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Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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McCart Reed AE, Kalaw E, Nones K, Bettington M, Lim M, Bennett J, Johnstone K, Kutasovic JR, Kazakoff S, Xu QC, Saunus JM, Reid LE, Black D, Niland C, Ferguson K, Gresshoff I, Raghavendra A, Liu JC, Kalinowski L, Reid AS, Davidson M, Pearson JV, Yamaguchi R, Harris G, Tse G, Papadimos D, Pathmanathan R, Pathmanathan N, Tan PH, Fox S, O'Toole S, Waddell N, Simpson PT, Lakhani SR. Abstract P3-08-03: Dissecting the heterogeneity of metaplastic breast cancer: A morphological, immunohistochemical and genomic analysis of a large cohort. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-08-03] [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
Although rare, Metaplastic Breast Carcinomas (MBC) account for significant global breast cancer mortality. This subgroup is extremely heterogeneous and by definition exhibits metaplastic change to squamous and/or mesenchymal elements, including but not limited to spindle, squamous, chondroid, osseous and rhabdomyoid elements. The WHO working group recognizes that the current classification is inadequate and in the interim, has suggested a purely descriptive classification. The mixed epithelial-mesenchymal morphology has led to speculation that MBC represent 'stem cell tumours'; in support of this, MBC have been shown to have a CD44+/CD24-/low phenotype. Clinically, patients present with tumours that are larger (higher stage), have increased likelihood of distant metastases at presentation and overall, have a reduced 5-year survival rate compared to Invasive Carcinoma-NST. Hence, this is a unique subtype with poor outcome but without a robust classification or understanding of the biology to aid clinical management. We present a detailed morphological, immunohistochemical and genomic analysis of a large series of MBC (n=347), as amassed through the Asia-Pacific MBC consortium. We consider our morphological dissection using the WHO subtyping guidelines and show that an increasing number of phenotypes in a mixed MBC (classified as WHO_1) significantly associates with a poor prognosis. Immunohistochemical analysis showed that a pure spindle (WHO_5) is significantly less likely to express vimentin, CK5/6, CK14, and CK19 than a mixed WHO_1 with spindle features. Similarly, a WHO_1 with chondroid features is less likely to express EGFR than WHO_1 with chondroid features and rhabdoid or osseous differentiation. Across the cohort, positivity for the AE1/3 antibody and a lack of EGFR expression both significantly associate with a better outcome. We report no significant association between patient age at diagnosis and breast cancer specific survival, nor between age and specific WHO MBC subtypes. We report a significant association between WHO_1 types and increasing tumour grade, and also between tumour size and grade, with tumour size being a highly significant prognostic indicator in this cohort. Our exome sequencing confirms a significant enrichment for TP53 and PTEN mutations in MBC, and intriguingly for concurrent mutations of TP53, PTEN and PIK3CA. A novel enrichment for NF1 mutations is also presented. In summary, we provide a thorough assessment of a large cohort of MBC, including morphology, survival, IHC and exome sequencing, and present our analysis contextualized by the WHO guidelines, extending the existing knowledge base of this rare tumour type.
Citation Format: McCart Reed AE, Kalaw E, Nones K, Bettington M, Lim M, Bennett J, Johnstone K, Kutasovic JR, Kazakoff S, Xu QC, Saunus JM, Reid LE, Black D, Niland C, Ferguson K, Gresshoff I, Raghavendra A, Liu JC, Kalinowski L, Reid AS, Davidson M, Pearson JV, Yamaguchi R, Harris G, Tse G, Papadimos D, Pathmanathan R, Pathmanathan N, Tan PH, Fox S, O'Toole S, Waddell N, Simpson PT, Lakhani SR. Dissecting the heterogeneity of metaplastic breast cancer: A morphological, immunohistochemical and genomic analysis of a large cohort [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 P3-08-03.
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Affiliation(s)
- AE McCart Reed
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - E Kalaw
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - K Nones
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - M Bettington
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - M Lim
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - J Bennett
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - K Johnstone
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - JR Kutasovic
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - S Kazakoff
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - QC Xu
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - JM Saunus
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - LE Reid
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - D Black
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - C Niland
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - K Ferguson
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - I Gresshoff
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - A Raghavendra
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - JC Liu
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - L Kalinowski
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - AS Reid
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - M Davidson
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - JV Pearson
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - R Yamaguchi
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - G Harris
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - G Tse
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - D Papadimos
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - R Pathmanathan
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - N Pathmanathan
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - PH Tan
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - S Fox
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - S O'Toole
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - N Waddell
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - PT Simpson
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
| | - SR Lakhani
- University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia; Kurume University School of Medicine, Kurume, Japan; Canterbury Health Laboratories, Christchurch, New Zealand; Prince of Wales Hospital, Hong Kong, Hong Kong; Sullivan Nicolaides Pathology, Brisbane, Australia; Sime Darby Medical Centre, Selangor, Malaysia; Westmead Breast Cancer Institute; University of Sydney, Sydney, Australia; Singapore General Hospital, Singapore, Singapore; Peter MacCallum Cancer Centre, Melbourne, Australia; Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Sydney, Australia
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