Thresholding of the proliferation module presumably reflects the prognostic importance of the modules as measured in the training set of RS.9 Our earlier analysis of the effect of thresholding on prognostic estimates with the RS showed the proliferation module being more informative when thresholding was applied.22 Practitioners should therefore not be surprised if a high RS tumor is associated with low proliferation as reflected, for example, by immunohistochemistry for protein encoded by the MKI67 gene or low grade as reported here. This evidence concerns the gene MKI67 and neoplasm.