Advanced Test Research Articles

A-227 One Step Toward Implementation of Advanced Lipoprotien Testing in Children: A Pilot Study on Pediatric Reference Ranges

Abstract Background Abnormal serum lipid levels in childhood are associated with dyslipidemia and increased risk of cardiovascular disease in adulthood. High prevalence of childhood obesity in the US has increased concerns about the adverse effects of abnormal lipids in children, prompting recommendations for universal lipid screening in adolescents. While specialized analysis of lipoproteins by nuclear magnetic resonance (NMR) has been predominately used in adults with risk factors for CVD, our laboratory also receives pediatric samples for NMR testing, most commonly associated with diagnostic codes for hyperlipidemia and/or abnormal weight gain. Currently adult-based reference ranges for the NMR lipoprotein measurements are used in children. The objective of this pilot study was to compare lipoprotein profiles of healthy adults and children and to assess the impact of reference intervals for children on clinical interpretation of pediatric results. Methods Serum samples were collected from 60 healthy children, ages 1 - 17 years, and 148 self-identified healthy adults, ages 19 - 64 years old. NMR lipoprotein analysis was performed using the Axinon lipoFIT by NMR assay on a 600 MHz NMR (Bruker). Statistical analysis was conducted in Excel and Graph Pad Prism. Reference intervals (RIs) were determined in EP Evaluator as the central 95% interval. Results The levels of atherogenic low-density lipoprotein particle number (LDL-P) and small LDL-P (sLDL-P) were significantly lower in children compared to adults: 783±222 vs 1212±412 nmol/L and 302±142 vs 498±306 nmol/L, respectively (p<0.00001). Additionally, LDL size (LDL-s) was significantly larger in children than adults (21.23±0.29 vs 21.06±0.44 nm, p=0.006), reflecting prevalence of less dense LDL-P in the former group. Pediatric samples also had lower number of anti-atherogenic high-density lipoprotein particles (HDL-P) compared to adults: 29.4±4.6 vs 33.5±4.6 µmol/L, p<0.00001. The significant differences in the number and size of lipoprotein particles between adults and children implies that currently used adult reference intervals might not be appropriate for evaluating pediatric NMR samples. Therefore, we estimated RIs for our heathy pediatric and adult cohorts and applied these RIs to our retrospective data of 618 samples from children 1-17 years old, which were submitted for NMR lipoprotein testing in recent years. The analysis showed that using the adult RIs, 37% and 27% of pediatric samples would not flag for abnormally elevated LDL-P and sLDL-P, respectively; but they would be flagged based on the RI derived from our pediatric cohort. Moreover, 12% pediatric samples flagged for low HDL-P would have normal HDL-P levels if pediatric RIs are used instead of adult RIs. Conclusions Use of adult reference intervals in children may result in misclassification of lipid status and underestimation or overestimation of dyslipidemia and CVD risk in children. This pilot study highlights the need for pediatric reference intervals to guide interpretation of advanced lipid testing in children.

Is Clinical Medicine Dying?

Recently, I came across a few discussions and write-ups on the dying art of clinical medicine caused by rapid advances in technology, which is replacing previously indispensable instruments such as stethoscope. Fred has interestingly termed it "Hyposkillia."1 Multiple editorials have decried the loss of clinical skills, and medical educators justify not only teaching but also using basic history-taking and physical examination skills in routine patient care.2-4 However, some skeptics suggest that emphasis on clinical skills is from a bygone era and that the availability of advanced imaging techniques and laboratory tests has supplanted ambiguous history and physical findings.5,6 Here is what I think.

Cytogenetic spectrum and clinical presentation of Klinefelter syndrome: A comprehensive study from South India

BackgroundKlinefelter syndrome (KS) is a common sex chromosome abnormality that mostly presents as testicular failure and a myriad of other clinical features. The phenotypic features and their severity vary between individuals, age groups and cytogenetic subtypes. Karyotyping remains the method of choice for the diagnosis of KS despite advanced molecular testing in this modern era. The objective of this study was to determine the cytogenetic subtypes, clinical presentation and hormonal profile of patients with KS. MethodsRetrospective observational study comprised patients with KS determined by cytogenetic analysis at the tertiary care centre in south India from 2001 to 2019. Clinical details including testicular size, hormone levels and semen analysis were obtained from the medical records. ResultsThere were 147 KS (145 post-natal and 2 pre-natal) patients ranging in age from two days to 51 years, 116 (74.8%) patients being ≥18 years. Classic (cKS), mosaic (mKS) and variant KS (vKS) accounted for 126 (85.7%), 9 (6.1%) and 12 (8.2%) cases and their mean ages were 26.6, 29.6 and 12.8 years, respectively. cKS and mKS had diverse clinical presentations including several co-morbidities of which small testes were most common (94.8%). vKS presented with behavioural problems (58.3%) without any comorbidities. Testosterone (p < 0.05), FSH and LH levels were abnormal in >90% of patients. ConclusionAll three cytogenetic subtypes of KS were seen in our patients. cKS was seen in all ages, mKS was common in adults and vKS was seen predominantly in children. Early diagnosis of KS and timely medical intervention may alter the clinical outcomes and improve the quality of life.

Osteosarcoma and Langerhans Cell Histiocytosis in a Pediatric Patient with Lynch Syndrome: A Case Report.

Lynch syndrome (hereditary nonpolyposis colorectal cancer) is associated with extracolonic manifestations, but skeletal tumors are rare. Our patient, a 12-year-old boy with Lynch syndrome, developed osteosarcoma of the left femur. Treatment included cytotoxic chemotherapy, wide resection, and pembrolizumab. Two years later, he developed an aggressive lesion in the contralateral femur that was thought to be metastatic osteosarcoma but which histology revealed to be Langerhans cell histiocytosis. This case underscores the importance of advanced testing in patients with osteosarcoma and poor response to chemotherapy, and of tissue sampling when patients with a primary malignancy develop new bone lesions. IV.

Full-Field Measurement of Lightweight Nonlinear Structures Using Three-Dimensional Scanning Laser Doppler Vibrometry

Modern noncontact measurement techniques such as the three-dimensional scanning laser Doppler vibrometry (3D SLDV) are advantageous in measuring vibrations of lightweight, thin-walled aerospace structures, which were conventionally deemed as difficult or not feasible to apply using attached transducers. Nevertheless, the full-field measurements using 3D SLDV are still limited to extracting modal properties of linear structures, while measurements of complex nonlinear structures are rarely reported. This paper aims to extend the full-field measurement capability of 3D SLDV and combines it with a multiple-input–single-output vibration controller to deal with nonlinear structures. An advanced test strategy is introduced, which is capable of obtaining amplitude-dependent resonant frequencies, modal damping ratios, and full-field, multiharmonic mode shapes of nonlinear normal modes (NNMs). Conflicting parameters such as the frequency resolution and measurement time are optimized by combining phase separation and phase resonance testing techniques in a coherent strategy. The capabilities of the proposed nonlinear modal testing strategy are demonstrated on a realistic, large-scale fan blade that exhibits softening behaviors. Two of its NNMs were investigated at larger vibration amplitudes. Its nonlinear modal parameters were successfully extracted and validated, highlighting the time efficiency and data accuracy of the proposed strategy for measuring industrial-scale, lightweight nonlinear structures.

Advanced test automation techniques for DevOps: Bridging the gap between test-driven development and continuous deployment in agile environments

As software development continues to change, it becomes more important to incorporate modern test automation approaches in DevOps to support efficient deployment. This work investigates TDD and CD in Agile to critically appraise advanced automation technologies and practices to fill existing deficits. This research demonstrates that the brighter Test Automation Framework approaches could improve code quality and deployment time, along with the culture of embracing best practices. The results can help practitioners who want to make their DevOps practices even more efficient and focused on quickly delivering high-quality products.

2024 Tianmulake Advanced Anode Materials Innovation Forum and Sixth National Conference of Advanced Battery Failure Analysis and Testing Technology concluded successfully

2024 Tianmulake Advanced Anode Materials Innovation Forum and Sixth National Conference of Advanced Battery Failure Analysis and Testing Technology concluded successfully

Strengthening Fungal Infection Diagnosis and Treatment: An In-depth Analysis of Capabilities in Honduras.

Invasive fungal infections (IFIs) are a major public health concern in low- and middle-income countries (LMICs) due to limited diagnostic and treatment resources, leading to high morbidity and mortality. Despite their significant global burden, IFIs are underrecognized and underdiagnosed in LMICs. This study evaluates the diagnostic and therapeutic capacities for managing IFI in Honduras, a country with unique health care challenges. From March to December 2023, a comprehensive survey was conducted across multiple health care centers in Honduras. The survey, reviewed for content and clarity by local medical institutions, targeted medical microbiologists and clinicians to assess various aspects of fungal disease diagnosis and treatment. Data included the availability and use of diagnostic tools and antifungal therapies, identifying gaps and limitations in current practices. The survey revealed that Candida spp (97.4%) and Aspergillus spp (35.9%) were the most concerning pathogens. Although microscopy and culture methods were available in most institutions, their application in suspected IFI cases was inconsistent, and antifungal susceptibility testing was rarely performed. Advanced diagnostic techniques, such as antigen detection, were available in only a few institutions, while antibody detection and polymerase chain reaction testing were entirely absent. All hospitals had access to at least 1 triazole antifungal, typically fluconazole, but there was a notable scarcity of more potent antifungals, including amphotericin B formulations and echinocandins. The limited use of available diagnostic tools and the restricted availability of essential antifungals were identified as major barriers to effective IFI management. This study highlights significant gaps in the diagnostic and therapeutic capabilities for managing IFI in Honduras. The underutilization of basic diagnostic tools, the inaccessibility of advanced testing methods, and the limited availability of essential antifungal medications underscore the urgent need for capacity-building initiatives, infrastructure improvements, and policy reforms. Addressing these deficiencies is critical for enhancing the management of IFI in Honduras, with broader implications for similar LMIC settings. These findings can inform targeted interventions and resource allocation to improve outcomes for patients with IFI.

Understanding the dynamics of nipah virus (NiV) transmission and outbreaks in India from Kerala’s perspective

This comprehensive analysis delves into the series of Nipah virus (NiV) outbreaks across India, with a particular focus on occurrences in Kerala. NiV, which belongs to the Paromyxoviridae family and Henipavirus genus, originated in Malaysia in 1998 and has consistently posed significant global health threats. In India, NiV outbreaks have sporadically emerged since the initial case in West Bengal in 2001, often with alarming mortality rates. The 2018 resurgence in Kerala exhibited an astonishing case fatality rate of 89%, emphasizing the need for tailored diagnostic and management strategies due to substantial variability in the incubation period and clinical manifestations. Understanding the predominant person-to-person transmission underscores the importance of comprehending transmission dynamics. Early detection, facilitated by the Integrated Disease Surveillance Program (IDSP), remains vital, as treatment options are currently confined to supportive care, necessitating the exploration of more effective therapeutics. The sporadic nature of NiV outbreaks, exemplified by the recent Kerala episode, emphasizes the urgency for robust response mechanisms, while collaborative efforts and capacity-building initiatives are essential for effectively managing these occurrences. Continued focus on prompt detection, advanced laboratory testing, accessibility to cutting-edge facilities, and heightened infection control measures remains imperative to mitigate future incidents.

Contribution of Lobe Power to Experiment Heating in the Advanced Test Reactor

In order to ease the computational burden associated with designing irradiation experiments in the Advanced Test Reactor (ATR), scaling factors are often used to estimate design parameters at different lobe powers. This paper examines the validity of long-standing assumptions about the contribution of lobe power to total experiment heating in the ATR. For each of the ATR’s 77 different experiment positions, the fractional contribution of each of the ATR’s five lobes to the total heating in that position is calculated and compared to traditional assumptions. The updated fractional contributions are then used to scale heating rates in a sample problem, and the results are compared to traditional scaling methods as well as explicit MC21 heating calculations. It is concluded that for experiment locations in close proximity to the ATR driver fuel (i.e. flux traps and the A, H, and B positions), heating rates scaled with the updated fractional contributions generally agree better with explicit MC21 calculations than do heating rates scaled using the traditionally assumed contributions. For the I positions, which are located on the very periphery of the ATR core, both scaling methods led to poor results when compared against explicit calculations due to the effect that movement of the outer shim control cylinders has on the experiment heating in those positions.

Progress on Pu-238 production at Idaho National Laboratory from February 2022 to July 2023

Idaho National Laboratory (INL) has continued to qualify irradiation positions in the Advanced Test Reactor (ATR) for Pu-238 production to support NASA deep space missions. Over the past year, INL qualified Np-237 targets for ATR’s North East Flux Trap (NEFT), Inner-A and H positions. Work has begun to requalify the South Flux Trap (SFT) and to qualify the East Flux Trap (EFT) for the ATR GEN I target and is midway through the qualification process. This paper gives an overview of operational and technical activities from February 2022 to July 2023.

Alternatives to Reduce Hot Cracking Susceptibility of IN718 Casting Alloy Laser Beam Welds with a Mushroom Shape

Reducing hot cracking is essential for ensuring seamless production of nickel superalloys, which are extensively used in welded structures for aircraft engines. The prevalence of hot cracking in precipitation-strengthened alloy 718 is primarily governed by two factors: firstly, the chemical composition and the coarse microstructure formed during solidification, and secondly, the activation of hot cracking mechanisms, which is particularly critical in mushroom-shaped welding morphologies. In this study, different nickel-based superalloys welded using laser beam welding (LBW), more specifically bead on plate welding (BoP), specimens are compared. The cracking susceptibility of both wrought and two investment casting 718 alloys with tailored chemical compositions is examined through the application of both continuous and pulsed LBW. Additionally, various pre-weld treatments, including with and without Pre-HIP (hot isostatic pressing), are analyzed. The influences of chemical composition, LBW parameters and pre- and post-welding treatments on both internal and external cracks determined by conventional and advanced non-destructive tests are studied. A clear reduction of hot cracking susceptibility and overall welding quality improvement was observed in a tailored 718 alloy with relatively high Ni (55.6% wt) and Co (1.11% wt) contents.

Optimizing modified asphalt binder performance at high and intermediate temperatures using experimental and machine learning approaches

Asphalt pavements are highly susceptible to temperature-induced stresses, which can lead to significant deterioration such as rutting at high temperatures and cracking at low temperatures. These challenges are exacerbated by global warming, which raises pavement temperatures and potentially accelerates material degradation. Addressing these issues, this study utilizes two base asphalt binders, PG 64–22 and PG 76–22, and the use of phase change materials (PCMs) like styrene-butadiene-styrene, lignin, and ground tire rubber to enhance the resilience of asphalt binders. Through an extensive experimental investigation, which includes aging processes such as rolling thin film oven and pressure aging vessel, alongside a series of both traditional and advanced tests (including dynamic shear rheometer, rotational viscometer, Fourier transform infrared spectroscopy, among others), a comprehensive set of 51 samples were analysed. By incorporating these binders and PCMs into asphalt, the experimental work demonstrated a significant improvement in the thermal and mechanical properties, effectively increasing resistance to high-temperature rutting and fatigue cracking. Complementing the experimental approach, machine learning models were employed to predict complex asphalt binder properties, such as combustion value and failure temperature, based on the experimental data. This dual approach fills a significant gap in the literature by offering a more efficient method and prediction model for optimizing pavement materials amidst climate change, while also promising to significantly advance pavement technology by enhancing material design and performance.

Big-Data Technology in Finance: Quality of Stock-Trading Information in Vietnamese Stock Market

Quantitative finance is a field of applied research where the data is important information investors’ profitability and financial risk of financial assets in the processes of decision-making. And financial institutions and securities have applied big-data technologies in stock market to exploit useful information for investors using mobile stock-trading apps. The standardization of database from the raw data of companies’ financial statements, statistical reports and stock-trading data support to enhance data mining analysis by predictive patterns with high feasibility for useful information for investors’ decision-making. And quantitative tools of predictive patterns for financial advanced indexes test expected market return and favourable market timing for buying or selling stocks in stages of market cycle and prediction of market risk before market-trend crash. On the development of securities’ mobile stock-trading apps, the addition of new advanced indexes increases the quality of stock-trading information in Vietnamese stock market generally, seeks competitive advantages of market segments for securities particularly when they change big-data technology in mobile stock-trading apps. This contribution has a better using FinTech combined with stock-trading algorithms to provide more useful and confident information of optimal profitability and financial risk management that individual and institutional investors catch up the trend of big-data technology.

Construction of a stable YOLOv8 classification model for apple bruising detection based on physicochemical property analysis and structured-illumination reflectance imaging

Effective and accurate detection of bruises at all stages has always been a challenge in non-destructive grading of apples. In this study, the visible structured-illumination reflectance imaging (SIRI) combing with deep learning method was proposed to identify bruised ‘Fuji’ apples at four different time stages (0, 6, 12 and 24 h). The macroscopic/microscopic structures and physicochemical properties of bruised tissue were measured and analyzed to determine the relationship between bruising time and these properties, as well as how they affect the accuracy of bruising detection. Results indicated that classification accuracy increased with the decrease of water and total phenolic content of the bruised tissue, as well as with the increase of color browning and bruised area. The YOLOv8 model achieved the highest detection accuracy (99.5 %) and stability. This research enhances understanding of apple bruise optics and aids in developing advanced nondestructive testing techniques.

Post irradiation examinations of FeCrAl cladding in PWR conditions

FeCrAl alloys have been one of the prominent Accident Tolerant Fuel (ATF) cladding material candidates, primarily due to their excellent oxidation resistance in high-temperature steam conditions when compared to Zr-based alloys. Prototypic irradiation of fueled FeCrAl rods is a fundamental step in confirming the integral performance behavior during in-pile conditions. Early generation C26M cladding, fabricated through wrought metallurgy techniques, was fueled with UO2 fuel pellets and irradiated in a pressurized water loop in the Advanced Test Reactor (ATR) at the Idaho National Lab (INL) to a burnup (BU) of ∼25 GWd/tHM. After irradiation, the rodlets were nondestructively and destructively examined. Nondestructive examinations included visual exams, profilometry, and gamma scanning. These examinations highlight the unique deposits, BU profile of the rodlets as well as the migration path of fission gases within the rodlet, and typical diametrical morphology of fuel rodlets. During handling, brittle failure of one end cap on one pin occurred. Destructive examinations included microscopy and mechanical testing. Radial cross sections of the cladding were analyzed metallographically through light optical microscopy (LOM), scanning electron microscopy (SEM) highlighting a unique corrosion morphology and micro-cracking (∼20–30 μm past the main oxide layer) at the metal-oxide interface. Ring compression testing (RCT) was used to elucidate the mechanical property change of the FeCrAl cladding after neutron irradiation. In contrast to the non-irradiated material, which remained ductile at all test temperatures between 25 °C and 250 °C, the irradiated cladding fractured in a brittle manner at 50 °C and below. The results of the tests show that some challenges remain in the development of FeCrAl cladding for LWR cladding applications including improvement of in-reactor waterside corrosion performance and the retention of ductility after neutron irradiation.

Hybridization effect of Kevlar and glass fiber on carbon/epoxy composites to enhance the damage strength under low velocity impact. Part II: Numerical simulations

The research outlined in this paper extends the authors previous work to explore the impact resistance enhancement of CFRP composites through numerical simulations, focusing on the incorporation of a hybrid combination of Kevlar and glass fibers. Experimental drop weight low velocity impact and advanced NDT tests on CFRP and hybrid laminates were carried out in previous work. The current work focuses on the analysis of the dynamic behavior of hybrid composite subjected to LVI by numerical simulation methods. The numerical simulations have been validated with experiments and the damage area of numerical and experimental tests were compared. CFRP and hybrid laminates were modeled using Abaqus/Explicit FEA software to investigate the damage modes and mechanisms. The history curves of simulation results such as load/displacement-time etc. compared with experimental. Results show that incorporating 25% Kevlar fibers on the outer layer of the CFRP, denoted as [01K/06C/01K] resulted in a reduction of laminate deflection by 63.64%. Additionally, the stress distribution expanded over a larger area. A good concurrence between the simulation and experimental findings has been established, indicating that the modeling approach is suitable for conducting further parametric investigations.

Micro- and macro-scale fracture behaviour of brittle rocks: Comparison between the conventional Brazilian test and the advanced universal snap-back indirect tensile test (AUSBIT)

Post-peak behaviour is crucial for the estimation of rock mass fracturing in cave mining operations where hard rocks can exhibit class-II or snap-back response when subjected to loading. Despite the rapid development of research into class-II rocks under compression, the corresponding behaviour in tensile tests has rarely been investigated, which is critical considering the complexity of rock mass fracturing under various stress states. The post-peak response of brittle rocks involves abrupt micro-fracturing, leading to brittle macro-scale behaviour. Controlling the fracture process using the Advanced Universal Snap-Back Indirect Tensile test (AUSBIT) allowed the acquisition of the complete macro-scale class-II behaviour in the post-peak regime, facilitating the use of advanced techniques for insights into both micro and macro-scale fracture. In this study, the AUSBIT tests with digital image correlation (DIC) and acoustic emission (AE) instrumentation were conducted to analyse the progressive failure in Calca granite and Gosford sandstone specimens. Post-test observations of the fracture surfaces were performed using a scanning electron microscope (SEM). From a macroscale viewpoint, the lateral strain control in AUSBIT enabled controlled cracking with significant lateral strain extension prior to failure accompanied by gradual energy dissipation and higher rates of AE activity as smaller magnitudes of energy are being released by each AE hit or microcrack compared to conventional Brazilian tests. The stable microcrack propagation was also identified from SEM observations with more uniform profiles of microcracks and less debris observed in AUSBIT specimens. These findings were more significant in Calca granite, which verified its extreme class-II behaviour while also demonstrating the efficiency of AUSBIT in controlling the violent failure of high-strength brittle rocks commonly encountered in deep mining projects, leading to the acquisition of more accurate material behaviour in terms of micro and macro-scale post-peak features which was unattainable from conventional indirect tensile tests.

The effects of brown rice as functional food on Lee Index, adipose tissues and PRDM16 levels in obesity model &lt;i&gt;Rattus norvegicus&lt;/i&gt;

Brown rice is a functional food known to improve the Lee Index, influencing PRDM16 levels in obesity conditions. Therefore, this study aims to determine the differences in Lee Index, Brown Adipose Tissue (BAT) weight, White Adipose Tissue (WAT) weight, BeAT weight, total body fat, and PRDM16 levels of obese model rats with the intervention of brown and white rice, as well as ℽ-oryzanol. A true experimental method was used with a post-test-only control group in vivo design. The obesity model was constructed with male Sprague Dawley rats (Rattus norvegicus), divided into five diet groups namely standard and HFHF diet control, as well as HFHF + brown rice, HFHF + white rice, and HFHF + ℽ-oryzanol combination diet. The experiment was carried out for 26 weeks, with details of 14 weeks to form an obese model and 12 weeks for the intervention. Before statistical correlation was tested, Lee index values, adipose tissues, and PRDM16 were analyzed. The anthropometric data collection method was carried out by weighing before and after the intervention, while adipose tissue was collected by weighing after sacrifice. The immunofluorescence method was used to collect the expression of PRDM16 and the mean of PRDM16 levels was analyzed in the ImageJ application. After the data collection process, analysis was performed using SPSS to determine possible differences in each group. Normally distributed data were analyzed using One-Way ANOVA, while those without normal distribution were assessed using the Kruskall-Walis method and the Mann Whitney-U advanced test, with a p-value of &lt;0.05 considered significantly different.The result showed that there were differences among several groups regarding total body fat (p=0.012), WAT (p=0.026), and BAT (p=0.025). However, no differences were found between all groups regarding the Lee index (p=0.275), BeAT (p=0.079), and PRDM16 level (p=0.292). In conclusion, brown rice intervention did not significantly affect Lee index values, the expression of PRDM16, and adipose tissue weights at the end of the intervention.

Optimized biomarker evaluation and molecular testing in the era of breast cancer precision medicine

ABSTRACT Ground breaking advances in medicine, driven in part by major technologic developments in molecular biology have led us to a new model for cancer care that has been termed personalized, or precision medicine. Precision medicine is a model for making medical decisions that employs an innovative clinical approach and advanced tumor testing methods that are tailored to understanding an individual patient’s tumor biology and the molecular drivers of their disease. This medical model includes a combination of diagnostic testing and specific treatment options that can be offered to patients at presentation and in theory throughout the course of their disease as new mutations arise with the development of disease recurrence. Although the precision medicine model offers incredible potential to transform cancer care, these advances are only meaningful when they reach the correct patients. The evolving paradigm of precision medicine is changing the practice of pathology, and the pathology community needs to be mindful of these changes because every tissue specimen represents a patient’s life, and those patients are depending on the pathology community to handle their tissue correctly. The diagnostic tests performed in the pathology laboratory for precision medicine are increasingly complex, and pathologists along with the entire laboratory and clinical communities need to take steps to ensure that the right diagnosis is given to the right patient to inform the right treatment options, at the right time, along every step of the continuum of care for cancer patients. While hormone receptors and human epidermal growth factor receptor 2 (HER2) overexpression and/or amplification have been the mainstay for risk-stratification, and treatment decision making in breast cancer since the early 2000’s, the seminal work on gene expression by Perou and colleagues in the early 2000’s opened the door for molecular testing in the prognostic and predictive assessment of breast cancer. Molecular testing is now part of the standard of care in the precision medicine model for breast cancer care. In this article, the reader will gain a better understanding of how the lack of standardization of pre-analytic factors has the potential to negatively impact the quality of the tissue specimen for downstream biomarker and molecular testing, which ultimately can negatively affect patient care. The reader will also gain insight into the current climate surrounding molecular testing in breast cancer.