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Abstract
Stromal tumor-infiltrating lymphocytes (sTILs) are a potential predictive biomarker for immunotherapy response in metastatic triple-negative breast cancer (TNBC). To incorporate sTILs into clinical trials and diagnostics, reliable assessment is essential. In this review, we propose a new concept, namely the implementation of a risk-management framework that enables the use of sTILs as a stratification factor in clinical trials. We present the design of a biomarker risk-mitigation workflow that can be applied to any biomarker incorporation in clinical trials. We demonstrate the implementation of this concept using sTILs as an integral biomarker in a single-center phase II immunotherapy trial for metastatic TNBC (TONIC trial, NCT02499367), using this workflow to mitigate risks of suboptimal inclusion of sTILs in this specific trial. In this review, we demonstrate that a web-based scoring platform can mitigate potential risk factors when including sTILs in clinical trials, and we argue that this framework can be applied for any future biomarker-driven clinical trial setting.
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1 The Netherlands Cancer Institute, Department of Research IT, Amsterdam, The Netherlands (GRID:grid.430814.a)
2 The Netherlands Cancer Institute, Division of Tumor Biology and Immunology, Amsterdam, The Netherlands (GRID:grid.430814.a)
3 The Netherlands Cancer Institute, Division of Molecular Pathology, Amsterdam, The Netherlands (GRID:grid.430814.a)
4 The Netherlands Cancer Institute, Department of Pathology, Amsterdam, The Netherlands (GRID:grid.430814.a)
5 Ghent University Hospital, Department of Pathology, Ghent, Belgium (GRID:grid.410566.0) (ISNI:0000 0004 0626 3303)
6 The Netherlands Cancer Institute, Department of Biometrics, Amsterdam, The Netherlands (GRID:grid.430814.a)
7 New York University School of Medicine, Department of Medicine, Perlmutter Cancer Center, New York, USA (GRID:grid.137628.9) (ISNI:0000 0004 1936 8753)
8 Weill Cornell Medicine, Department of Radiation Oncology, New York, USA (GRID:grid.5386.8) (ISNI:000000041936877X); Weill Cornell Medicine, Department of Pathology and Laboratory Medicine, New York, USA (GRID:grid.5386.8) (ISNI:000000041936877X)
9 IEO European Institute of Oncology IRCCS, International Breast Cancer Study Group Central Pathology Office, Department of Pathology and Laboratory Medicine, Milan, Italy (GRID:grid.15667.33) (ISNI:0000 0004 1757 0843); University of Milan, Milan, Italy (GRID:grid.4708.b) (ISNI:0000 0004 1757 2822)
10 University of British Columbia, Department of Pathology and Laboratory Medicine, Genetic Pathology Evaluation Centre, Vancouver, Canada (GRID:grid.17091.3e) (ISNI:0000 0001 2288 9830)
11 Indiana University Simon Cancer Center, Department of Pathology and Laboratory Medicine, Indianapolis, USA (GRID:grid.257413.6) (ISNI:0000 0001 2287 3919)
12 Université Paris-Saclay, Service de Biostatistique et d’Epidémiologie, Gustave Roussy, CESP, Université-Paris Sud, Villejuif, France (GRID:grid.460789.4) (ISNI:0000 0004 4910 6535); Université Paris-Saclay, CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Villejuif, France (GRID:grid.460789.4) (ISNI:0000 0004 4910 6535)
13 M.D. Anderson Cancer Center, Department of Pathology, Houston, USA (GRID:grid.240145.6) (ISNI:0000 0001 2291 4776)
14 Université Libre de Bruxelles, Breast Cancer Translational Research Laboratory, Institut Jules Bordet, U-CRC, Brussels, Belgium (GRID:grid.4989.c) (ISNI:0000 0001 2348 0746)
15 Yale School of Medicine, Department of Pathology, New Haven, USA (GRID:grid.47100.32) (ISNI:0000000419368710); Yale University School of Medicine, Department of Medicine, New Haven, USA (GRID:grid.47100.32) (ISNI:0000000419368710)
16 National Cancer Institute, Laboratory of Pathology, Center for Cancer Research, Bethesda, USA (GRID:grid.48336.3a) (ISNI:0000 0004 1936 8075)
17 Charité Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany (GRID:grid.6363.0) (ISNI:0000 0001 2218 4662); Philipps-University Marburg, Institute of Pathology, Marburg, Germany (GRID:grid.10253.35) (ISNI:0000 0004 1936 9756)
18 German Breast Group, Neu-Isenburg, Germany (GRID:grid.434440.3) (ISNI:0000 0004 0457 2954)
19 University of Melbourne, Division of Research and Clinical Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia (GRID:grid.1008.9) (ISNI:0000 0001 2179 088X)
20 Ontario Institute for Cancer Research, Toronto, Canada (GRID:grid.419890.d) (ISNI:0000 0004 0626 690X); IGMM, Edinburgh, UK (GRID:grid.415854.9) (ISNI:0000 0004 0605 7892); Western General Hospital, Edinburgh Cancer Research Centre, Edinburgh, UK (GRID:grid.417068.c) (ISNI:0000 0004 0624 9907)
21 IRCCS Fondazion - Instituto Nazionale Tumori, Department of Pathology and Laboratory Medicine, Milan, Italy (GRID:grid.417893.0) (ISNI:0000 0001 0807 2568); University of Milan, School of Medicine, Milan, Italy (GRID:grid.4708.b) (ISNI:0000 0004 1757 2822)
22 Harvard Medical School, Department of Pathology, Brigham and Women’s Hospital, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X)
23 The Institute of Cancer Research, Clinical Trials and Statistics Unit, Surrey, UK (GRID:grid.18886.3f) (ISNI:0000 0001 1271 4623)
24 The Institute of Cancer Research, Breast Cancer Now Toby Robins Research Centre, London, UK (GRID:grid.18886.3f) (ISNI:0000 0001 1271 4623)
25 Vivactiv Ltd, Research and Development, Chesham, UK (GRID:grid.18886.3f)
26 University of Ottawa, Department of Pathology and Laboratory Medicine, Ottawa, Canada (GRID:grid.28046.38) (ISNI:0000 0001 2182 2255)
27 University of Melbourne, Division of Research and Clinical Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia (GRID:grid.1008.9) (ISNI:0000 0001 2179 088X); GZA-ZNA Ziekenhuizen, Department of Pathology, Antwerp, Belgium (GRID:grid.428965.4) (ISNI:0000 0004 7536 2436)
28 The Netherlands Cancer Institute, Division of Tumor Biology and Immunology, Amsterdam, The Netherlands (GRID:grid.430814.a); The Netherlands Cancer Institute, Department of Medical Oncology, Amsterdam, The Netherlands (GRID:grid.430814.a)
29 The Netherlands Cancer Institute, Division of Molecular Pathology, Amsterdam, The Netherlands (GRID:grid.430814.a); The Netherlands Cancer Institute, Department of Pathology, Amsterdam, The Netherlands (GRID:grid.430814.a)
30 Department of Oral and Maxillofacial Diseases, Helsinki, Finland (GRID:grid.430814.a)
31 Department of Pathology, Matsuyama Shimin Hospital, Matsuyama, Japan (GRID:grid.459780.7) (ISNI:0000 0004 1772 4320)
32 Surgical Oncology, Baylor College of Medicine, Houston, USA (GRID:grid.39382.33) (ISNI:0000 0001 2160 926X)
33 Roche Diagnostics, Mechelen, Belgium (GRID:grid.39382.33)
34 Departments of Pathology, Genomic Medicine, Dermatology, and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA (GRID:grid.240145.6) (ISNI:0000 0001 2291 4776)
35 PhenoPath Laboratories, Seattle, USA (GRID:grid.240145.6)
36 Research Pathology, Genentech Inc., South San Francisco, USA (GRID:grid.418158.1) (ISNI:0000 0004 0534 4718)
37 University of Turin/Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy (GRID:grid.7605.4) (ISNI:0000 0001 2336 6580)
38 Case Western Reserve University, Cleveland, USA (GRID:grid.67105.35) (ISNI:0000 0001 2164 3847); Louis Stokes Cleveland Veterans Health Administration Medical Center, Cleveland, USA (GRID:grid.67105.35)
39 Pulmonary Pathology, New York University Center for Biospecimen Research and Development, New York University, New York, USA (GRID:grid.137628.9) (ISNI:0000 0004 1936 8753)
40 Department of Pathology, Johns Hopkins Hospital, Baltimore, USA (GRID:grid.411935.b) (ISNI:0000 0001 2192 2723)
41 Department of Pathology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy (GRID:grid.4708.b) (ISNI:0000 0004 1757 2822)
42 PathAI, Inc, Cambridge, USA (GRID:grid.479429.5)
43 Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, USA (GRID:grid.412584.e) (ISNI:0000 0004 0434 9816)
44 Department of Oncology, IVO, Valencia, Spain (GRID:grid.418082.7) (ISNI:0000 0004 1771 144X)
45 Cancer Bioinformatics Lab, Cancer Centre at Guy’s Hospital, London, UK (GRID:grid.239826.4) (ISNI:0000 0004 0391 895X); School of Life Sciences and Medicine, King’s College London, London, UK (GRID:grid.13097.3c) (ISNI:0000 0001 2322 6764)
46 Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden (GRID:grid.13097.3c)
47 Dana Farber Cancer Institute, Boston, USA (GRID:grid.65499.37) (ISNI:0000 0001 2106 9910)
48 Institut Curie, Paris Sciences Lettres Université, Inserm U934, Department of Pathology, Paris, France (GRID:grid.65499.37)
49 Department of Surgical Pathology, Zealand University Hospital, Køge, Denmark (GRID:grid.476266.7)
50 Department of Biomedical Informatics, Emory University, USA (GRID:grid.189967.8) (ISNI:0000 0001 0941 6502)
51 Departments of Pathology and Oncology, The Johns Hopkins Hospital, Baltimore, USA (GRID:grid.411935.b) (ISNI:0000 0001 2192 2723)
52 National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, USA (GRID:grid.21925.3d) (ISNI:0000 0004 1936 9000)
53 Department of Pathology, Karolinska Institutet, Karolinska, Sweden (GRID:grid.4714.6) (ISNI:0000 0004 1937 0626)
54 Department of Pathology, New York University Langone Medical Centre, New York, USA (GRID:grid.4714.6)
55 Department of Pathology and Laboratory Medicine, UNC School of Medicine, Chapel Hill, USA (GRID:grid.10698.36) (ISNI:0000000122483208)
56 Bioinformatics and Computational Genomics Laboratory, Princess Margaret Cancer Center, Toronto, Canada (GRID:grid.10698.36)
57 Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia (GRID:grid.1055.1) (ISNI:0000000403978434)
58 Department of Medicine, University of Melbourne, Parkville, Australia (GRID:grid.1008.9) (ISNI:0000 0001 2179 088X)
59 Trev & Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, Canada (GRID:grid.248762.d) (ISNI:0000 0001 0702 3000)
60 Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories (OSEL), Center for Devices and Radiological Health (CDRH), Rockville, USA (GRID:grid.413579.d) (ISNI:0000 0001 2285 9893)
61 Department of Research, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (GRID:grid.419177.d) (ISNI:0000 0004 0644 4024); Department of Research, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (GRID:grid.419177.d) (ISNI:0000 0004 0644 4024)
62 Providence Cancer Research Center, Portland, Oregon, USA (GRID:grid.419177.d)
63 Department of Medical Oncology, Istituto Europeo di Oncologia, Milan, Italy (GRID:grid.15667.33) (ISNI:0000 0004 1757 0843)
64 Roche Diagnostics, Mechelen, Belgium (GRID:grid.15667.33)
65 Department of Pathology, AZ Turnhout, Turnhout, Belgium (GRID:grid.476094.8)
66 Department of Pathology, St Vincent’s University Hospital and University College Dublin, Dublin, Ireland (GRID:grid.7886.1) (ISNI:0000 0001 0768 2743)
67 Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, USA (GRID:grid.21925.3d) (ISNI:0000 0004 1936 9000)
68 Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, University College London, London, UK (GRID:grid.83440.3b) (ISNI:0000000121901201)
69 Azienda AUSL, Regional Hospital of Aosta, Aosta, Italy (GRID:grid.83440.3b)
70 Université Paris-Sud, Institut National de la Santé et de la Recherche Médicale, Villejuif, France (GRID:grid.5842.b) (ISNI:0000 0001 2171 2558); Gustave Roussy, Universite Paris-Saclay, Villejuif, France (GRID:grid.14925.3b) (ISNI:0000 0001 2284 9388)
71 University Hospital Halle (Saale), Institute of Pathology, Halle, Germany (GRID:grid.461820.9) (ISNI:0000 0004 0390 1701)
72 Department of Pathology, UCL Cancer Institute, UCL, London, UK (GRID:grid.83440.3b) (ISNI:0000000121901201); University College Hospitals NHS Trust, London, UK (GRID:grid.52996.31) (ISNI:0000 0000 8937 2257)
73 Department of Pathology, Jules Bordet Institute, Brussels, Belgium (GRID:grid.418119.4) (ISNI:0000 0001 0684 291X)
74 Department of Clinical Medicine, Macquarie University, Sydney, Australia (GRID:grid.1004.5) (ISNI:0000 0001 2158 5405)
75 HistoGeneX NV, Antwerp, Belgium and AZ Sint-Maarten Hospital, Mechelen, Belgium (GRID:grid.1004.5)
76 Oncology Clinical Development, Bristol-Myers Squibb, Princeton, USA (GRID:grid.419971.3)
77 Institut für Pathologie, UK Hamburg, Germany (GRID:grid.5252.0) (ISNI:0000 0004 1936 973X)
78 Department of Medicine, Vanderbilt University Medical Centre, Nashville, USA (GRID:grid.412807.8) (ISNI:0000 0004 1936 9916)
79 Department of Cancer CV, Jacksonville, USA (GRID:grid.412807.8)
80 Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA (GRID:grid.51462.34) (ISNI:0000 0001 2171 9952)
81 Department of Oncology, Mayo Clinic, Rochester, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X)
82 Roche, Tucson, USA (GRID:grid.418158.1) (ISNI:0000 0004 0534 4718)
83 Department of Pathology, Herlev and Gentofte Hospital, Gentofte, Denmark (GRID:grid.411646.0) (ISNI:0000 0004 0646 7402)
84 Université Paris-Saclay, Univ. Paris-Sud, Villejuif, France (GRID:grid.5842.b) (ISNI:0000 0001 2171 2558); Service de biostatistique et d’épidémiologie, Gustave Roussy, Villejuif, France (GRID:grid.14925.3b) (ISNI:0000 0001 2284 9388)
85 Yale School of Medicine, Department of Pathology, New Haven, USA (GRID:grid.47100.32) (ISNI:0000000419368710)
86 Department of Pathology, Universidad de La Frontera, Temuco, Chile (GRID:grid.412163.3) (ISNI:0000 0001 2287 9552); Departamento de Anatomía Patológica, Universidad de La Frontera, Temuco, Chile (GRID:grid.412163.3) (ISNI:0000 0001 2287 9552)
87 Tumor Pathology Department, Maria Sklodowska-Curie Memorial Cancer Center, Gliwice, Poland (GRID:grid.418165.f) (ISNI:0000 0004 0540 2543)
88 Pathology and Tissue Analytics, Roche, Neuherberg, Germany (GRID:grid.424277.0)
89 Department of Medical Oncology, Gustave Roussy, Villejuif, France (GRID:grid.14925.3b) (ISNI:0000 0001 2284 9388)
90 Sunnybrook Health Sciences Centre, Toronto, Canada (GRID:grid.413104.3) (ISNI:0000 0000 9743 1587)
91 Tehran University of Medical Sciences, Tehran, Iran (GRID:grid.411705.6) (ISNI:0000 0001 0166 0922)
92 Pathology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain (GRID:grid.5515.4) (ISNI:0000000119578126); GEICAM-Spanish Breast Cancer Research Group, Madrid, Spain (GRID:grid.430580.a)
93 Translational Research, Montreal, Canada (GRID:grid.430580.a)
94 Computational Pathology Group, Department of Pathology, Nijmegen, The Netherlands (GRID:grid.430580.a)
95 Oncology Biomarker Development, Genentech-Roche, Neuherberg, Germany (GRID:grid.430580.a)
96 Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA (GRID:grid.430503.1) (ISNI:0000 0001 0703 675X)
97 Charité Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany (GRID:grid.6363.0) (ISNI:0000 0001 2218 4662)
98 Centre de Lutte Contre le cancer - Centre Jean Perrin, Clermont-Ferrand, France (GRID:grid.418113.e) (ISNI:0000 0004 1795 1689)
99 Department of Pathology, Hospital de Oncología Maria Curie, Buenos Aires, Argentina (GRID:grid.418113.e)
100 Directorate of Surgical Pathology, SA Pathology, Adelaide, Australia (GRID:grid.414733.6) (ISNI:0000 0001 2294 430X)
101 Department of Pathology, GZA-ZNA Ziekenhuizen, Wilrijk, Belgium (GRID:grid.414733.6)
102 University of Milano, Instituto Europeo di Oncologia, IRCCS, Milano, Italy (GRID:grid.4708.b) (ISNI:0000 0004 1757 2822); Division of Early Drug Development for Innovative Therapy, IEO, European Institute of Oncology IRCCS, Milan, Italy (GRID:grid.15667.33) (ISNI:0000 0004 1757 0843)
103 Department of Imaging and Pathology, Laboratory of TranslCal Cell & Tissue Research, Leuven, Belgium (GRID:grid.15667.33); KU Leuven- University Hospitals Leuven, Department of Pathology, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884)
104 Department of Pathology, University Hospital of Antwerp, Antwerp, Belgium (GRID:grid.411414.5) (ISNI:0000 0004 0626 3418)
105 Paula I, Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, USA (GRID:grid.412807.8) (ISNI:0000 0004 1936 9916)
106 Translational Health Sciences, Department of Cellular Pathology, North Bristol NHS Trust, University of Bristol, Bristol, UK (GRID:grid.5337.2) (ISNI:0000 0004 1936 7603)
107 Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA (GRID:grid.50956.3f) (ISNI:0000 0001 2152 9905)
108 Helsinki University Central Hospital, Helsinki, Finland (GRID:grid.15485.3d) (ISNI:0000 0000 9950 5666)
109 Department of Clinical Pathology, Akademiska University Hospital, Uppsala, Sweden (GRID:grid.412354.5) (ISNI:0000 0001 2351 3333)
110 Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan (GRID:grid.412094.a) (ISNI:0000 0004 0572 7815)
111 Department of Oncology, National Taiwan University Cancer Center, Taipei, Taiwan (GRID:grid.19188.39) (ISNI:0000 0004 0546 0241); Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan (GRID:grid.19188.39) (ISNI:0000 0004 0546 0241)
112 International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France (GRID:grid.17703.32) (ISNI:0000000405980095)
113 Department of Pathology, Sanatorio Mater Dei, Buenos Aires, Argentina (GRID:grid.17703.32)
114 Institute of Pathology, Medical University of Graz, Graz, Austria (GRID:grid.11598.34) (ISNI:0000 0000 8988 2476)
115 Department of Oncology, National Cancer Centre Singapore, Singapore, Singapore (GRID:grid.410724.4) (ISNI:0000 0004 0620 9745)
116 Department of Pathology, Brigham and Women’s Hospital, Boston, USA (GRID:grid.62560.37) (ISNI:0000 0004 0378 8294)
117 Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands (GRID:grid.430814.a)
118 PathAI Inc, Cambridge, USA (GRID:grid.479429.5)
119 Visiopharm A/S, Hørsholm, Denmark (GRID:grid.479429.5); DTU Compute, Department of Applied Mathematics, Technical University of Denmark, Lyngby, Denmark (GRID:grid.5170.3) (ISNI:0000 0001 2181 8870)
120 Nuffield Department of Population Health, University of Oxford, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); Department of Medical Oncology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK (GRID:grid.410421.2) (ISNI:0000 0004 0380 7336)
121 Computational Pathology Group, Department of Pathology, Nijmegen, The Netherlands (GRID:grid.410421.2)
122 R&D UNICANCER, Paris, France (GRID:grid.410421.2)
123 Translational Sciences, MedImmune, Gaithersberg, USA (GRID:grid.418152.b)
124 Breast Unit, Champalimaud Clinical Centre, Lisboa, Portugal (GRID:grid.418152.b)
125 Department of Pathology, Massachusetts General Hospital, Boston, USA (GRID:grid.32224.35) (ISNI:0000 0004 0386 9924)
126 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X)
127 Biomedical Informatics Department, Stony Brook University, Stony Brook, USA (GRID:grid.36425.36) (ISNI:0000 0001 2216 9681)
128 Department of Oncology and Pathology, Karolinska Institutet and University Hospital, Solna, Sweden (GRID:grid.24381.3c) (ISNI:0000 0000 9241 5705)
129 Department of Medicine, Clinical Division of Oncology, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria (GRID:grid.22937.3d) (ISNI:0000 0000 9259 8492)
130 Leicester Cancer Research Centre, University of Leicester, Leicester, and MRC Toxicology Unit, University of Cambridge, Cambridge, UK (GRID:grid.5335.0) (ISNI:0000000121885934)
131 Merck & Co., Inc, Kenilworth, USA (GRID:grid.417993.1) (ISNI:0000 0001 2260 0793)
132 Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA (GRID:grid.51462.34) (ISNI:0000 0001 2171 9952); Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, USA (GRID:grid.51462.34) (ISNI:0000 0001 2171 9952)
133 Department of Research, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (GRID:grid.419177.d) (ISNI:0000 0004 0644 4024)
134 Department of Medicine, Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein Medical Center, Bronx, USA (GRID:grid.419177.d)
135 GHI Le Raincy-Montfermeil, Chelles, Île-de-France, France (GRID:grid.420138.c) (ISNI:0000 0000 8620 9964)
136 Department of Pathology, Universidad de La Frontera, Temuco, Chile (GRID:grid.412163.3) (ISNI:0000 0001 2287 9552)
137 Department of Pathology, Gustave Roussy, Grand Paris, France (GRID:grid.14925.3b) (ISNI:0000 0001 2284 9388)
138 Departments of Medicine and Cancer Biology, Vanderbilt University Medical Centre, Nashville, USA (GRID:grid.412807.8) (ISNI:0000 0004 1936 9916)
139 VMscope GmbH, Berlin, Germany (GRID:grid.412807.8)
140 Department of Pathology, Breast Pathology Section, Northwestern University, Chicago, USA (GRID:grid.16753.36) (ISNI:0000 0001 2299 3507)
141 Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (GRID:grid.16753.36)
142 NSABP/NRG Oncology, Pittsburgh, USA (GRID:grid.434440.3)
143 Division of Molecular Pathology, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK (GRID:grid.18886.3f) (ISNI:0000 0001 1271 4623)
144 Cancer Biomarkers Working Group, Faculty of Medicine and Pharmacy, Université Mohamed Premier, Oujda, Morocco (GRID:grid.410890.4) (ISNI:0000 0004 1772 8348)
145 Yale Cancer Center Genetics, Genomics and Epigenetics Program, Yale School of Medicine, New Haven, USA (GRID:grid.47100.32) (ISNI:0000000419368710)
146 Pathology Department, Stanford University Medical Centre, Stanford, USA (GRID:grid.47100.32)
147 Pathology and Tissue Analytics, Roche Innovation Centre Munich, Penzberg, Germany (GRID:grid.47100.32)
148 Pathology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain (GRID:grid.411142.3) (ISNI:0000 0004 1767 8811); GEICAM-Spanish Breast Cancer Research Group, Madrid, Spain (GRID:grid.430580.a)
149 Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (GRID:grid.430580.a)
150 Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, USA (GRID:grid.16753.36) (ISNI:0000 0001 2299 3507)
151 Center for Pharmacogenomics and Fudan-Zhangjiang, Center for Clinical Genomics School of Life Sciences and Shanghai Cancer Center, Fudan University, Fudan, China (GRID:grid.8547.e) (ISNI:0000 0001 0125 2443)
152 GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre and Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands (GRID:grid.412966.e) (ISNI:0000 0004 0480 1382)
153 Oncology Biomarker Development, Genentech-Roche, Neuherberg, Germany (GRID:grid.412966.e)
154 Biorepository and Tissue Technology Shared Resources, University of California San Diego, San Diego, USA (GRID:grid.266100.3) (ISNI:0000 0001 2107 4242)
155 Department of Pathology, Gustave Roussy, Villejuif, France (GRID:grid.14925.3b) (ISNI:0000 0001 2284 9388)
156 Departments of Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, USA (GRID:grid.240145.6) (ISNI:0000 0001 2291 4776)
157 Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (GRID:grid.5650.6) (ISNI:0000000404654431)
158 Department of Pathology, University of São Paulo, São Paulo, Brazil (GRID:grid.11899.38) (ISNI:0000 0004 1937 0722); Hospital das Clínicas, Sao Paulo, Brasil (GRID:grid.411074.7) (ISNI:0000 0001 2297 2036)
159 Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy (GRID:grid.5608.b) (ISNI:0000 0004 1757 3470)
160 Department of Medical Biology and Pathology, Gustave Roussy Cancer Campus, Villejuif, France (GRID:grid.14925.3b) (ISNI:0000 0001 2284 9388)
161 Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium (GRID:grid.418119.4) (ISNI:0000 0001 0684 291X)
162 Roche Tissue Diagnostics, Digital Pathology, Santa Clara, USA (GRID:grid.22937.3d)
163 Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Centre, Nashville, USA (GRID:grid.412807.8) (ISNI:0000 0004 1936 9916)
164 Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA (GRID:grid.65499.37) (ISNI:0000 0001 2106 9910); Harvard Medical School, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X)
165 Roche Diagnostics Information Solutions, Belmont, USA (GRID:grid.418158.1) (ISNI:0000 0004 0534 4718)
166 Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Australia (GRID:grid.416153.4) (ISNI:0000 0004 0624 1200)
167 Vernon Cancer Center, Newton-Wellesley Hospital, Newton, USA (GRID:grid.416176.3) (ISNI:0000 0000 9957 1751)
168 Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (GRID:grid.416176.3)
169 Service de pathologique, Cliniques universitaires Saint-Luc, Bruxelles, Belgique (GRID:grid.48769.34) (ISNI:0000 0004 0461 6320)
170 Department of Research, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (GRID:grid.419177.d) (ISNI:0000 0004 0644 4024)
171 Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, USA (GRID:grid.189967.8) (ISNI:0000 0001 0941 6502)
172 Breast Center, Dept. OB&GYN and CCC (LMU), University of Munich, Munich, Germany (GRID:grid.5252.0) (ISNI:0000 0004 1936 973X)
173 Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, USA (GRID:grid.239395.7) (ISNI:0000 0000 9011 8547)
174 University of Leuven, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884)
175 Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (GRID:grid.5596.f)
176 Université Paris-Saclay, Service de Biostatistique et d’Epidémiologie, Gustave Roussy, CESP, Université-Paris Sud, Villejuif, France (GRID:grid.460789.4) (ISNI:0000 0004 4910 6535)
177 Department of Surgical Pathology and Biopathology, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France (GRID:grid.460789.4)
178 Johanniter GmbH - Evangelisches Krankenhaus Bethesda Mönchengladbach, West German Study Group, Mönchengladbach, Germany (GRID:grid.476830.e)
179 Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain (GRID:grid.411083.f) (ISNI:0000 0001 0675 8654)
180 Department of Pathology, University of Marburg, Marburg, Germany (GRID:grid.10253.35) (ISNI:0000 0004 1936 9756)
181 Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, USA (GRID:grid.412807.8) (ISNI:0000 0004 1936 9916)
182 Department of Histopathology, Manipal Hospitals Dwarka, New Delhi, India (GRID:grid.412807.8)
183 Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada (GRID:grid.17091.3e) (ISNI:0000 0001 2288 9830)
184 University of Melbourne, Division of Research and Clinical Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia (GRID:grid.1008.9) (ISNI:0000 0001 2179 088X); The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia (GRID:grid.1008.9) (ISNI:0000 0001 2179 088X)
185 Peter MacCallum Cancer Centre, Melbourne, Australia (GRID:grid.1055.1) (ISNI:0000000403978434); Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia (GRID:grid.1008.9) (ISNI:0000 0001 2179 088X)
186 Department of Anatomical Pathology, St Vincent’s Hospital Melbourne, Fitzroy, Australia (GRID:grid.413105.2) (ISNI:0000 0000 8606 2560)
187 Icahn School of Medicine at Mt. Sinai, New York, USA (GRID:grid.59734.3c) (ISNI:0000 0001 0670 2351)
188 NRG Oncology/NSABP, Pittsburgh, USA (GRID:grid.59734.3c)
189 Cancer Immunotherapy Trials Network, Central Laboratory and Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, USA (GRID:grid.270240.3) (ISNI:0000 0001 2180 1622)
190 Clinical Trial Service Unit & Epidemiological Studies Unit, University of Oxford, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948)
191 Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (GRID:grid.66875.3a)
192 Department of Pathology, Fudan University Cancer Center, Shanghai, China (GRID:grid.8547.e) (ISNI:0000 0001 0125 2443)
193 Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium (GRID:grid.428965.4) (ISNI:0000 0004 7536 2436)
194 University of British Columbia, Vancouver, Canada (GRID:grid.17091.3e) (ISNI:0000 0001 2288 9830)
195 Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Research Institute, Toronto, Canada (GRID:grid.17063.33) (ISNI:0000 0001 2157 2938)
196 Merck Oncology, Kenilworth, USA (GRID:grid.17063.33)
197 The Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, Australia (GRID:grid.415306.5) (ISNI:0000 0000 9983 6924)
198 Georgetown University Medical Center, Washington, USA (GRID:grid.411667.3) (ISNI:0000 0001 2186 0438)
199 FDA/CDRH/OSEL/Division of Imaging, Diagnostics, and Software Reliability, Silver Spring, USA (GRID:grid.411667.3)
200 Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA (GRID:grid.414118.9) (ISNI:0000 0004 0464 4831)
201 Translational Medicine, Bristol-Myers Squibb, Princeton, USA (GRID:grid.419971.3)
202 Anatomic Pathology, Boston, USA (GRID:grid.21925.3d)
203 Guy’s Hospital, London, UK (GRID:grid.239826.4) (ISNI:0000 0004 0391 895X); King’s College London, London, UK (GRID:grid.13097.3c) (ISNI:0000 0001 2322 6764)
204 Peking University First Hospital Breast Disease Center, Beijing, China (GRID:grid.411472.5) (ISNI:0000 0004 1764 1621)
205 Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia (GRID:grid.1055.1) (ISNI:0000000403978434)
206 Dipartimento di Scienze della Salute (DSS), Firenze, Italy (GRID:grid.1055.1)
207 Department of Oncology, Champalimaud Clinical Centre, Lisbon, Portugal (GRID:grid.1055.1)
208 Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany (GRID:grid.21925.3d)
209 Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, USA (GRID:grid.67033.31) (ISNI:0000 0000 8934 4045)
210 Harvard Medical School, Department of Pathology, Brigham and Women’s Hospital, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X); Dana-Farber Cancer Institute, Boston, USA (GRID:grid.65499.37) (ISNI:0000 0001 2106 9910)
211 Department of Pathology, Fundación Valle del Lili, Cali, Valle del Cauca, Colombia (GRID:grid.477264.4)
212 The University of Queensland Centre for Clinical Research and Pathology Queensland, Brisbane, Australia (GRID:grid.1003.2) (ISNI:0000 0000 9320 7537)
213 Department of Pathology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, USA (GRID:grid.240283.f) (ISNI:0000 0001 2152 0791)
214 Department of Pathology, University Hospital of Bellvitge, Oncobell, IDIBELL, L’Hospitalet del Llobregat, Barcelona, Spain (GRID:grid.240283.f)
215 Department of Development and Regeneration, Laboratory of Experimental Urology, KU Leuven, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884)
216 Department of Medical Oncology, Austin Health, Heidelberg, Australia (GRID:grid.410678.c)
217 Department of Surgery, Kansai Medical School, Hirakata, Japan (GRID:grid.410783.9) (ISNI:0000 0001 2172 5041)
218 Roche Tissue Diagnostics, Digital Pathology, Santa Clara, USA (GRID:grid.410783.9)
219 Bioinformatics and Computational Genomics Laboratory, Princess Margaret Cancer Center, Toronto, Canada (GRID:grid.32224.35)
220 Pathology Department, H.U. Vall d’Hebron, Barcelona, Spain (GRID:grid.32224.35)
221 Division of Bioinformatics and Biostatistics, US Food and Drug Administration, Silver Spring, USA (GRID:grid.417587.8) (ISNI:0000 0001 2243 3366)
222 Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Providence, USA (GRID:grid.17063.33)
223 Université Paris-Est, Créteil, France (GRID:grid.410511.0) (ISNI:0000 0001 2149 7878)
224 Praava Health, Dhaka, Bangladesh (GRID:grid.410511.0)
225 Department of Pathology, Medical University of Vienna, Vienna, Austria (GRID:grid.22937.3d) (ISNI:0000 0000 9259 8492)