veltkamp R. Preexisting cognitive impairment in intracerebral hemorrhage. Acta Neurol Scand 2017; 135:628-634. [PMID: 27502449 DOI: 10.1111/ane.12646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Preexisting cognitive impairment is a predictor of cognitive decline after ischemic stroke, but evidence in intracerebral hemorrhage (ICH) is limited. We aimed to determine the prevalence of premorbid cognitive impairment in patients with ICH. MATERIALS AND METHODS We included patients with acute ICH. Pre-ICH cognitive impairment was determined based on the results of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) that uses information from close relatives. Patients were assessed as having been cognitively impaired with an IQCODE score of ≥3.44; an IQCODE ≥4.00 indicated pre-ICH dementia. CT and MRI images were reviewed to determine the extent of white matter lesions and to measure the radial width of the temporal horn as marker of brain atrophy. We investigated differences of cardiovascular risk factors and imaging data between patients with and without pre-ICH cognitive impairment using correlation analyses, uni- and multivariable regression models. Functional neurological state was assessed using the modified Rankin Scale (mRS). The mRS was dichotomized at the level of 3, and a premorbid mRS of 0-2 was considered as functional independency. RESULTS Among the 89 participants, median age was 70 years (interquartile range 58-78) and 52 (58.4%) were male. IQCODE indicated pre-ICH cognitive impairment in 18.0% (16 of 89), and 83.1% were functionally independent before ICH. Cognitive impairment was associated with a premorbid mRS≥3 (chi squared test, P=0.009). In multivariable analysis, prior stroke/transient ischemic attack (OR 18.29, 95%-CI 1.945-172.033, P=.011) and hematoma volume (OR 0.90, 95%-CI 0.812-0.991, P=.033) were independently associated with pre-ICH cognitive impairment. CONCLUSIONS In conclusion, cognitive impairment frequently precedes ICH. A higher frequency of cerebrovascular events suggests a role of vascular processes in the development of cognitive impairment before ICH.
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Affiliation(s)
- M. Laible
- Department of Neurology; Heidelberg University Hospital; Heidelberg Germany
| | - S. Horstmann
- Department of Neurology; Heidelberg University Hospital; Heidelberg Germany
| | - M. Möhlenbruch
- Department of Neuroradiology; Heidelberg University Hospital; Heidelberg Germany
| | - S. Schueler
- Institute of Medical Biometry and Informatics; University of Heidelberg; Heidelberg Germany
| | - T. Rizos
- Department of Neurology; Heidelberg University Hospital; Heidelberg Germany
| | - R. Veltkamp
- Department of Neurology; Heidelberg University Hospital; Heidelberg Germany
- Department of Stroke Medicine; Imperial College London; London UK
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Wirtz RM, Scheffen I, Marme F, Laible M, Sclombs K, Schumacher C, Schneeweiss A, Eidt S, Sinn HP. Abstract P2-05-25: Predictive value of ultra-high ESR1 mRNA expression in early breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Quantitative determination of estrogen receptor mRNA expression in luminal breast tumors is predictive for benefit from adjuvant tamoxifen compared to placebo treatment as has been shown in the large randomized NSABP B-14 trial, while protein determination by IHC or LBA is not (Kim et al JCO 2011). Interestingly, the ultrahigh expression of ESR1 mRNA (above ER score 10 by Oncotype test) has been indicative for tamoxifen benefit. This predictive cut-off value of mRNA expression is significantly higher than the diagnostic cut-off (at ER score 6.5). Here we tested wether the ultrahigh expression of ESR1 mRNA determined by commercial MammaTyper® testing is predictive for survival after neoadjuvant chemotherapy treatment of advanced breast cancer.
Materials and Methods
Pretreatment core cut biopsies from n=54 patients with PBC treated within a randomized phase II trial (2) of anthracyline/taxane based NAC with available clinical follow-up information were examined. RNA was extracted from the FFPE sections and ESR1 mRNA from each section was measured by commercial assays. For technical comparison of ESR1 mRNA values by Oncotype DX versus MammaTyper® from n=113 surgical samples were analyzed by both commercial assays in a blinded fashion. Statistical analysis was performed using the SAS JMP® 9.0.0 software.
Results
Quantification of ESR1 mRNA expression after RNA extraction from separate slices of 113 primary breast tumors and determination by different commercial RT-qPCR assays resulted in high correlation of continuous expression results (Spearman r=0,85; p<0,0001). The rate of ESR1 mRNA negative cases by both methods by predefined diagnostic cut-offs was low in this cohort (1/113 and 6/113, respectively) resulting in high concordance for positive ER status by both methods.The median expression of ER score and ESR1 40-DDCq was high (10,2 and 39,8, respectively) and almost exactly at the predictive ER score cut-off. Hence, the Tamoxifen benefit cut-off of ER score 10 by Oncotype is comparable with a 40-DDCqvalue of 39,6 for ESR1 mRNA determination by MammaTyper®, which resembles an ESR1 mRNA expression 3fold above the diagnostic cut-off. In the independent chemotherapy cohort theoptimal discrimination for overall survival could be achieved by an elevated ESR1 mRNA expression exactly at 39,6 resulting in 100% overall survival for ultra-high expressors and 75 % overall survival for lower ESR1 mRNA expression after 5 years (p=0,006).
Conclusion
Previous data suggest that ultrahigh expression of ESR1 mRNA is predictive for improved overall survival and tamoxifen benefit (1). Here we show that ultrahigh expression of ESR1 mRNA is also prognostic in more advanced breast tumors after neoadjuvant chemotherapy. These findings validate the importance of quantitative determination of estrogen receptor expression and substantiate the understanding of receptor expression being a continuous determinant with indication specific cut-off values. Ultrahigh expression of ESR1 seems to identify a distinct subset of luminal breast tumors with superior prognosis and benefit from tamoxifen treatment. These findings warrant further investigation, which are currently being done in independent large breast cancer cohorts.
Citation Format: Wirtz RM, Scheffen I, Marme F, Laible M, Sclombs K, Schumacher C, Schneeweiss A, Eidt S, Sinn H-P. Predictive value of ultra-high ESR1 mRNA expression in early breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-25.
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Affiliation(s)
- RM Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - I Scheffen
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - F Marme
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - M Laible
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - K Sclombs
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - C Schumacher
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - A Schneeweiss
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - S Eidt
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - H-P Sinn
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
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Laible M, Möhlenbruch M, Horstmann S, Pfaff J, Geis NA, Pleger S, Schüler S, Rizos T, Bendszus M, Veltkamp R. Peri-procedural silent cerebral infarcts after left atrial appendage occlusion. Eur J Neurol 2016; 24:53-57. [PMID: 27647674 DOI: 10.1111/ene.13129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE To determine the rate of peri-interventional silent brain infarcts after left atrial appendage occlusion (LAAO). METHODS In this prospective, uncontrolled single-center pilot study, consecutive patients with atrial fibrillation undergoing LAAO between July 2013 and January 2016 were included. The Amplatzer Cardiac Plug, WATCHMAN or Amulet device was used. A neurological examination and cranial magnetic resonance imaging (MRI) were performed within 48 h before and after the procedure. MRI was evaluated for new diffusion-weighted imaging (DWI) hyperintensities, cerebral microbleeds (CMBs) and white-matter lesions (WMLs). RESULTS Left atrial appendage occlusion was performed in 21 patients (mean age, 73.2 ± 9.5 years). Main reasons for LAAO were previous intracerebral hemorrhage (n = 11) and major systemic bleeding (n = 6). No clinically overt stroke occurred peri-interventionally. After the intervention, one patient had a small cerebellar hyperintensity on DWI (4.8%; 95% confidence interval, 0.0-14.3) that was not present on the MRI 1 day before the procedure. Among 11 patients with available MRI just before LAAO, there were no significant changes in the number of CMBs and the severity of WMLs after LAAO. CONCLUSIONS This study of peri-interventional MRI in LAAO suggests a low rate of silent peri-procedural infarcts in this elderly population. Confirmation in larger studies is needed.
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Affiliation(s)
- M Laible
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - S Horstmann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - N A Geis
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany
| | - S Pleger
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany
| | - S Schüler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - T Rizos
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - R Veltkamp
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Stroke Medicine, Imperial College London, London, UK
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Ratz L, Laible M, Altevogt P, Klauck S, Sültmann H. Overexpression of TMPRSS2:ERG variants activates TGF-β signaling and promotes invasion of prostate cancer cells. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61037-7] [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: 10/21/2022]
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Horstmann S, Möhlenbruch M, Wegele C, Rizos T, Laible M, Rauch G, Veltkamp R. Prevalence of atrial fibrillation and association of previous antithrombotic treatment in patients with cerebral microbleeds. Eur J Neurol 2014; 22:1355-62. [PMID: 25557113 DOI: 10.1111/ene.12608] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/07/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral microbleeds (CMBs) are associated with an increased risk of intracerebral hemorrhage. The impact of oral anticoagulation (OAC) on CMBs is not well characterized. Our aim was to assess the prevalence of CMBs in stroke and transient ischaemic attack (TIA) patients with atrial fibrillation (AF) and to analyze the implications of previous treatment with OAC. METHODS In this retrospective analysis on data from a prospectively recruiting stroke registry, patients with ischaemic stroke or TIA with brain magnetic resonance imaging including susceptibility weighted imaging were consecutively enrolled during a 3-year period. For each patient cardiovascular risk factors, AF history and recent diagnosis of AF, present use of OAC and antiplatelets, the National Institute of Health Stroke Scale and the premorbid modified Rankin Scale score were recorded. Two independent raters identified CMBs according to consensus criteria. CMB location was classified as lobar, deep or in the posterior fossa. RESULTS In all, 785 patients (mean age 63.9 ± 14.2 years) were included. At least one CMB was detected in 186 (23.7%) patients. CMBs were significantly more frequent in patients with AF (30.5% vs. 22.4%). Patients with previous OAC treatment were more likely to have CMBs (36.7% vs. 22.8%, P = 0.03) and abundant CMBs (n > 10) were more frequent in anticoagulated patients even after adjustment for age. However, age was the only independent factor predicting CMBs (P = 0.001). CONCLUSIONS Cerebral microbleeds are common in elderly AF patients with acute ischaemic stroke. Previous OAC is associated with a higher number of CMBs predominantly in the lobar location. Establishing a causal relationship requires prospective longitudinal investigation.
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Affiliation(s)
- S Horstmann
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - M Möhlenbruch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - C Wegele
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - T Rizos
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - M Laible
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - G Rauch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - R Veltkamp
- Department of Neurology, University of Heidelberg, Heidelberg, Germany.,Department of Stroke Medicine, Imperial College London, London, UK
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Laible M, Horstmann S, Rizos T, Rauch G, Zorn M, Veltkamp R. Prevalence of renal dysfunction in ischaemic stroke and transient ischaemic attack patients with or without atrial fibrillation. Eur J Neurol 2014; 22:64-9, e4-5. [PMID: 25091540 DOI: 10.1111/ene.12528] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/09/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Chronic kidney disease (CKD) is associated with a higher risk of stroke and atrial fibrillation (AF). There are limited data on the comorbidity of renal dysfunction and AF in stroke patients. Our aim was to determine the frequency of kidney dysfunction in ischaemic stroke patients with and without AF. METHODS In a prospectively collected, single center cohort of acute ischaemic stroke and transient ischaemic attack (TIA) patients, glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease equation on admission. Renal function was graded into five categories (cat.): cat. 1, eGRF ≥90 ml/min/1.73 m(2); cat. 2, 60-89; cat. 3, 30-59; cat. 4, 15-29; cat. 5, <15. The diagnosis of AF was based on medical history, a 12-lead electrocardiogram (ECG) and 24-h Holter or continuous ECG monitoring. RESULTS In total, 2274 patients (1727 stroke, 547 TIA; median age 71.0) were included. Median eGFR was 78.6 ml/min/1.73 m(2) (interquartile range 61/95); 21.1% were in cat. 3, 2.1% in cat. 4, 0.7% in cat. 5. In all, 535 patients (23.5%) suffered from AF; 28.0% of these were in cat. 3, 2.6% and 0.8% in cat. 4 and cat. 5, respectively. In multivariable analysis, age [odds ratio (OR) 1.1], diabetes (OR 1.8), heart failure (OR 1.7) and AF (OR 1.4) were independently associated with kidney dysfunction (eGFR < 60). CONCLUSIONS Renal dysfunction is far more common in stroke patients than in the general population and more common in AF-related stroke. These findings may have implications for the choice of anticoagulants.
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Affiliation(s)
- M Laible
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
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Affiliation(s)
- M Lettau
- Division of Neuroradiology, Department of Neurosurgery, University of Freiburg Medical Center, Breisacher Straße 64, 79106, Freiburg, Germany,
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Lettau M, Laible M. [Paraganglioma of the terminal filum]. ROFO-FORTSCHR RONTG 2012; 185:166-7. [PMID: 23108899 DOI: 10.1055/s-0032-1325432] [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: 10/27/2022]
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Lettau M, Laible M. [Mild form of the middle interhemispheric variant of holoprosencephaly]. ROFO-FORTSCHR RONTG 2012; 184:1059-60. [PMID: 22851296 DOI: 10.1055/s-0032-1313046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Lettau
- Neuroradiologie, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.
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Laible M, Schoenberg SO, Weckbach S, Lettau M, Winnik E, Bischof J, Franke R, Reiser M, Kramer H. Whole-body MRI and MRA for evaluation of the prevalence of atherosclerosis in a cohort of subjectively healthy individuals. Insights Imaging 2012; 3:485-93. [PMID: 22836780 PMCID: PMC3443278 DOI: 10.1007/s13244-012-0180-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 05/23/2012] [Accepted: 06/04/2012] [Indexed: 01/07/2023] Open
Abstract
Objectives To assess the prevalence of cardiovascular findings in asymptomatic individuals by means of 1.5-T whole-body magnetic resonance imaging and angiography. Methods A cohort of 138 individuals (118 men, 20 women) with a mean age of 54 years (SD ± 7.55) was referred to whole-body MRI at 1.5-T, including contrast-enhanced whole-body MR angiography (MRA) and cardiac MRI. A total of 2,065/2,070 vessel segments (99.8%) and cardiac function were evaluated. Results Approximately one-fourth of the participating individuals had vascular abnormalities. In 17 subjects (12.3% of all subjects) significant luminal narrowing was observed in at least one vascular segment. Luminal narrowing (mild to severe) was observed in 1 (0.7% of all subjects respectively) of the renal arteries, 7 (5.0%) of the carotid arteries, and 3 (2.2%) of the pelvic and upper leg arteries, and in 17 segments (12.3%) of arteries in the lower leg. In cardiac function and perfusion imaging, wall motion disorders were observed in six patients (4.3%), with additional delayed enhancement and isolated delayed enhancement present in two cases. Functional parameters differed from reference values in 55 cases. Conclusions Even in an asymptomatic cohort of middle-aged predominantly male individuals, atherosclerotic disease is not uncommon and is detectable by whole-body MRI. Main Messages In middle-aged predominantly male individuals, atherosclerotic disease is not uncommon. Even in an asymptomatic collective, approximately one fourth had vascular abnormalities. Using whole-body MR angiography (MRA), 99.8% of 2,070 vessel segments could be evaluated.
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Affiliation(s)
- M Laible
- Department of Clinical Radiology, University Hospital Munich, Grosshadern Campus, Munich, Germany,
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Lettau M, Laible M, Barrows R, Heiland S, Bendszus M, Hähnel S. 3-T contrast-enhanced MR angiography with parallel imaging in cerebral venous and sinus thrombosis. J Neuroradiol 2011; 38:275-82. [DOI: 10.1016/j.neurad.2011.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 12/18/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
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Lettau M, Laible M. Kallmann-Syndrom mit Hypoplasie der Hypophyse. ROFO-FORTSCHR RONTG 2011; 183:576-8. [DOI: 10.1055/s-0031-1273336] [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: 10/18/2022]
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Lettau M, Laible M. 3T-diffusionsgewichtete Aufnahmen mit hohen b-Werten bei hyperakuten Hirnstammischämien. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279217] [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: 10/18/2022]
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25
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Lettau M, Laible M. [A cystic tumor simulating hypophyseal necrosis]. ROFO-FORTSCHR RONTG 2011; 183:858-60. [PMID: 21442566 DOI: 10.1055/s-0031-1273204] [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: 10/18/2022]
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26
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Lettau M, Laible M. [Colloid cyst in the cavernous sinus]. ROFO-FORTSCHR RONTG 2011; 183:282-4. [PMID: 21274829 DOI: 10.1055/s-0029-1245865] [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: 10/18/2022]
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27
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Lettau M, Laible M. [Idiopathic hypertrophic pachymeningitis]. ROFO-FORTSCHR RONTG 2010; 182:1013-5. [PMID: 20830653 DOI: 10.1055/s-0029-1245702] [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: 10/19/2022]
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28
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Lettau M, Laible M. [Rasmussen encephalitis]. ROFO-FORTSCHR RONTG 2010; 183:71-3. [PMID: 20830652 DOI: 10.1055/s-0029-1245701] [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: 10/19/2022]
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29
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30
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Laible M, Lettau M. „Akutes Leriche-Syndrom”. ROFO-FORTSCHR RONTG 2010; 182:531-3. [DOI: 10.1055/s-0029-1245325] [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: 10/19/2022]
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31
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Laible M, Läppchen CH, Hören M, Mader I, Weiller C, Hamzei F. Was verbirgt sich hinter der Spiegeltherapie? Eine fMRT Studie. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238488] [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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32
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Läppchen CH, Lange R, Laible M, Hören M, Mader I, Weiller C, Hamzei F. Die intrakortikale Inhibition verändert sich durch die „Spiegeltherapie“. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238632] [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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33
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Schilling C, Laible M, Läppchen CH, Mader I, Weiller C, Hamzei F. Nervus medianus Stimulation verbessert den Effekt der Spiegeltherapie bei gesunden Probanden: eine fMRT Studie. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238468] [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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34
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Hören M, Vry M, Läppchen C, Laible M, Hieß J, Mader I, Weiller C, Hamzei F. Pars opercularis and pars triangularis of the inferior frontal gyrus are active during action observation. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71535-6] [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] Open
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35
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Hören M, Vry M, Läppchen C, Laible M, Hieß J, Mader I, Weiller C, Hamzei F. Functional anatomy of the human action recognition system. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0029-1216158] [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: 10/21/2022]
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36
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Laible M, Hoeren M, Laeppchen CH, Bauer J, Mader I, Hamzei F, Weiller C. Sensory recovery after constraint – induced movement therapy. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0029-1216250] [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: 10/21/2022]
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37
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Laible M, Hörer M, Wanschura J, Tepper M, Mader I, Weiller C, Hamzei F. Interaktion zwischen prämotorischem Kortex und primär sensomotorischem Kortex als Effekt der Spiegeltherapie. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086867] [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: 10/21/2022]
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38
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Läppchen C, Laible M, Mader I, Weiller C, Hamzei F. Präsentation des „mirror neurons systems“ im Bereich des linken Gyrus frontalis inferior und prämotorischen Kortex bei Menschen. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086963] [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: 10/21/2022]
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