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The same KRAS-TMGB assay was independently developed previously [10] and used for KRAS mutation assessment in CRC [7].
Diagnostic targeted mutation assessment on FFPE-DNA is very efficient with Q-PCR methods in comparison to dideoxy-sequencing.
In this study, dideoxy-sequencing was used as a reference for mutation assessment in order to validate the results obtained by Q-PCR assays, especially KRAS-TMGB that had not previously been validated in the diagnostic setting.
Testing for tumor specific mutations on routine formalin-fixed paraffin-embedded (FFPE) tissues may predict response to treatment in Medical Oncology and has already entered diagnostics, with KRAS mutation assessment as a paradigm.
These methods are developed to overcome the shortcomings of conventional dideoxy-sequencing, the as yet golden standard for mutation assessment, namely labor, time and expertise requirements, low sensitivity at 30% detection of mutant cells in tissues and variously low efficiency on FFPE-DNA [23], [24].
The new mechanism will undoubtedly reset the traditional way of mutation assessment and interpretation.
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Indeed, Q-PCR methods are easy, fast and surpass the requirement of "1% sensitivity" set for diagnostic mutation assessments [21], while the infrastructure necessary to perform these tests is increasingly acquired in diagnostic laboratories.
A variety of PCR methods, increasingly real time PCR (Q-PCR) targeted mutation detection assays, are currently applied for diagnostic KRAS mutation assessments [20], [21], some of which have already acquired the license for in vitro diagnostic (IVD) use in Europe [22].
DxS-KRAS [http:// www.dxsdiagnostics.com/Content/TheraScreenKRAS.aspx], KRAS-TMGB ([42] and this study), as well as further Q-PCR approaches that have been developed for point mutation assessments [25], [50], may be highly sensitive in detecting rare mutant alleles in a wild type environment.
The implication of a germline polymorphism as opposed to a somatic mutation for assessment of metastasis risk is that risk assessment can be done using any tissue at the time of diagnosis or even before diagnosis of a primary tumor [ 24].
As FFPE tissues are the most common clinical specimens available for mutation analysis, assessment of the analytical sensitivity of the KRAS HRM assay was performed with patient FFPE-derived DNA instead of control cell lines bearing known KRAS mutations.
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