Triage of women with ASCUS and LSIL cytology
BACKGROUND. The identification of a small percentage of high‐grade cervical intraepithelial neoplasias (HGCIN) among patients with minor cytological abnormalities (atypical squamous cells of undetermined significance [ASCUS] and/or low‐grade squamous intraepithelial lesions [LSIL] group) is a major...
Saved in:
Published in | Cancer Vol. 111; no. 1; pp. 58 - 66 |
---|---|
Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Hoboken
Wiley Subscription Services, Inc., A Wiley Company
25.02.2007
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | BACKGROUND.
The identification of a small percentage of high‐grade cervical intraepithelial neoplasias (HGCIN) among patients with minor cytological abnormalities (atypical squamous cells of undetermined significance [ASCUS] and/or low‐grade squamous intraepithelial lesions [LSIL] group) is a major problem in cytology‐based cervical cancer screening. The authors investigated the efficacy of p16INK4a as a biomarker to identify samples of patients with HGCIN among those with an ASCUS or LSIL result in Papanicolaou cytology.
METHODS.
Consecutive liquid‐based cytology specimens of 137 ASCUS and 88 LSIL results were selected from gynecologists who adopted a triage regimen with biopsy under colposcopy 2 months later, independent of the p16INK4a result. p16INK4a stained slides were prepared and independently read by 2 observers, who used a recently described score to categorize p16INK4a stained squamous cells. The endpoint of the study was detection of a biopsy‐confirmed HGCIN.
RESULTS.
The overall sensitivity and specificity of p16INK4a positive cells with a nuclear score >2 for diagnosis of HGCIN in ASCUS and LSIL cases combined was 96% and 83%, respectively. The sensitivity and specificity in the ASCUS group was 95% and 84%, and 100% and 81% in the LSIL group, respectively. Two observers had a high concordance in assessing p16INK4a stained cells (κ value of 0.841).
CONCLUSIONS.
These data suggested that the use of p16INK4a as a biomarker combined with nuclear scoring of p16INK4a positive cells in cervical cytology to triage ASCUS and/or LSIL cases allows identification of HGCIN with good sensitivity and specificity. Cancer (Cancer Cytopathol) 2007. © 2006 American Cancer Society.
The authors investigated the efficacy of p16INK4a as a biomarker to identify samples of patients with high‐grade cervical intraepithelial neoplasia among those with atypical squamous cells of undetermined significance or low‐grade squamous intraepithelial lesion result in Papanicolaou cytology. |
---|---|
AbstractList | BACKGROUND.
The identification of a small percentage of high‐grade cervical intraepithelial neoplasias (HGCIN) among patients with minor cytological abnormalities (atypical squamous cells of undetermined significance [ASCUS] and/or low‐grade squamous intraepithelial lesions [LSIL] group) is a major problem in cytology‐based cervical cancer screening. The authors investigated the efficacy of p16INK4a as a biomarker to identify samples of patients with HGCIN among those with an ASCUS or LSIL result in Papanicolaou cytology.
METHODS.
Consecutive liquid‐based cytology specimens of 137 ASCUS and 88 LSIL results were selected from gynecologists who adopted a triage regimen with biopsy under colposcopy 2 months later, independent of the p16INK4a result. p16INK4a stained slides were prepared and independently read by 2 observers, who used a recently described score to categorize p16INK4a stained squamous cells. The endpoint of the study was detection of a biopsy‐confirmed HGCIN.
RESULTS.
The overall sensitivity and specificity of p16INK4a positive cells with a nuclear score >2 for diagnosis of HGCIN in ASCUS and LSIL cases combined was 96% and 83%, respectively. The sensitivity and specificity in the ASCUS group was 95% and 84%, and 100% and 81% in the LSIL group, respectively. Two observers had a high concordance in assessing p16INK4a stained cells (κ value of 0.841).
CONCLUSIONS.
These data suggested that the use of p16INK4a as a biomarker combined with nuclear scoring of p16INK4a positive cells in cervical cytology to triage ASCUS and/or LSIL cases allows identification of HGCIN with good sensitivity and specificity. Cancer (Cancer Cytopathol) 2007. © 2006 American Cancer Society.
The authors investigated the efficacy of p16INK4a as a biomarker to identify samples of patients with high‐grade cervical intraepithelial neoplasia among those with atypical squamous cells of undetermined significance or low‐grade squamous intraepithelial lesion result in Papanicolaou cytology. |
Author | Bergeron, Christine Wentzensen, Nicolas Vinokurova, Svetlana Cas, Frederic von Knebel Doeberitz, Magnus |
Author_xml | – sequence: 1 givenname: Nicolas surname: Wentzensen fullname: Wentzensen, Nicolas – sequence: 2 givenname: Christine surname: Bergeron fullname: Bergeron, Christine – sequence: 3 givenname: Frederic surname: Cas fullname: Cas, Frederic – sequence: 4 givenname: Svetlana surname: Vinokurova fullname: Vinokurova, Svetlana – sequence: 5 givenname: Magnus surname: von Knebel Doeberitz fullname: von Knebel Doeberitz, Magnus email: knebel@med.uni‐heidelberg.de |
BookMark | eNotz99KwzAYBfAgE-ymNz5BHsDOL1-SprkcRd2gKNgK3oWYP7PStdIOSt9eN70659wc-C3Jouu7QMgtgzUDwHvXuWGNKBAuSMJAqxSYwAVJACBPpeDvV2Q5jl-_U6HkCbmrh8buA-0jnfpD6OjUHD_ppireKmo7T8tqV1I3H_u238_X5DLadgw3_7ki9eNDXWzT8uVpV2zK1OUcUh8i8-Cj9JFxHbOQC8ajzCDjqFFJBS7DEFCDcE6h5d7GqJWKTFuvsw--IuzvdmraMJvvoTnYYTYMzMloTkZzNpriuXg9N_4DGGtHAg |
CitedBy_id | crossref_primary_10_1002_dc_21349 crossref_primary_10_1016_S1470_2045_08_70208_0 crossref_primary_10_1186_1742_6413_4_7 crossref_primary_10_11144_Javeriana_umed61_1_dual crossref_primary_10_3892_etm_2011_316 crossref_primary_10_1002_ijc_24774 crossref_primary_10_18231_j_ijpo_2022_055 crossref_primary_10_1111_cyt_12083 crossref_primary_10_1016_j_pog_2011_01_007 crossref_primary_10_1016_j_ajog_2008_12_025 crossref_primary_10_4103_am_am_17_20 crossref_primary_10_1007_s00105_009_1809_y crossref_primary_10_1016_j_pog_2009_12_003 crossref_primary_10_1002_dc_21270 crossref_primary_10_1158_1055_9965_EPI_08_0508 crossref_primary_10_1007_s00292_012_1613_9 crossref_primary_10_1093_jnci_djq562 crossref_primary_10_1002_cncy_20078 crossref_primary_10_1158_1055_9965_EPI_08_0306 crossref_primary_10_1016_j_ctrv_2008_10_005 crossref_primary_10_1155_2012_289315 crossref_primary_10_1155_2020_6878761 crossref_primary_10_1097_PAT_0000000000000249 crossref_primary_10_1007_s00120_011_2693_5 crossref_primary_10_1002_ijc_30783 crossref_primary_10_3238_arztebl_2008_0617 crossref_primary_10_1016_S1386_6532_09_70006_X crossref_primary_10_1016_S1470_2045_08_70238_9 crossref_primary_10_5301_tj_5000524 crossref_primary_10_1177_039463201102400219 crossref_primary_10_1586_eog_11_13 crossref_primary_10_1002_cncy_20140 crossref_primary_10_1002_cncy_20143 crossref_primary_10_1002_cncy_21473 crossref_primary_10_1007_s00129_007_1966_y crossref_primary_10_1002_cncy_21233 crossref_primary_10_1002_cncy_21511 crossref_primary_10_1016_j_ygyno_2010_06_011 crossref_primary_10_1097_IGC_0b013e3182009eea crossref_primary_10_4155_bio_13_233 crossref_primary_10_1002_ijc_26017 crossref_primary_10_1111_j_1582_4934_2008_00631_x crossref_primary_10_1016_S1470_2045_12_70529_6 crossref_primary_10_1002_jmv_23310 crossref_primary_10_1128_JCM_00181_12 crossref_primary_10_1002_dc_20822 crossref_primary_10_1002_dc_21757 crossref_primary_10_1016_j_gyobfe_2008_03_016 crossref_primary_10_1002_ijc_27750 crossref_primary_10_1002_dc_21758 crossref_primary_10_1002_cncy_21205 crossref_primary_10_4103_1742_6413_76379 crossref_primary_10_1007_s00428_018_2432_z crossref_primary_10_1309_AJCP3CD9YKYFJDQL crossref_primary_10_1002_cncy_22103 crossref_primary_10_1155_2012_507286 crossref_primary_10_1158_1055_9965_EPI_09_0328 |
ContentType | Journal Article |
Copyright | Copyright © 2006 American Cancer Society |
Copyright_xml | – notice: Copyright © 2006 American Cancer Society |
DOI | 10.1002/cncr.22420 |
DatabaseTitleList | |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 1097-0142 |
EndPage | 66 |
ExternalDocumentID | CNCR22420 |
Genre | article |
GrantInformation_xml | – fundername: University of Heidelberg |
GroupedDBID | --- -~X .3N .GA .Y3 05W 0R~ 10A 1CY 1L6 1OC 24P 29B 31~ 33P 3SF 3WU 4.4 4ZD 50Y 50Z 51W 51X 52M 52N 52O 52P 52R 52S 52T 52U 52V 52W 52X 53G 5GY 5VS 66C 6J9 6P2 6PF 702 7PT 8-0 8-1 8-3 8-4 8-5 85S 8UM 930 A01 A03 AAESR AAEVG AAHHS AANLZ AAONW AARRQ AAWTL AAXRX AAZKR ABCQN ABCUV ABEML ABHFT ABIJN ABIVO ABJNI ABLJU ABOCM ABPPZ ABPVW ABQWH ABXGK ACAHQ ACCFJ ACCZN ACFBH ACGFO ACGFS ACGOF ACMXC ACNCT ACPOU ACPRK ACSCC ACXBN ACXQS ADBBV ADBTR ADEOM ADIZJ ADKYN ADMGS ADOZA ADXAS ADZMN ADZOD AEEZP AEIGN AEIMD AENEX AEQDE AEUQT AEUYR AFBPY AFFNX AFFPM AFGKR AFPWT AFRAH AFZJQ AGNAY AHBTC AIACR AIAGR AITYG AIURR AIWBW AJBDE ALAGY ALMA_UNASSIGNED_HOLDINGS ALUQN AMBMR AMYDB ATUGU AZBYB AZVAB BAFTC BAWUL BFHJK BHBCM BMXJE BROTX BRXPI BY8 C1A C45 CS3 D-6 D-7 D-E D-F DCZOG DIK DPXWK DR2 DRFUL DRMAN DRSTM E3Z EBS EJD EX3 F00 F01 F04 F5P FD6 FUBAC G-S G.N GNP GODZA GX1 H.X HBH HGLYW HHY HHZ HZ~ IH2 IX1 J0M J5H JPC KBYEO KQQ KZ1 L7B LATKE LAW LC2 LC3 LH4 LITHE LMP LOXES LP6 LP7 LSO LUTES LW6 LYRES MEWTI MK4 MRFUL MRMAN MRSTM MSFUL MSMAN MSSTM MXFUL MXMAN MXSTM N04 N05 N4W N9A NEJ NF~ NNB O66 O9- OIG OK1 OVD P2P P2W P2X P2Z P4B P4D Q.N Q11 QB0 QRW R.K ROL RWI RX1 RYL SJN SUPJJ TEORI UDS UHB V2E V8K V9Y W8V W99 WBKPD WH7 WHWMO WIH WIJ WIK WIN WJL WOHZO WQJ WRC WVDHM WXI WXSBR XG1 XPP XV2 Z0Y ZGI ZZTAW ~IA ~WT |
ID | FETCH-LOGICAL-c830-def1d0df5df139f6e8413f560632927570c62ee2904cc72a3daff977f19ad96b3 |
IEDL.DBID | DR2 |
ISSN | 0008-543X |
IngestDate | Sat Aug 24 00:50:40 EDT 2024 |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 1 |
Language | English |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c830-def1d0df5df139f6e8413f560632927570c62ee2904cc72a3daff977f19ad96b3 |
Notes | The excellent technical assistance of Denise Eschenbach and Nina Hensch is gratefully acknowledged. Magnus von Knebel Doeberitz is a shareholder, advisor to, and member of the board of MTM Laboratoies AG, a company that develops and markets products related to the scientific content of this article. Fax:(011) 49‐6221‐565981 |
PageCount | 1 |
ParticipantIDs | wiley_primary_10_1002_cncr_22420_CNCR22420 |
PublicationCentury | 2000 |
PublicationDate | 25 February 2007 |
PublicationDateYYYYMMDD | 2007-02-25 |
PublicationDate_xml | – month: 02 year: 2007 text: 25 February 2007 day: 25 |
PublicationDecade | 2000 |
PublicationPlace | Hoboken |
PublicationPlace_xml | – name: Hoboken |
PublicationTitle | Cancer |
PublicationYear | 2007 |
Publisher | Wiley Subscription Services, Inc., A Wiley Company |
Publisher_xml | – name: Wiley Subscription Services, Inc., A Wiley Company |
References | 2002; 38 2001; 92 2004; 122 2001; 93 2004; 445 2004; 102 2004; 48 1996; 93 2000; 95 2003; 16 2003; 95 2006; 118 1998; 153 2004; 10 2004; 96 2002; 26 2006; 108 2003; 127 2005; 105 2004; 13 2003; 47 2005; 97 1996; 334 2003; 189 2003; 188 |
References_xml | – volume: 96 start-page: 280 year: 2004 end-page: 293 article-title: Virologic versus cytologic triage of women with equivocal Pap smears: a meta‐analysis of the accuracy to detect high‐grade intraepithelial neoplasia publication-title: J Natl Cancer Inst. – volume: 188 start-page: 1383 year: 2003 end-page: 1392 article-title: Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance publication-title: Am J Obstet Gynecol. – volume: 95 start-page: 46 year: 2003 end-page: 52 article-title: Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: a 10‐year cohort analysis publication-title: J Natl Cancer Inst. – volume: 189 start-page: 295 year: 2003 end-page: 304 article-title: 2001 consensus guidelines for the management of women with cervical intraepithelial neoplasia publication-title: Am J Obstet Gynecol. – volume: 48 start-page: 771 year: 2004 end-page: 782 article-title: Morphologic characteristics of p16 ‐positive cells in cervical cytology samples publication-title: Acta Cytol. – volume: 47 start-page: 753 year: 2003 end-page: 761 article-title: Performance of a new, liquid‐based cervical screening technique in the clinical setting of a large French laboratory publication-title: Acta Cytol. – volume: 153 start-page: 1741 year: 1998 end-page: 1748 article-title: Expression status of p16 protein is associated with human papillomavirus oncogenic potential in cervical and genital lesions publication-title: Am J Pathol. – volume: 93 start-page: 4350 year: 1996 end-page: 4354 article-title: Inhibition of cyclin D‐CDK4/CDK6 activity is associated with an E2F‐mediated induction of cyclin kinase inhibitor activity publication-title: Proc Natl Acad Sci U S A. – volume: 108 start-page: 119 year: 2006 end-page: 123 article-title: Role of P16((INK4a)) expression in identifying CIN2 or more severe lesions among HPV‐positive patients referred for colposcopy after abnormal cytology publication-title: Cancer. – volume: 334 start-page: 1030 year: 1996 end-page: 1038 article-title: Cancer of the uterine cervix publication-title: N Engl J Med. – volume: 122 start-page: 894 year: 2004 end-page: 901 article-title: The predictive value of p16 (INK4a) and hybrid capture 2 human papillomavirus testing for high‐grade cervical intraepithelial neoplasia publication-title: Am J Clin Pathol. – volume: 127 start-page: 946 year: 2003 end-page: 949 article-title: Findings to date from the ASCUS‐LSIL Triage Study (ALTS) publication-title: Arch Pathol Lab Med. – volume: 93 start-page: 293 year: 2001 end-page: 299 article-title: Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial publication-title: J Natl Cancer Inst. – volume: 97 start-page: 35 year: 2005 end-page: 40 article-title: Is p16(INK4A) expression more useful than human papillomavirus test to determine the outcome of atypical squamous cells of undetermined significance‐categorized Pap smear? A comparative analysis using abnormal cervical smears with follow‐up biopsies publication-title: Gynecol Oncol. – volume: 95 start-page: 821 year: 2000 end-page: 827 article-title: Human papillomavirus testing in women with mild cytologic atypia publication-title: Obstet.Gynecol. – volume: 26 start-page: 1389 year: 2002 end-page: 1399 article-title: p16INK4a immunohistochemistry improves interobserver agreement in the diagnosis of cervical intraepithelial neoplasia publication-title: Am J Surg Pathol. – volume: 102 start-page: 100 year: 2004 end-page: 108 article-title: Usefulness of liquid‐based cytology specimens for the immunocytochemical study of p16 expression and human papillomavirus testing: a comparative study using simultaneously sampled histology materials publication-title: Cancer. – volume: 13 start-page: 1355 year: 2004 end-page: 1360 article-title: Validation of p16INK4a as a marker of oncogenic human papillomavirus infection in cervical biopsies from a population‐based cohort in Costa Rica publication-title: Cancer Epidemiol Biomarkers Prev. – volume: 105 start-page: 461 year: 2005 end-page: 467 article-title: Evaluation of a nuclear score for p16INK4a‐stained cervical squamous cells in liquid‐based cytology samples publication-title: Cancer. – volume: 118 start-page: 1254 year: 2006 end-page: 1260 article-title: Immunocytochemistry in liquid‐based cervical cytology: analysis of clinical use following a cross‐sectional study publication-title: Int J Cancer. – volume: 16 start-page: 665 year: 2003 end-page: 673 article-title: p16(INK4a) expression correlates with degree of cervical neoplasia: a comparison with Ki‐67 expression and detection of high‐risk HPV types publication-title: Mod Pathol. – volume: 38 start-page: 2229 year: 2002 end-page: 2242 article-title: New markers for cervical dysplasia to visualise the genomic chaos created by aberrant oncogenic papillomavirus infections publication-title: Eur J Cancer. – volume: 10 start-page: 2407 year: 2004 end-page: 2414 article-title: Predictive significance of the alterations of p16INK4A, p14ARF, p53, and proliferating cell nuclear antigen expression in the progression of cervical cancer publication-title: Clin Cancer Res. – volume: 92 start-page: 276 year: 2001 end-page: 284 article-title: Overexpression of p16(INK4A) as a specific marker for dysplastic and neoplastic epithelial cells of the cervix uteri publication-title: Int J Cancer. – volume: 445 start-page: 616 year: 2004 end-page: 620 article-title: p16INK4a expression and progression risk of low‐grade intraepithelial neoplasia of the cervix uteri publication-title: Virchows Arch. |
SSID | ssj0007253 |
Score | 1.8822209 |
Snippet | BACKGROUND.
The identification of a small percentage of high‐grade cervical intraepithelial neoplasias (HGCIN) among patients with minor cytological... |
SourceID | wiley |
SourceType | Publisher |
StartPage | 58 |
SubjectTerms | ASCUS biomarker cervical screening human papillomavirus (HPV) liquid‐based cytology LSIL p16INK4a triage |
Title | Triage of women with ASCUS and LSIL cytology |
URI | https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fcncr.22420 |
Volume | 111 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnZ1JSwMxFMdD8SBe3MWdHDyJaTOZyWQGvJTRUqX20AV6kSGrB2EqtT3UT2-WaYve9BZIAnlkef-8JL8AcEM8lI1wlKRCo0SbBHFtdylZxDHPTWZYoH320-44eZ7QSQPcr97CBD7EOuDmZoZfr90E5-KztYGGykrOmtYBEbdhj2Lm7nM9DDbsKEZqBCXOEE3iyZpNSlqbqj8lqfcpnT3wumpNuEry3lzMRVN-_QI1_re5-2C3FpuwHUbHAWjo6hBsv9TH6UfgbmSH35uGUwM9iQG6qCxsD4vxEPJKwd7wqQfl0n9xuzwGo87jqOii-vsEJLMYI6VNpLAyVBmr8kyqM-uvjBU4aUxywijDMiVakxwnUjLCY8WNsWrQRDlXeSriE7BVTSt9CqB7P2vzc2W1R2KzBBPW9VGCU8Gk4PQM3HrTy49AyCgDC5mUzujSG10W_WLgU-d_KXwBdkIwlSBCL8HWfLbQV1YFzMW17-1v2qurJw |
link.rule.ids | 315,783,787,1378,27938,27939,46308,46732 |
linkProvider | Wiley-Blackwell |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnZ07T8MwEMctVCRg4Y1444EJ4TZ1HDsZq0DVQtqhTaVukZ8MSCkq7VA-PbYTtYINtkiOpZzsy_19tn8HwD32UDbMEaFCI6INQVzbVUrc5gFPTGxYRfsc0t6EvEyjaX02x92FqfgQ64Sb8wz_v3YO7hLSrQ01VJZy3rQRCNsV-7b199AVMHgabehRDNcQyiBGEQmnazopbm36_hSlPqp0D6rSqZ8eRugOk7w3lwvRlF-_UI3__uBDsF_rTdipJsgR2NLlMdgZ1DvqJ-AxtzPwTcOZgR7GAF1iFnbG6WQMealgNu5nUK58ldvVKci7z3naQ3UFBSTjMEBKm7YKlImUsULPUB3bkGWsxqEhTjCLWCAp1honAZGSYR4qbowVhKadcJVQEZ6BRjkr9TmA7gqtbU-UlR_ENgkmbPSLcEAFk4JHF-DB2158VJCMosIh48IZXXiji3SYjvzT5V9evgO7vXyQFVl_-HoF9qrcKkY4ugaNxXypb6woWIhbP_TfsZSvQQ |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnZ3LS8MwHMfDmDC8-Bbf5uBJzJaladqCl9FZNp1D9oBdpOTpQejG2A7zrzdNuw296S2QBPIjj983vySfAHBHHJSNcESZ0IhqQxHXdpcSNjnmkQlNUNA--6wzps8Tf1IBj-u3MAUfYhNwy2eGW6_zCT5TprGFhspMzuvWARG7Yd-hzMP5ha72YAuPCkjJoMQh8qk32cBJSWNb96cmdU4l2Qfv6-YUd0k-68uFqMuvX6TG_7b3AOyVahO2iuFxCCo6OwK11_I8_Rg8jOz4-9BwaqBDMcA8LAtbw3g8hDxTsDfs9qBcuT9uVydglDyN4g4q_09AMvQwUto0FVbGV8bKPMN0aB2WsQqHeSQigR9gyYjWJMJUyoBwT3FjrBw0zYiriAnvFFSzaabPAMwf0Nr8SFnxQW2WCIT1fT7BTARScP8c3DvT01mByEgLGDJJc6NTZ3Qa9-OBS138pfAtqL21k7TX7b9cgt0isEoQ8a9AdTFf6murCBbixnX8N-SSrfA |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Triage+of+women+with+ASCUS+and+LSIL+cytology&rft.jtitle=Cancer&rft.au=Wentzensen%2C+Nicolas&rft.au=Bergeron%2C+Christine&rft.au=Cas%2C+Frederic&rft.au=Vinokurova%2C+Svetlana&rft.date=2007-02-25&rft.pub=Wiley+Subscription+Services%2C+Inc.%2C+A+Wiley+Company&rft.issn=0008-543X&rft.eissn=1097-0142&rft.volume=111&rft.issue=1&rft.spage=58&rft.epage=66&rft_id=info:doi/10.1002%2Fcncr.22420&rft.externalDBID=10.1002%252Fcncr.22420&rft.externalDocID=CNCR22420 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0008-543X&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0008-543X&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0008-543X&client=summon |