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RAS testing of colorectal carcinoma—a guidance document from the Association of Clinical Pathologists Molecular Pathology and Diagnostics Group
  1. Newton ACS Wong1,
  2. David Gonzalez2,
  3. Manuel Salto-Tellez3,
  4. Rachel Butler4,
  5. Salvador J Diaz-Cano5,
  6. Mohammad Ilyas6,
  7. William Newman7,
  8. Emily Shaw8,
  9. Philippe Taniere9,
  10. Shaun V Walsh10
  1. 1Consultant Histopathologist, Bristol Royal Infirmary, Bristol, UK
  2. 2Consultant Clinical Scientist, The Centre for Molecular Pathology, The Royal Marsden NHS Foundation Trust, London, UK
  3. 3Chair of Molecular Pathology & Consultant, Northern Ireland—Molecular Pathology Laboratory, Queen's University Belfast, UK
  4. 4Consultant Clinical Scientist, University Hospital of Wales, Cardiff, UK
  5. 5Reader in Cellular and Molecular Pathology, King's College Hospital, London, UK
  6. 6Professor of Pathology, School of Molecular Medical Sciences, Division of Pathology, Queen's Medical Centre, Nottingham, UK
  7. 7Professor of Translational Genomic Medicine, Manchester Centre for Genomic Medicine, St Mary's Hospital, University of Manchester, UK
  8. 8Specialty Registrar, Salisbury NHS Foundation Trust and Cancer Research UK, London, UK
  9. 9Consultant Histopathologist, Queen Elizabeth Hospital, Birmingham, UK
  10. 10Consultant Histopathologist, Ninewells Hospital, Dundee, UK
  1. Correspondence to Dr Newton ACS Wong, Department of Histopathology, Bristol Royal Infirmary, Marlborough Street, Bristol, UK BS2 8HW; nacs.wong{at}


Analysis of colorectal carcinoma (CRC) tissue for KRAS codon 12 or 13 mutations to guide use of anti-epidermal growth factor receptor (EGFR) therapy is now considered mandatory in the UK. The scope of this practice has been recently extended because of data indicating that NRAS mutations and additional KRAS mutations also predict for poor response to anti-EGFR therapy. The following document provides guidance on RAS (i.e., KRAS and NRAS) testing of CRC tissue in the setting of personalised medicine within the UK and particularly within the NHS. This guidance covers issues related to case selection, preanalytical aspects, analysis and interpretation of such RAS testing.


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