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REC E ~ EIV Eastern Health - source: Pam Elliott Volume 9 Page 031 CIHRT Exhibit P-3695 Page 1 / .._r. . .-- ---- ...... . : I. ) I IT [: ( :. . /. -r""' .. ~ t 11 C a 1~e .__ -- -- ------- Hea 1 ' . . . .- --' Corp or ation of St. [ohn's DE C3 0 2 0 05 Dr. Robert Williams Vi ce President, Medical Services , i ; I i I \ \ . ' ---- _. _ .... - ... . Tel: (709) 777-1308 Fax: (709) 778-6307

Mo ~ ~ ~oay ular c e ~ N CIHRT Exhibit P-3695 Page 2 M o '"' O I l & 0\ '"' § ;g D i a g n o s t i c s i n B r e a s t Patho ) + e !OMJTl !WTr u'lW' .,. ·.. ; S ' · " 1 ' · . . . ' r _ , ' . h-'- Y i ' " ' ; " " m ,...... . . . , ;;';:"" , ' ' 0:...: . __ •.._ s '--. , . _ ..• _::... .• / i Anthony M. Magliocco MD FRCPC / ! Associate Professor of Oncology, Pathology and ! Laboratory Medicine University - o f Calgary ] U o f T Pathology Update Course November 2005 @ E & '"' ~ o ' " , . s 0 ; '"' - : : r : : <:: '"' t'i J3

.~ . ~ ~ ~ ..;,-,.: ~ "'. CIHRT Exhibit P-3695 Page 3 M o 0- " a ::: '3 ER Immuno .-p:;.-' r - ..,... r~ ii " . ~ • .. ,' .•. . _.~_ i_ •• ... """,-~ , ; , : 1l As many as 20 % fa lse negatives " Of positives, 50% fai l treatment These tests a re probablhstlcl!l 'ffi Not Abso l ute Ei3 a § ::: o "' o ;: "'@ " ::r: E * .s

T " ' = "' ~ .K: . ~ : - "' l" . = C~ " " W ' 7' i ;: ~ ~ ~ · .~ · ~. ~ , ~ . ~ , ;: , _, _ . . ~ .,. ' CIHRT Exhibit P-3695 Page 4 M o 0) 01) 0\ 0) a =' '3 m Contro ll ing Immune 'Z , i variables Tissue acquistion (labeling ) , Tissue fi xation and processing m Antigen Retrie val rn Decl oaker Antibod y Clone Detection Method ra a Interpretation 0) ~ o '" , .£ til ::1! E 0) to '" [..L.l

~ ~ ~ ~ .~ -:; ,...;; _ ~ . ~ ~ ~ Of) CIHRT Exhibit P-3695 Page 5 M o 0- " a ::: '3 Co rrr olh nq Immuno __ ~, .~ •• ~ •. • •• ~ ... ~~ • ••• \ ~ . .. _, . _ •• .•• ;;. _ , .: .. '_' 0 EJ There are probably 50 steps in immuno! Control the control lable External and Internal contro ls - selection of contro l also critical - use physiologica l L!] Need to periodically re-titrate Abs Ei3 a § ::: o "' o ;: "'@ " ::r: E * .s

_. ~ .~ . ~ ~ ~ 'D CIHRT Exhibit P-3695 Page 6 M o 0) 01) 0\ JI Controlling Irnrnu no ::= ::w. ;.:- ....:. .;;,o:.. ,,::. .; ..:', .• . . ;_ . .". :.-;,j Identify critical values (ie 0 in ER) where a treatment may be denied , May need to repeat as or 'use 2 nd clone? - Participate in QA program - . Recognize that tests give a probability not a certaintv!l ra a 0) ~ o '" , .£ til ::1! E 0) to '" [..L.l