Browsing by Author "Wright, Colleen A."
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- ItemReclassification of early stage breast cancer into treatment groups by combining the use of immunohistochemistry and microarray analysis(Academy of Science of South Africa, 2019) Grant, Kathleen A.; Myburgh, Ettienne J.; Murray, Elizabeth; Pienaar, Fredrieka M.; Kidd, Martin; Wright, Colleen A.; Kotze, Maritha J.ENGLISH ABSTRACT: Immunohistochemistry (IHC) is routinely used to approximate breast cancer intrinsic subtypes, which were initially discovered by microarray analysis. However, IHC assessment of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) status, is a poor surrogate of molecular subtype. Therefore, MammaPrint/BluePrint (MP/BP) microarray gene expression profiling is increasingly used to stratify breast cancer patients into different treatment groups. In this study, ER/PR status, as reported by standard IHC and single-gene mRNA analysis using TargetPrint, was compared with molecular subtyping to evaluate the combined use of MP/BP in South African breast cancer patients. Pathological information of 74 ER/PR positive, HER2 negative tumours from 73 patients who underwent microarray testing, were extracted from a central breast cancer genomics database. The IHC level was standardised by multiplying the intensity score (0–3) by the reported proportion of positively stained nuclei, giving a score of 0–300. Comparison between mRNA levels and IHC determination of ER/PR status demonstrated a significant correlation (p<0.001) for both receptors (ER: 0.34 and PR: 0.54). Concordance was shown in 61 (82%) cases and discordance in 13 (18%) of the 74 tumours tested. Further stratification by MP/BP identified 49 (66.2%) Luminal A, 21 (28.4%) Luminal B and 4 (5.4%) Basal-like tumours. Neither IHC nor TargetPrint could substitute BP subtyping, which measures the functional integrity of ER and can identify patients with false-positive tumours who are resistant to hormone therapy. These findings support the implementation of a pathology-supported genetic testing approach combining IHC and microarray gene profiling for definitive prognostic and predictive treatment decision-making in patients with early stage breast cancer.
- ItemUltrathin bronchoscopy for solitary pulmonary lesions in a region endemic for tuberculosis : a randomised pilot trial(BioMed Central, 2016) Franzen, Daniel; Diacon, Andreas H.; Freitag, Lutz; Schubert, Pawel T.; Wright, Colleen A.; Schuurman, Mace M.Background: The evaluation of solitary pulmonary lesions (SPL) requires a balance between procedure-related morbidity and diagnostic yield, particularly in areas where tuberculosis (TB) is endemic. Data on ultrathin bronchoscopy (UB) for this purpose is limited. To evaluate feasibility and safety of UB compared to SB for diagnosis of SPL in a TB endemic region. Methods: In this prospective randomised trial we compared diagnostic yield and adverse events of UB with standard- size bronchoscopy (SB), both combined with fluoroscopy, in a cohort of patients with SPL located beyond the visible range of SB. Results: We included 40 patients (mean age 55.2 years, 45 % male) with malignant SPL ( n = 16; 40 %), tuberculous SPL ( n = 11; 27.5 %) and other benign SPL ( n = 13; 32.5 %). Mean procedure time in UB and SB was 30.6 and 26.0 min, respectively ( p = 0.15). By trend, adverse events were recorded more often with UB than with SB (30.0 vs. 5.0 %, p = 0.091), including extensive coughing ( n = 2), blocked working channel ( n = 2), and arterial hypertension requiring therapeutic intervention ( n = 1), all with UB. The overall diagnostic yield of UB compared to SB was 55.0 % vs. 80.0 %, respectively ( p = 0.18). Sensitivity for the diagnosis of malignancy of UB and SB was 50.0 % and 62.5 %, respectively ( p =0.95). Conclusion: UB is not superior to SB for the evaluation of SPL in a region endemic with tuberculosis, when combined with fluoroscopic guidance only. Trial registration: ClinicalTrials.gov (Identifier: NCT02490059).