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Zwager MC, Yu S, Buikema HJ, de Bock GH, Ramsing TW, Thagaard J, Koopman T, van der Vegt B. Advancing Ki67 hotspot detection in breast cancer: a comparative analysis of automated digital image analysis algorithms. Histopathology 2024. [PMID: 39104219 DOI: 10.1111/his.15294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/25/2024] [Accepted: 07/20/2024] [Indexed: 08/07/2024]
Abstract
AIM Manual detection and scoring of Ki67 hotspots is difficult and prone to variability, limiting its clinical utility. Automated hotspot detection and scoring by digital image analysis (DIA) could improve the assessment of the Ki67 hotspot proliferation index (PI). This study compared the clinical performance of Ki67 hotspot detection and scoring DIA algorithms based on virtual dual staining (VDS) and deep learning (DL) with manual Ki67 hotspot PI assessment. METHODS Tissue sections of 135 consecutive invasive breast carcinomas were immunohistochemically stained for Ki67. Two DIA algorithms, based on VDS and DL, automatically determined the Ki67 hotspot PI. For manual assessment; two independent observers detected hotspots and calculated scores using a validated scoring protocol. RESULTS Automated hotspot detection and assessment by VDS and DL could be performed in 73% and 100% of the cases, respectively. Automated hotspot detection by VDS and DL led to higher Ki67 hotspot PIs (mean 39.6% and 38.3%, respectively) compared to manual consensus Ki67 PIs (mean 28.8%). Comparing manual consensus Ki67 PIs with VDS Ki67 PIs revealed substantial correlation (r = 0.90), while manual consensus versus DL Ki67 PIs demonstrated high correlation (r = 0.95). CONCLUSION Automated Ki67 hotspot detection and analysis correlated strongly with manual Ki67 assessment and provided higher PIs compared to manual assessment. The DL-based algorithm outperformed the VDS-based algorithm in clinical applicability, because it did not depend on virtual alignment of slides and correlated stronger with manual scores. Use of a DL-based algorithm may allow clearer Ki67 PI cutoff values, thereby improving the clinical usability of Ki67.
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Affiliation(s)
- Mieke C Zwager
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Shibo Yu
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk J Buikema
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Timco Koopman
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Pathologie Friesland, Leeuwarden, The Netherlands
| | - Bert van der Vegt
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Sarf EA, Dyachenko EI, Bel’skaya LV. The Role of Salivary Vascular Endothelial Growth Factor A, Cytokines, and Amino Acids in Immunomodulation and Angiogenesis in Breast Cancer. Biomedicines 2024; 12:1329. [PMID: 38927536 PMCID: PMC11201966 DOI: 10.3390/biomedicines12061329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
In this work, we focused on the analysis of VEGF content in saliva and its relationship with pro-inflammatory cytokines and amino acids involved in immunomodulation and angiogenesis in breast cancer. The study included 230 breast cancer patients, 92 patients with benign breast disease, and 59 healthy controls. Before treatment, saliva samples were obtained from all participants, and the content of VEGF and cytokines in saliva was determined by an enzyme-linked immunosorbent assay, as well as the content of amino acids by high-performance liquid chromatography. It was found that VEGF was positively correlated with the level of pro-inflammatory cytokines IL-1β (r = 0.6367), IL-6 (r = 0.3813), IL-8 (r = 0.4370), and IL-18 (r = 0.4184). Weak correlations were shown for MCP-1 (r = 0.2663) and TNF-α (r = 0.2817). For the first time, we demonstrated changes in the concentration of VEGF and related cytokines in saliva in different molecular biological subtypes of breast cancer depending on the stage of the disease, differentiation, proliferation, and metastasis to the lymph nodes. A correlation was established between the expression of VEGF and the content of aspartic acid (r = -0.3050), citrulline (r = -0.2914), and tryptophan (r = 0.3382) in saliva. It has been suggested that aspartic acid and citrulline influence the expression of VEGF via the synthesis of the signaling molecule NO, and then tryptophan ensures tolerance of the immune system to tumor cells.
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Affiliation(s)
| | | | - Lyudmila V. Bel’skaya
- Biochemistry Research Laboratory, Omsk State Pedagogical University, 14, Tukhachevsky Str., 644099 Omsk, Russia; (E.A.S.); (E.I.D.)
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Bel’skaya LV, Sarf EA, Solomatin DV. Free Salivary Amino Acid Profile in Breast Cancer: Clinicopathological and Molecular Biological Features. Curr Issues Mol Biol 2024; 46:5614-5631. [PMID: 38921007 PMCID: PMC11202888 DOI: 10.3390/cimb46060336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
The study of salivary amino acid profiles has attracted the attention of researchers, since amino acids are actively involved in most metabolic processes, including breast cancer. In this study, we analyzed the amino acid profile of saliva in a sample including all molecular biological subtypes of breast cancer to obtain a more complete picture and evaluate the potential utility of individual amino acids or their combinations for diagnostic purposes. This study included 116 patients with breast cancer, 24 patients with benign breast disease, and 25 healthy controls. From all patients, strictly before the start of treatment, saliva samples were collected, and the quantitative content of 26 amino acids was determined. Statistically significant differences between the three groups are shown in the content of Asp, Gly, Leu + Ile, Orn, Phe, Pro, Thr, and Tyr. To differentiate the three groups from each other, a decision tree was built. To construct it, we selected those amino acids for which the change in concentrations in the subgroups was multidirectional (GABA, Hyl, Arg, His, Pro, and Car). For the first time, it is shown that the amino acid profile of saliva depends on the molecular biological subtype of breast cancer. The most significant differences are shown for the luminal B HER2-positive and TNBC subgroups. In our opinion, it is critically important to consider the molecular biological subtype of breast cancer when searching for potential diagnostic markers.
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Affiliation(s)
- Lyudmila V. Bel’skaya
- Biochemistry Research Laboratory, Omsk State Pedagogical University, 644099 Omsk, Russia;
| | - Elena A. Sarf
- Biochemistry Research Laboratory, Omsk State Pedagogical University, 644099 Omsk, Russia;
| | - Denis V. Solomatin
- Department of Mathematics and Mathematics Teaching Methods, Omsk State Pedagogical University, 644099 Omsk, Russia;
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4
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Yücel Z, Akal F, Oltulu P. Automated AI-based grading of neuroendocrine tumors using Ki-67 proliferation index: comparative evaluation and performance analysis. Med Biol Eng Comput 2024; 62:1899-1909. [PMID: 38409645 DOI: 10.1007/s11517-024-03045-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/03/2024] [Indexed: 02/28/2024]
Abstract
Early detection is critical for successfully diagnosing cancer, and timely analysis of diagnostic tests is increasingly important. In the context of neuroendocrine tumors, the Ki-67 proliferation index serves as a fundamental biomarker, aiding pathologists in grading and diagnosing these tumors based on histopathological images. The appropriate treatment plan for the patient is determined based on the tumor grade. An artificial intelligence-based method is proposed to aid pathologists in the automated calculation and grading of the Ki-67 proliferation index. The proposed system first performs preprocessing to enhance image quality. Then, segmentation process is performed using the U-Net architecture, which is a deep learning algorithm, to separate the nuclei from the background. The identified nuclei are then evaluated as Ki-67 positive or negative based on basic color space information and other features. The Ki-67 proliferation index is then calculated, and the neuroendocrine tumor is graded accordingly. The proposed system's performance was evaluated on a dataset obtained from the Department of Pathology at Meram Faculty of Medicine Hospital, Necmettin Erbakan University. The results of the pathologist and the proposed system were compared, and the proposed system was found to have an accuracy of 95% in tumor grading when compared to the pathologist's report.
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Affiliation(s)
- Zehra Yücel
- Necmettin Erbakan University, Department of Computer Technologies, Konya, Turkey.
- Hacettepe University, Graduate School of Science and Engineering, Ankara, Turkey.
| | - Fuat Akal
- Hacettepe University, Faculty of Engineering, Department of Computer Engineering, Ankara, Turkey
| | - Pembe Oltulu
- Necmettin Erbakan University, Faculty of Medicine, Department of Pathology, Konya, Turkey
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5
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Sarf EA, Dyachenko EI, Bel’skaya LV. Salivary Tryptophan as a Metabolic Marker of HER2-Negative Molecular Subtypes of Breast Cancer. Metabolites 2024; 14:247. [PMID: 38786723 PMCID: PMC11123106 DOI: 10.3390/metabo14050247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Changes in the concentration of tryptophan (Trp) indicate a serious metabolic restructuring, which is both a cause and a consequence of many diseases. This work examines the upward change in salivary Trp concentrations among patients with breast cancer. This study involved volunteers divided into three groups: breast cancer (n = 104), non-malignant breast pathologies (n = 30) and healthy controls (n = 20). In all participants, before treatment, the quantitative content of Trp in saliva was determined by capillary electrophoresis. In 20 patients with breast cancer, Trp was re-tested four weeks after surgical removal of the tumor. An increase in the Trp content in saliva in breast cancer has been shown, which statistically significantly decreases after surgical removal of the tumor. A direct correlation was found between increased Trp levels with the degree of malignancy and aggressive molecular subtypes of breast cancer, namely triple negative and luminal B-like HER2-negative. These conclusions were based on an increase in Ki-67 and an increase in Trp in HER2-negative and progesterone-negative subtypes. Factors under which an increase in Trp concentration in saliva was observed were identified: advanced stage of breast cancer, the presence of regional metastasis, low tumor differentiation, a lack of expression of HER2, estrogen and progesterone receptors and the high proliferative activity of the tumor. Thus, the determination of salivary Trp may be a valuable tool in the study of metabolic changes associated with cancer, particularly breast cancer.
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Affiliation(s)
| | | | - Lyudmila V. Bel’skaya
- Biochemistry Research Laboratory, Omsk State Pedagogical University, 644099 Omsk, Russia; (E.A.S.); (E.I.D.)
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6
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Ma Q, Liu YB, She T, Liu XL. The Role of Ki-67 in HR+/HER2- Breast Cancer: A Real-World Study of 956 Patients. BREAST CANCER (DOVE MEDICAL PRESS) 2024; 16:117-126. [PMID: 38476641 PMCID: PMC10929654 DOI: 10.2147/bctt.s451617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
Objective This study determined the cut-off value of Ki-67 expression and discussed the interaction between Ki-67 and histological grade, further explored the prognostic role of Ki-67 in hormone receptor-positive and human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer;. Materials and Methods We assessed the Ki-67 expression of 956 patients with HR+/HER2 breast cancer diagnosed in the General Hospital of Ningxia Medical University from 2015 to 2019 by immunohistochemistry (IHC), The disease-free survival (DFS) was defined as the time from postoperative to the first local recurrence, distant metastasis or death of the disease. The follow-up by means of inpatient or outpatient medical records and telephone. Results 22.5% was used as the cut-off for low/high Ki-67 expression in HR+/HER2- breast cancer. Compared with the value of 14%, which is commonly used in clinic at present, the consistency of the two values is moderate (Kappa = 0.484, P<0.001). The expression of Ki-67 was increased with the grade. (Median: G1:10%; G2:20%; G3:40%. Mean: G1:13%; G2:23%; G3:39%, P <0.001). Survival analysis was based on all patients for a median of 51 months (24-89 months), 63 cases had recurrence or metastasis during the follow-up, which 21 cases had low expression of Ki-67 and 42 cases had high expression. The patients with Ki-67 ≥ 22.5% had a 2.969 higher risk of early recurrence and metastasis than the patients with Ki-67 < 22.5%. There were 4 cases of local recurrence, 7 cases of regional lymph node metastasis, and 52 cases of distant metastasis in all patients, the common distant metastases were bone, liver, and lung, and rare metastases were adrenal gland, bone marrow, and pericardium. Conclusion In HR+/HER2- breast cancer, patients with Ki-67 > 22.5% have a worse prognosis and are more likely to have early recurrence and metastasis.
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Affiliation(s)
- Qin Ma
- Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, People’s Republic of China
| | - Yao-Bang Liu
- Department of Surgical Oncology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, People’s Republic of China
| | - Tong She
- Hospital of Zhongwei, Zhongwei, People’s Republic of China
| | - Xin-Lan Liu
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, People’s Republic of China
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Zilenaite-Petrulaitiene D, Rasmusson A, Besusparis J, Valkiuniene RB, Augulis R, Laurinaviciene A, Plancoulaine B, Petkevicius L, Laurinavicius A. Intratumoral heterogeneity of Ki67 proliferation index outperforms conventional immunohistochemistry prognostic factors in estrogen receptor-positive HER2-negative breast cancer. Virchows Arch 2024:10.1007/s00428-024-03737-4. [PMID: 38217716 DOI: 10.1007/s00428-024-03737-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
In breast cancer (BC), pathologists visually score ER, PR, HER2, and Ki67 biomarkers to assess tumor properties and predict patient outcomes. This does not systematically account for intratumoral heterogeneity (ITH) which has been reported to provide prognostic value. This study utilized digital image analysis (DIA) and computational pathology methods to investigate the prognostic value of ITH indicators in ER-positive (ER+) HER2-negative (HER2-) BC patients. Whole slide images (WSIs) of surgically excised specimens stained for ER, PR, Ki67, and HER2 from 254 patients were used. DIA with tumor tissue segmentation and detection of biomarker-positive cells was performed. The DIA-generated data were subsampled by a hexagonal grid to compute Haralick's texture indicators for ER, PR, and Ki67. Cox regression analyses were performed to assess the prognostic significance of the immunohistochemistry (IHC) and ITH indicators in the context of clinicopathologic variables. In multivariable analysis, the ITH of Ki67-positive cells, measured by Haralick's texture entropy, emerged as an independent predictor of worse BC-specific survival (BCSS) (hazard ratio (HR) = 2.64, p-value = 0.0049), along with lymph node involvement (HR = 2.26, p-value = 0.0195). Remarkably, the entropy representing the spatial disarrangement of tumor proliferation outperformed the proliferation rate per se established either by pathology reports or DIA. We conclude that the Ki67 entropy indicator enables a more comprehensive risk assessment with regard to BCSS, especially in cases with borderline Ki67 proliferation rates. The study further demonstrates the benefits of high-capacity DIA-generated data for quantifying the essentially subvisual ITH properties.
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Affiliation(s)
- Dovile Zilenaite-Petrulaitiene
- Institute of Informatics, Faculty of Mathematics and Informatics, Vilnius University, Naugarduko Str. 24, 03225, Vilnius, Lithuania.
- Department of Pathology and Forensic Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101, Vilnius, Lithuania.
- National Centre of Pathology, affiliate of Vilnius University Hospital Santaros Klinikos, P. Baublio Str. 5, 08406, Vilnius, Lithuania.
| | - Allan Rasmusson
- Department of Pathology and Forensic Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101, Vilnius, Lithuania
- National Centre of Pathology, affiliate of Vilnius University Hospital Santaros Klinikos, P. Baublio Str. 5, 08406, Vilnius, Lithuania
| | - Justinas Besusparis
- Department of Pathology and Forensic Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101, Vilnius, Lithuania
- National Centre of Pathology, affiliate of Vilnius University Hospital Santaros Klinikos, P. Baublio Str. 5, 08406, Vilnius, Lithuania
| | - Ruta Barbora Valkiuniene
- Department of Pathology and Forensic Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101, Vilnius, Lithuania
- National Centre of Pathology, affiliate of Vilnius University Hospital Santaros Klinikos, P. Baublio Str. 5, 08406, Vilnius, Lithuania
| | - Renaldas Augulis
- Department of Pathology and Forensic Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101, Vilnius, Lithuania
- National Centre of Pathology, affiliate of Vilnius University Hospital Santaros Klinikos, P. Baublio Str. 5, 08406, Vilnius, Lithuania
| | - Aida Laurinaviciene
- Department of Pathology and Forensic Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101, Vilnius, Lithuania
- National Centre of Pathology, affiliate of Vilnius University Hospital Santaros Klinikos, P. Baublio Str. 5, 08406, Vilnius, Lithuania
| | - Benoit Plancoulaine
- Department of Pathology and Forensic Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101, Vilnius, Lithuania
- Path-Image/BioTiCla, University of Caen Normandy, François Baclesse Comprehensive Cancer Center, 3 Av. du Général Harris, 14000, Caen, France
| | - Linas Petkevicius
- Institute of Informatics, Faculty of Mathematics and Informatics, Vilnius University, Naugarduko Str. 24, 03225, Vilnius, Lithuania
| | - Arvydas Laurinavicius
- Department of Pathology and Forensic Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101, Vilnius, Lithuania
- National Centre of Pathology, affiliate of Vilnius University Hospital Santaros Klinikos, P. Baublio Str. 5, 08406, Vilnius, Lithuania
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Sathyamoorthy H, Mahmood H, Zubir AZA, Hankinson P, Khurram SA. Prognostic importance of mitosis quantification and PHH3 expression in oral epithelial dysplasia. Virchows Arch 2024; 484:47-59. [PMID: 37882821 PMCID: PMC10791886 DOI: 10.1007/s00428-023-03668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
Oral epithelial dysplasia (OED) is diagnosed and graded using a range of histological features, making grading subjective and challenging. Mitotic counting and phosphohistone-H3 (PHH3) staining have been used for the prognostication of various malignancies; however, their importance in OED remains unexplored. This study conducts a quantitative analysis of mitotic activity in OED using both haematoxylin and eosin (H&E)-stained slides and immunohistochemical (IHC) staining for PHH3. Specifically, the diagnostic and prognostic importance of mitotic number, mitotic type and intra-epithelial location is evaluated. Whole slide images (WSI) of OED (n = 60) and non-dysplastic tissue (n = 8) were prepared for analysis. Five-year follow-up data was collected. The total number of mitosis (TNOM), mitosis type and intra-epithelial location was manually evaluated on H&E images and a digital mitotic count performed on PHH3-stained WSI. Statistical associations between these features and OED grade, malignant transformation and OED recurrence were determined. Mitosis count increased with grade severity (H&E: p < 0.005; IHC: p < 0.05), and grade-based differences were seen for mitosis type and location (p < 0.05). The ratio of normal-to-abnormal mitoses was higher in OED (1.61) than control (1.25) and reduced with grade severity. TNOM, type and location were better predictors when combined with histological grading, with the most prognostic models demonstrating an AUROC of 0.81 for transformation and 0.78 for recurrence, exceeding conventional grading. Mitosis quantification and PHH3 staining can be an adjunct to conventional H&E assessment and grading for the prediction of OED prognosis. Validation on larger multicentre cohorts is needed to establish these findings.
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Affiliation(s)
- Hrishikesh Sathyamoorthy
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK
| | - Hanya Mahmood
- Academic Unit of Oral & Maxillofacial Surgery, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK
| | - Amir Zaki Abdullah Zubir
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK
| | - Paul Hankinson
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK
| | - Syed Ali Khurram
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK.
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Lu W, Lashen AG, Wahab N, Miligy IM, Jahanifar M, Toss M, Graham S, Bilal M, Bhalerao A, Atallah NM, Makhlouf S, Ibrahim AY, Snead D, Minhas F, Raza SEA, Rakha E, Rajpoot N. AI-based intra-tumor heterogeneity score of Ki67 expression as a prognostic marker for early-stage ER+/HER2- breast cancer. J Pathol Clin Res 2024; 10:e346. [PMID: 37873865 PMCID: PMC10766021 DOI: 10.1002/cjp2.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/11/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023]
Abstract
Early-stage estrogen receptor positive and human epidermal growth factor receptor negative (ER+/HER2-) luminal breast cancer (BC) is quite heterogeneous and accounts for about 70% of all BCs. Ki67 is a proliferation marker that has a significant prognostic value in luminal BC despite the challenges in its assessment. There is increasing evidence that spatial colocalization, which measures the evenness of different types of cells, is clinically important in several types of cancer. However, reproducible quantification of intra-tumor spatial heterogeneity remains largely unexplored. We propose an automated pipeline for prognostication of luminal BC based on the analysis of spatial distribution of Ki67 expression in tumor cells using a large well-characterized cohort (n = 2,081). The proposed Ki67 colocalization (Ki67CL) score can stratify ER+/HER2- BC patients with high significance in terms of BC-specific survival (p < 0.00001) and distant metastasis-free survival (p = 0.0048). Ki67CL score is shown to be highly significant compared with the standard Ki67 index. In addition, we show that the proposed Ki67CL score can help identify luminal BC patients who can potentially benefit from adjuvant chemotherapy.
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Affiliation(s)
- Wenqi Lu
- Tissue Image Analytics (TIA) Centre, Department of Computer ScienceUniversity of WarwickCoventryUK
| | - Ayat G Lashen
- Academic Unit for Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK
- Department of Pathology, Faculty of MedicineMenoufia UniversityMenoufiaEgypt
| | - Noorul Wahab
- Tissue Image Analytics (TIA) Centre, Department of Computer ScienceUniversity of WarwickCoventryUK
| | - Islam M Miligy
- Academic Unit for Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK
- Department of Pathology, Faculty of MedicineMenoufia UniversityMenoufiaEgypt
| | - Mostafa Jahanifar
- Tissue Image Analytics (TIA) Centre, Department of Computer ScienceUniversity of WarwickCoventryUK
| | - Michael Toss
- Academic Unit for Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK
| | - Simon Graham
- Tissue Image Analytics (TIA) Centre, Department of Computer ScienceUniversity of WarwickCoventryUK
| | - Mohsin Bilal
- Tissue Image Analytics (TIA) Centre, Department of Computer ScienceUniversity of WarwickCoventryUK
| | - Abhir Bhalerao
- Tissue Image Analytics (TIA) Centre, Department of Computer ScienceUniversity of WarwickCoventryUK
| | - Nehal M Atallah
- Academic Unit for Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK
| | - Shorouk Makhlouf
- Academic Unit for Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK
| | - Asmaa Y Ibrahim
- Academic Unit for Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK
| | - David Snead
- Department of PathologyUniversity Hospitals Coventry and Warwickshire NHS TrustCoventryUK
| | - Fayyaz Minhas
- Tissue Image Analytics (TIA) Centre, Department of Computer ScienceUniversity of WarwickCoventryUK
| | - Shan E Ahmed Raza
- Tissue Image Analytics (TIA) Centre, Department of Computer ScienceUniversity of WarwickCoventryUK
| | - Emad Rakha
- Academic Unit for Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK
| | - Nasir Rajpoot
- Tissue Image Analytics (TIA) Centre, Department of Computer ScienceUniversity of WarwickCoventryUK
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10
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Cho Y, Lee J, Han B, Yoon SE, Kim SJ, Kim WS, Cho J. Tumor-infiltrating T lymphocytes evaluated using digital image analysis predict the prognosis of patients with diffuse large B-cell lymphoma. J Pathol Transl Med 2024; 58:12-21. [PMID: 38229430 DOI: 10.4132/jptm.2023.11.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/01/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The implication of the presence of tumor-infiltrating T lymphocytes (TIL-T) in diffuse large B-cell lymphoma (DLBCL) is yet to be elucidated. We aimed to investigate the effect of TIL-T levels on the prognosis of patients with DLBCL. METHODS Ninety-six patients with DLBCL were enrolled in the study. The TIL-T ratio was measured using QuPath, a digital pathology software package. The TIL-T ratio was investigated in three foci (highest, intermediate, and lowest) for each case, resulting in TIL-T-Max, TIL-T-Intermediate, and TIL-T-Min. The relationship between the TIL-T ratios and prognosis was investigated. RESULTS When 19% was used as the cutoff value for TIL-T-Max, 72 (75.0%) and 24 (25.0%) patients had high and low TIL-T-Max, respectively. A high TIL-T-Max was significantly associated with lower serum lactate dehydrogenase levels (p < .001), with patient group who achieved complete remission after RCHOP therapy (p < .001), and a low-risk revised International Prognostic Index score (p < .001). Univariate analysis showed that patients with a low TIL-T-Max had a significantly worse prognosis in overall survival compared to those with a high TIL-T-Max (p < .001); this difference remained significant in a multivariate analysis with Cox proportional hazards (hazard ratio, 7.55; 95% confidence interval, 2.54 to 22.42; p < .001). CONCLUSIONS Patients with DLBCL with a high TIL-T-Max showed significantly better prognosis than those with a low TIL-T-Max, and the TIL-T-Max was an independent indicator of overall survival. These results suggest that evaluating TIL-T ratios using a digital pathology system is useful in predicting the prognosis of patients with DLBCL.
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Affiliation(s)
- Yunjoo Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiyeon Lee
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Bogyeong Han
- Department of Pathology, Seoul National University, Seoul National College of Medicine, Seoul, Korea
| | - Sang Eun Yoon
- Division of Hematology and Oncology, Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junhun Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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11
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Zehra T, Jaffar N, Shams M, Chundriger Q, Ahmed A, Anum F, Alsubaie N, Ahmad Z. Use of a Novel Deep Learning Open-Source Model for Quantification of Ki-67 in Breast Cancer Patients in Pakistan: A Comparative Study between the Manual and Automated Methods. Diagnostics (Basel) 2023; 13:3105. [PMID: 37835848 PMCID: PMC10572449 DOI: 10.3390/diagnostics13193105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 10/15/2023] Open
Abstract
Introduction: Breast cancer is the most common cancer in women; its early detection plays a crucial role in improving patient outcomes. Ki-67 is a biomarker commonly used for evaluating the proliferation of cancer cells in breast cancer patients. The quantification of Ki-67 has traditionally been performed by pathologists through a manual examination of tissue samples, which can be time-consuming and subject to inter- and intra-observer variability. In this study, we used a novel deep learning model to quantify Ki-67 in breast cancer in digital images prepared by a microscope-attached camera. Objective: To compare the automated detection of Ki-67 with the manual eyeball/hotspot method. Place and duration of study: This descriptive, cross-sectional study was conducted at the Jinnah Sindh Medical University. Glass slides of diagnosed cases of breast cancer were obtained from the Aga Khan University Hospital after receiving ethical approval. The duration of the study was one month. Methodology: We prepared 140 digital images stained with the Ki-67 antibody using a microscope-attached camera at 10×. An expert pathologist (P1) evaluated the Ki-67 index of the hotspot fields using the eyeball method. The images were uploaded to the DeepLiif software to detect the exact percentage of Ki-67 positive cells. SPSS version 24 was used for data analysis. Diagnostic accuracy was also calculated by other pathologists (P2, P3) and by AI using a Ki-67 cut-off score of 20 and taking P1 as the gold standard. Results: The manual and automated scoring methods showed a strong positive correlation as the kappa coefficient was significant. The p value was <0.001. The highest diagnostic accuracy, i.e., 95%, taking P1 as gold standard, was found for AI, compared to pathologists P2 and P3. Conclusions: Use of quantification-based deep learning models can make the work of pathologists easier and more reproducible. Our study is one of the earliest studies in this field. More studies with larger sample sizes are needed in future to develop a cohort.
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Affiliation(s)
- Talat Zehra
- Department of Pathology, Jinnah Sindh Medical University, Karachi 75001, Pakistan; (T.Z.); (N.J.)
| | - Nazish Jaffar
- Department of Pathology, Jinnah Sindh Medical University, Karachi 75001, Pakistan; (T.Z.); (N.J.)
| | - Mahin Shams
- Department of Pathology, United Medical and Dental College, Karachi 71500, Pakistan;
| | - Qurratulain Chundriger
- Department of Pathology and Laboratory Medicine, Section of Histopathology, Aga Khan University Hospital, Karachi 3500, Pakistan; (Q.C.); (A.A.)
| | - Arsalan Ahmed
- Department of Pathology and Laboratory Medicine, Section of Histopathology, Aga Khan University Hospital, Karachi 3500, Pakistan; (Q.C.); (A.A.)
| | - Fariha Anum
- Research Department, Ziauddin University, Karachi 75600, Pakistan;
| | - Najah Alsubaie
- Department of Computer Sciences, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University (PNU), P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Zubair Ahmad
- Consultant Histopathologist, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Seeb P.O. Box 556, Oman;
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12
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Liu Y, Han D, Parwani AV, Li Z. Applications of Artificial Intelligence in Breast Pathology. Arch Pathol Lab Med 2023; 147:1003-1013. [PMID: 36800539 DOI: 10.5858/arpa.2022-0457-ra] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 02/19/2023]
Abstract
CONTEXT.— Increasing implementation of whole slide imaging together with digital workflow and advances in computing capacity enable the use of artificial intelligence (AI) in pathology, including breast pathology. Breast pathologists often face a significant workload, with diagnosis complexity, tedious repetitive tasks, and semiquantitative evaluation of biomarkers. Recent advances in developing AI algorithms have provided promising approaches to meet the demand in breast pathology. OBJECTIVE.— To provide an updated review of AI in breast pathology. We examined the success and challenges of current and potential AI applications in diagnosing and grading breast carcinomas and other pathologic changes, detecting lymph node metastasis, quantifying breast cancer biomarkers, predicting prognosis and therapy response, and predicting potential molecular changes. DATA SOURCES.— We obtained data and information by searching and reviewing literature on AI in breast pathology from PubMed and based our own experience. CONCLUSIONS.— With the increasing application in breast pathology, AI not only assists in pathology diagnosis to improve accuracy and reduce pathologists' workload, but also provides new information in predicting prognosis and therapy response.
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Affiliation(s)
- Yueping Liu
- From the Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China (Liu, Han)
| | - Dandan Han
- From the Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China (Liu, Han)
| | - Anil V Parwani
- The Department of Pathology, The Ohio State University, Columbus (Parwani, Li)
| | - Zaibo Li
- From the Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China (Liu, Han)
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13
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Stålhammar G, Grossniklaus HE. Overrepresentation of human epidermal growth factor receptor 2 positive- and Luminal B breast cancer metastases in the eyes and orbit. Eye (Lond) 2023; 37:2499-2504. [PMID: 36517577 PMCID: PMC10397265 DOI: 10.1038/s41433-022-02363-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer to spread to the choroid and orbit. Depending on a set of prognostic and predictive biomarkers, breast cancer can be divided into at least four distinct subtypes with separate treatment and clinical course. SUBJECTS Thirty-two patients with metastases to the eye and periocular area diagnosed between 2005 and 2020, of which 11 also had primary tumour tissue available. Expression levels of oestrogen- (ER) and progesterone receptors (PR), Human epidermal growth factor receptor 2 (HER2) and the proliferation marker Ki67 were analysed. RESULTS Twenty-five of 32 patients (78%) had a history of primary breast cancer, whereas the remaining 7 (22%) presented with metastatic disease. Of available metastases, 83% were positive for ER, 37% for PR, 54% for HER2, and 50% for Ki67. Metastases had significantly lower proportions of PR-positive cells than primary tumours, and the distribution of the Luminal A, Luminal B, HER2 enriched and triple-negative subtypes differed between primary tumours and metastases (P = 0.012): Six of 9 patients with a full set of biomarkers on both primary tumours and metastases switched subtype (67%), and 23 of 32 metastases (77%) were of the Luminal B subtype. CONCLUSIONS Nearly 4 in 5 breast cancer metastases in the eyes and orbit are of the Luminal B subtype, and a majority are HER2 positive. The breast cancer subtype frequently switches between primary tumours and metastases. Future studies should evaluate these results in larger cohorts.
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Affiliation(s)
- Gustav Stålhammar
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
- St. Erik Eye Hospital, Stockholm, Sweden.
| | - Hans E Grossniklaus
- Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, GA, USA
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14
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Moscalu M, Moscalu R, Dascălu CG, Țarcă V, Cojocaru E, Costin IM, Țarcă E, Șerban IL. Histopathological Images Analysis and Predictive Modeling Implemented in Digital Pathology-Current Affairs and Perspectives. Diagnostics (Basel) 2023; 13:2379. [PMID: 37510122 PMCID: PMC10378281 DOI: 10.3390/diagnostics13142379] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
In modern clinical practice, digital pathology has an essential role, being a technological necessity for the activity in the pathological anatomy laboratories. The development of information technology has majorly facilitated the management of digital images and their sharing for clinical use; the methods to analyze digital histopathological images, based on artificial intelligence techniques and specific models, quantify the required information with significantly higher consistency and precision compared to that provided by optical microscopy. In parallel, the unprecedented advances in machine learning facilitate, through the synergy of artificial intelligence and digital pathology, the possibility of diagnosis based on image analysis, previously limited only to certain specialties. Therefore, the integration of digital images into the study of pathology, combined with advanced algorithms and computer-assisted diagnostic techniques, extends the boundaries of the pathologist's vision beyond the microscopic image and allows the specialist to use and integrate his knowledge and experience adequately. We conducted a search in PubMed on the topic of digital pathology and its applications, to quantify the current state of knowledge. We found that computer-aided image analysis has a superior potential to identify, extract and quantify features in more detail compared to the human pathologist's evaluating possibilities; it performs tasks that exceed its manual capacity, and can produce new diagnostic algorithms and prediction models applicable in translational research that are able to identify new characteristics of diseases based on changes at the cellular and molecular level.
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Affiliation(s)
- Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Roxana Moscalu
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M139PT, UK
| | - Cristina Gena Dascălu
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Viorel Țarcă
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Ioana Mădălina Costin
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Elena Țarcă
- Department of Surgery II-Pediatric Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Ionela Lăcrămioara Șerban
- Department of Morpho-Functional Sciences II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
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15
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Stålhammar G, Gill VT. Digital morphometry and cluster analysis identifies four types of melanocyte during uveal melanoma progression. COMMUNICATIONS MEDICINE 2023; 3:60. [PMID: 37117276 PMCID: PMC10147908 DOI: 10.1038/s43856-023-00291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/18/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Several types of benign and malignant uveal melanocytes have been described based on their histological appearance. However, their characteristics have not been quantified, and their distribution during progression from normal choroidal melanocytes to primary tumors and metastases has not been reported. METHODS A total of 1,245,411 digitally scanned melanocytes from normal choroid, choroidal nevi, primary uveal melanomas, and liver metastases were entered into two-step cluster analyses to delineate cell types based on measured morphometric characteristics and expression of protein markers. RESULTS Here we show that a combination of the area and circularity of cell nuclei, and BAP-1 expression in nuclei and cytoplasms yields the highest silhouette of cohesion and separation. Normal choroidal melanocytes and three types of uveal melanoma cells are outlined: Epithelioid (large, rounded nuclei; BAP-1 low; IGF-1R, IDO, and TIGIT high), spindle A (small, elongated nuclei; BAP-1 high; IGF-1R low; IDO, and TIGIT intermediate), and spindle B (large, elongated nuclei; BAP-1, IGF-1R, IDO, and TIGIT low). In normal choroidal tissue and nevi, only normal melanocytes and spindle A cells are represented. Epithelioid and spindle B cells are overrepresented in the base and apex, and spindle A cells in the center of primary tumors. Liver metastases contain no normal melanocytes or spindle A cells. CONCLUSIONS Four basic cell types can be outlined in uveal melanoma progression: normal, spindle A and B, and epithelioid. Differential expression of tumor suppressors, growth factors, and immune checkpoints could contribute to their relative over- and underrepresentation in benign, primary tumor, and metastatic samples.
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Affiliation(s)
- Gustav Stålhammar
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden.
- St. Erik Eye Hospital, Stockholm, Sweden.
| | - Viktor Torgny Gill
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology, Vastmanland Hospital, Vasteras, Sweden
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16
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Dey P, Bansal B, Saini T. An emerging era of computational cytology. Diagn Cytopathol 2023; 51:270-275. [PMID: 36633016 DOI: 10.1002/dc.25101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/31/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND The significant advancement in digital imaging, data management, advanced computational power, and artificial neural network have an immense impact on the field of cytology. The amalgamation of these areas has generated a newer discipline known as computational cytology. AIMS AND OBJECTIVE In To discuss the various important aspects of computational cytology. MATERIALS AND METHODS We reviewed the different studies published in English during the last few years on computational cytology. RESULT Computational cytology is a newer and emerging discipline in pathology that deals with the patient's meta-data and digital image data to make a mathematical model to produce diagnostic interpretations and predictions. The role of the cytologist is now changing from a simple observational scientist and slide interpreter to a dynamic and integrated multi-parametric prediction-based scientist. CONCLUSION In the current stage, the cytologist must understand the situation and should have a vision of the complete scenario on computational cytology.
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Affiliation(s)
- Pranab Dey
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Baneet Bansal
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarunpreet Saini
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Lashen A, Toss MS, Green AR, Mongan NP, Rakha E. Ki67 assessment in invasive luminal breast cancer: a comparative study between different scoring methods. Histopathology 2022; 81:786-798. [PMID: 35997652 PMCID: PMC9826086 DOI: 10.1111/his.14781] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Ki67 reflects the proliferation activity in breast cancer (BC). However, an optimal method for its assessment in clinical settings has yet to be robustly defined. In this study we compared several methods to score Ki67 to identify a reliable and reproducible method for routine practice. METHODS Sections from luminal BC cohort (n = 1662) were immunohistochemically stained with Ki67 and were assessed for the percentage, pattern, and intensity of expression. Ki67 positivity was evaluated using three methods: (i) quantification of Ki67-positive cells among 1000 invasive tumour cells within hotspot, (ii) average estimation of Ki67 within a defined hotspot, and (iii) average estimation of Ki67 positivity within the whole section. Time required for scoring, interobserver agreement and association with outcome were determined. RESULTS The mean percentage of Ki67 expression per 1000 cells method was 16%, while the mean value of Ki67 scores using the average estimation within hotspot and whole slide were 14% and 12%, respectively. Quantification of Ki67-positive cells within 1000 cells had the highest degree of consistency between observers, and the highest hazard ratio predicting patient outcome when compared to using different common Ki67 cutoffs, which was independent of the other two methods. Granular pattern of Ki67 expression was associated with poorer outcome as compared to the other patterns. CONCLUSION Assessment of Ki67 expression using quantification positive cells among 1000 tumour cells is an optimal method to achieve high reliability and reproducibility. Comment on the predominant Ki67 expression pattern would add prognostic and predictive value in luminal BC.
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Affiliation(s)
- Ayat Lashen
- Academic Unit for Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK,Department of Pathology, Faculty of MedicineMenoufia UniversityShebin El KomEgypt,Nottingham Breast Cancer Research CentreUniversity of NottinghamNottinghamUK
| | - Michael S Toss
- Academic Unit for Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK,Nottingham Breast Cancer Research CentreUniversity of NottinghamNottinghamUK,Department of HistopathologySheffield Teaching Hospitals NHS Foundation Trust SheffieldUK
| | - Andrew R Green
- Academic Unit for Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK,Nottingham Breast Cancer Research CentreUniversity of NottinghamNottinghamUK
| | - Nigel P Mongan
- School of Veterinary Medicine and SciencesUniversity of NottinghamNottinghamUK,Department of PharmacologyWeill Cornell MedicineNew YorkUSA
| | - Emad Rakha
- Academic Unit for Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK,Department of Pathology, Faculty of MedicineMenoufia UniversityShebin El KomEgypt,Nottingham Breast Cancer Research CentreUniversity of NottinghamNottinghamUK
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18
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Differentiation of Urothelial Carcinoma in Histopathology Images Using Deep Learning and Visualisation. J Pathol Inform 2022; 14:100155. [DOI: 10.1016/j.jpi.2022.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/16/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
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19
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Acs B, Leung SCY, Kidwell KM, Arun I, Augulis R, Badve SS, Bai Y, Bane AL, Bartlett JMS, Bayani J, Bigras G, Blank A, Buikema H, Chang MC, Dietz RL, Dodson A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hartman J, Kos Z, Lænkholm AV, Laurinavicius A, Levenson RM, Mahboubi-Ardakani R, Mastropasqua MG, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Quintayo MA, Rau TT, Reinhard S, Robertson S, Salgado R, Sugie T, van der Vegt B, Viale G, Zabaglo LA, Hayes DF, Dowsett M, Nielsen TO, Rimm DL. Systematically higher Ki67 scores on core biopsy samples compared to corresponding resection specimen in breast cancer: a multi-operator and multi-institutional study. Mod Pathol 2022; 35:1362-1369. [PMID: 35729220 PMCID: PMC9514990 DOI: 10.1038/s41379-022-01104-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 02/06/2023]
Abstract
Ki67 has potential clinical importance in breast cancer but has yet to see broad acceptance due to inter-laboratory variability. Here we tested an open source and calibrated automated digital image analysis (DIA) platform to: (i) investigate the comparability of Ki67 measurement across corresponding core biopsy and resection specimen cases, and (ii) assess section to section differences in Ki67 scoring. Two sets of 60 previously stained slides containing 30 core-cut biopsy and 30 corresponding resection specimens from 30 estrogen receptor-positive breast cancer patients were sent to 17 participating labs for automated assessment of average Ki67 expression. The blocks were centrally cut and immunohistochemically (IHC) stained for Ki67 (MIB-1 antibody). The QuPath platform was used to evaluate tumoral Ki67 expression. Calibration of the DIA method was performed as in published studies. A guideline for building an automated Ki67 scoring algorithm was sent to participating labs. Very high correlation and no systematic error (p = 0.08) was found between consecutive Ki67 IHC sections. Ki67 scores were higher for core biopsy slides compared to paired whole sections from resections (p ≤ 0.001; median difference: 5.31%). The systematic discrepancy between core biopsy and corresponding whole sections was likely due to pre-analytical factors (tissue handling, fixation). Therefore, Ki67 IHC should be tested on core biopsy samples to best reflect the biological status of the tumor.
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Affiliation(s)
- Balazs Acs
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden.
| | | | - Kelley M Kidwell
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Indu Arun
- Tata Medical Center, Kolkata, West Bengal, India
| | - Renaldas Augulis
- Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Sunil S Badve
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yalai Bai
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Anita L Bane
- Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - John M S Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Jane Bayani
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Gilbert Bigras
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Annika Blank
- Institute of Pathology, University of Bern, Bern, Switzerland
- Institute of Pathology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Henk Buikema
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin C Chang
- Department of Pathology & Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Robin L Dietz
- Department of Pathology, Olive View-UCLA Medical Center, Los Angeles, CA, USA
| | - Andrew Dodson
- UK NEQAS for Immunocytochemistry and In-Situ Hybridisation, London, United Kingdom
| | - Susan Fineberg
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cornelia M Focke
- Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany
| | - Dongxia Gao
- University of British Columbia, Vancouver, BC, Canada
| | | | - Carolina Gutierrez
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Johan Hartman
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Zuzana Kos
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne-Vibeke Lænkholm
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Arvydas Laurinavicius
- Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Richard M Levenson
- Department of Medical Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Rustin Mahboubi-Ardakani
- Department of Medical Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Sharon Nofech-Mozes
- University of Toronto Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C Kent Osborne
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Frédérique M Penault-Llorca
- Imagerie Moléculaire et Stratégies Théranostiques, UMR1240, Université Clermont Auvergne, INSERM, Clermont-Ferrand, France
- Service de Pathologie, Centre Jean PERRIN, Clermont-Ferrand, France
| | - Tammy Piper
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom
| | | | - Tilman T Rau
- Institute of Pathology, University of Bern, Bern, Switzerland
- Institute of Pathology, Heinrich Heine University and University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Stefan Reinhard
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Stephanie Robertson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Roberto Salgado
- Department of Pathology, GZA-ZNA, Antwerp, Belgium
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | | | - Bert van der Vegt
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Giuseppe Viale
- European Institute of Oncology, Milan, Italy
- European Institute of Oncology IRCCS, and University of Milan, Milan, Italy
| | - Lila A Zabaglo
- The Institute of Cancer Research, London, United Kingdom
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Mitch Dowsett
- The Institute of Cancer Research, London, United Kingdom
| | | | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
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20
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Staaf J, Häkkinen J, Hegardt C, Saal LH, Kimbung S, Hedenfalk I, Lien T, Sørlie T, Naume B, Russnes H, Marcone R, Ayyanan A, Brisken C, Malterling RR, Asking B, Olofsson H, Lindman H, Bendahl PO, Ehinger A, Larsson C, Loman N, Rydén L, Malmberg M, Borg Å, Vallon-Christersson J. RNA sequencing-based single sample predictors of molecular subtype and risk of recurrence for clinical assessment of early-stage breast cancer. NPJ Breast Cancer 2022; 8:94. [PMID: 35974007 PMCID: PMC9381586 DOI: 10.1038/s41523-022-00465-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
Multigene assays for molecular subtypes and biomarkers can aid management of early invasive breast cancer. Using RNA-sequencing we aimed to develop single-sample predictor (SSP) models for clinical markers, subtypes, and risk of recurrence (ROR). A cohort of 7743 patients was divided into training and test set. We trained SSPs for subtypes and ROR assigned by nearest-centroid (NC) methods and SSPs for biomarkers from histopathology. Classifications were compared with Prosigna in two external cohorts (ABiM, n = 100 and OSLO2-EMIT0, n = 103). Prognostic value was assessed using distant recurrence-free interval. Agreement between SSP and NC for PAM50 (five subtypes) was high (85%, Kappa = 0.78) for Subtype (four subtypes) very high (90%, Kappa = 0.84) and for ROR risk category high (84%, Kappa = 0.75, weighted Kappa = 0.90). Prognostic value was assessed as equivalent and clinically relevant. Agreement with histopathology was very high or high for receptor status, while moderate for Ki67 status and poor for Nottingham histological grade. SSP and Prosigna concordance was high for subtype (OSLO-EMIT0 83%, Kappa = 0.73 and ABiM 80%, Kappa = 0.72) and moderate and high for ROR risk category (68 and 84%, Kappa = 0.50 and 0.70, weighted Kappa = 0.70 and 0.78). Pooled concordance for emulated treatment recommendation dichotomized for chemotherapy was high (85%, Kappa = 0.66). Retrospective evaluation suggested that SSP application could change chemotherapy recommendations for up to 17% of postmenopausal ER+/HER2-/N0 patients with balanced escalation and de-escalation. Results suggest that NC and SSP models are interchangeable on a group-level and nearly so on a patient level and that SSP models can be derived to closely match clinical tests.
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Affiliation(s)
- Johan Staaf
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden.
| | - Jari Häkkinen
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Cecilia Hegardt
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Lao H Saal
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Siker Kimbung
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Tonje Lien
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, POB 4953 Nydalen N-0424, Oslo, Norway
- Department of Pathology, Oslo University Hospital, POB 4953 Nydalen N-0424, Oslo, Norway
| | - Therese Sørlie
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, POB 4953 Nydalen N-0424, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Naume
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, POB 4953 Nydalen N-0424, Oslo, Norway
| | - Hege Russnes
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, POB 4953 Nydalen N-0424, Oslo, Norway
- Department of Pathology, Oslo University Hospital, POB 4953 Nydalen N-0424, Oslo, Norway
| | - Rachel Marcone
- ISREC-Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, CH-1015, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, CH-1005, Lausanne, Switzerland
| | - Ayyakkannu Ayyanan
- ISREC-Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, CH-1015, Lausanne, Switzerland
| | - Cathrin Brisken
- ISREC-Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, CH-1015, Lausanne, Switzerland
| | | | - Bengt Asking
- Department of Surgery, Region Jönköping County, Jönköping, Sweden
| | - Helena Olofsson
- Department of Clinical Pathology, Akademiska Hospital, Uppsala, Sweden
- Department of Pathology, Centre for Clinical Research of Uppsala University, Vastmanland´s Hospital Västerås, Västerås, Sweden
| | - Henrik Lindman
- Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Pär-Ola Bendahl
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Anna Ehinger
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
- Department of Genetics and Pathology, Laboratory Medicine, Region Skåne, Lund, Sweden
| | - Christer Larsson
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Niklas Loman
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Lisa Rydén
- Division of Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Surgery and Gastroenterology, Skåne University Hospital Malmö, Malmö, Sweden
| | - Martin Malmberg
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Åke Borg
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Johan Vallon-Christersson
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden.
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21
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Guo R, Jenkins SM, Johnson BJ, Reed K, Kroneman T, Choby G. Sinonasal Mucosal Melanoma: Role of Tumor Proliferative Indices and Pathological Factors in Survival. Laryngoscope 2022; 132:2350-2358. [PMID: 35661370 DOI: 10.1002/lary.30240] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study is to determine the association of proliferation indices and pathologic biomarkers on overall and recurrence/metastasis-free survival (OS and RMFS) in patients with sinonasal mucosal melanoma (SNMM) and to assess the genetic mutational landscape of SNMM. METHODS This is a retrospective cohort study of 45 SNMM patients without neoadjuvant therapy who underwent surgical therapy with curative intent and had tumor tissue available for histopathologic review, molecular analysis, and genetic mutational assessment. The OS and RMFS were assessed for associations with numerous tumor and patient-related factors. RESULTS Among proliferative indices, higher Ki67 and mitotic rates were associated with worsened OS and RMFS (Ki67: p = 0.0007 and p < 0.0001; mitotic rate: p = 0.005 and p = 0.0009, respectively). The presence of brisk tumor-infiltrating lymphocytes (TILs) was associated with improved RMFS (p = 0.007) and the presence of lymphovascular invasion was associated with worsened OS and RMFS (p = 0.02 and p = 0.04, respectively). Patients with amelanotic tumors were more likely to have higher T-stage (p = 0.046), less likely to have brisk TILs (p = 0.02) and had worsened RMFS (p = 0.03). Patients on immunotherapy with tumor Ki67 < 40% had better 3-year OS compared to those with higher Ki67 index (p = 0.004). Actionable genetic mutations such as BRAF V600E are rare and present in only 1 of 20 patients tested. CONCLUSION In SNMM patients, pathologic and proliferation markers such as Ki67, mitotic rate and brisk TILs are associated with survival and may be considered in future staging systems. Clinical response to immunotherapy appears to correlate with the Ki67 index. Given the distinct genetic profile of SNMM, targeted therapies against the MAPK kinase pathway have limited utility. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah M Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian J Johnson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Katelyn Reed
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Trynda Kroneman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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22
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Skjervold AH, Pettersen HS, Valla M, Opdahl S, Bofin AM. Visual and digital assessment of Ki-67 in breast cancer tissue - a comparison of methods. Diagn Pathol 2022; 17:45. [PMID: 35524221 PMCID: PMC9074355 DOI: 10.1186/s13000-022-01225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background In breast cancer (BC) Ki-67 cut-off levels, counting methods and inter- and intraobserver variation are still unresolved. To reduce inter-laboratory differences, it has been proposed that cut-off levels for Ki-67 should be determined based on the in-house median of 500 counted tumour cell nuclei. Digital image analysis (DIA) has been proposed as a means to standardize assessment of Ki-67 staining in tumour tissue. In this study we compared digital and visual assessment (VA) of Ki-67 protein expression levels in full-face sections from a consecutive series of BCs. The aim was to identify the number of tumour cells necessary to count in order to reflect the growth potential of a given tumour in both methods, as measured by tumour grade, mitotic count and patient outcome. Methods A series of whole sections from 248 invasive carcinomas of no special type were immunohistochemically stained for Ki-67 and then assessed by VA and DIA. Five 100-cell increments were counted in hot spot areas using both VA and DIA. The median numbers of Ki-67 positive tumour cells were used to calculate cut-off levels for Low, Intermediate and High Ki-67 protein expression in both methods. Results We found that the percentage of Ki-67 positive tumour cells was higher in DIA compared to VA (medians after 500 tumour cells counted were 22.3% for VA and 30% for DIA). While the median Ki-67% values remained largely unchanged across the 100-cell increments for VA, median values were highest in the first 1-200 cells counted using DIA. We also found that the DIA100 High group identified the largest proportion of histopathological grade 3 tumours 70/101 (69.3%). Conclusions We show that assessment of Ki-67 in breast tumours using DIA identifies a greater proportion of cases with high Ki-67 levels compared to VA of the same tumours. Furthermore, we show that diagnostic cut-off levels should be calibrated appropriately on the introduction of new methodology.
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Affiliation(s)
- Anette H Skjervold
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Erling Skjalgssons gate 1, Trondheim, Norway.
| | - Henrik Sahlin Pettersen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Erling Skjalgssons gate 1, Trondheim, Norway.,Department of Pathology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marit Valla
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Erling Skjalgssons gate 1, Trondheim, Norway.,Department of Pathology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Signe Opdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna M Bofin
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Erling Skjalgssons gate 1, Trondheim, Norway
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23
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Dependence of the Ki67 Labelling Index of Selected Canine Tumours on Patient Age, Sex and Tumour Size. J Comp Pathol 2022; 193:1-8. [DOI: 10.1016/j.jcpa.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/21/2021] [Accepted: 02/07/2022] [Indexed: 11/20/2022]
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24
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Sandeman K, Blom S, Koponen V, Manninen A, Juhila J, Rannikko A, Ropponen T, Mirtti T. AI Model for Prostate Biopsies Predicts Cancer Survival. Diagnostics (Basel) 2022; 12:diagnostics12051031. [PMID: 35626187 PMCID: PMC9139241 DOI: 10.3390/diagnostics12051031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/12/2022] [Accepted: 04/17/2022] [Indexed: 02/04/2023] Open
Abstract
An artificial intelligence (AI) algorithm for prostate cancer detection and grading was developed for clinical diagnostics on biopsies. The study cohort included 4221 scanned slides from 872 biopsy sessions at the HUS Helsinki University Hospital during 2016–2017 and a subcohort of 126 patients treated by robot-assisted radical prostatectomy (RALP) during 2016–2019. In the validation cohort (n = 391), the model detected cancer with a sensitivity of 98% and specificity of 98% (weighted kappa 0.96 compared with the pathologist’s diagnosis). Algorithm-based detection of the grade area recapitulated the pathologist’s grade group. The area of AI-detected cancer was associated with extra-prostatic extension (G5 OR: 48.52; 95% CI 1.11–8.33), seminal vesicle invasion (cribriform G4 OR: 2.46; 95% CI 0.15–1.7; G5 OR: 5.58; 95% CI 0.45–3.42), and lymph node involvement (cribriform G4 OR: 2.66; 95% CI 0.2–1.8; G5 OR: 4.09; 95% CI 0.22–3). Algorithm-detected grade group 3–5 prostate cancer depicted increased risk for biochemical recurrence compared with grade groups 1–2 (HR: 5.91; 95% CI 1.96–17.83). This study showed that a deep learning model not only can find and grade prostate cancer on biopsies comparably with pathologists but also can predict adverse staging and probability for recurrence after surgical treatment.
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Affiliation(s)
- Kevin Sandeman
- Medicum and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, P.O. Box 63, 00014 Helsinki, Finland; (A.R.); (T.M.)
- Department of Pathology, Division of Laboratory Medicine, Skåne University Hospital, Jan Waldenström Gata 59, 20502 Malmö, Sweden
- Correspondence:
| | - Sami Blom
- Aiforia Technologies Plc., Tukholmankatu 8, 00290 Helsinki, Finland; (S.B.); (V.K.); (A.M.); (J.J.); (T.R.)
| | - Ville Koponen
- Aiforia Technologies Plc., Tukholmankatu 8, 00290 Helsinki, Finland; (S.B.); (V.K.); (A.M.); (J.J.); (T.R.)
| | - Anniina Manninen
- Aiforia Technologies Plc., Tukholmankatu 8, 00290 Helsinki, Finland; (S.B.); (V.K.); (A.M.); (J.J.); (T.R.)
| | - Juuso Juhila
- Aiforia Technologies Plc., Tukholmankatu 8, 00290 Helsinki, Finland; (S.B.); (V.K.); (A.M.); (J.J.); (T.R.)
| | - Antti Rannikko
- Medicum and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, P.O. Box 63, 00014 Helsinki, Finland; (A.R.); (T.M.)
- Department of Urology, Helsinki University Hospital, P.O. Box 340, 00029 Helsinki, Finland
| | - Tuomas Ropponen
- Aiforia Technologies Plc., Tukholmankatu 8, 00290 Helsinki, Finland; (S.B.); (V.K.); (A.M.); (J.J.); (T.R.)
| | - Tuomas Mirtti
- Medicum and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, P.O. Box 63, 00014 Helsinki, Finland; (A.R.); (T.M.)
- Department of Pathology, HUSLAB Laboratory Services, Helsinki University Hospital, P.O. Box 720, 00029 Helsinki, Finland
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25
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Stålhammar G, Yeung A, Mendoza P, Dubovy SR, William Harbour J, Grossniklaus HE. Gain of Chromosome 6p Correlates with Severe Anaplasia, Cellular Hyperchromasia, and Extraocular Spread of Retinoblastoma. OPHTHALMOLOGY SCIENCE 2022; 2:100089. [PMID: 36246172 PMCID: PMC9560556 DOI: 10.1016/j.xops.2021.100089] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/03/2021] [Accepted: 12/03/2021] [Indexed: 06/16/2023]
Abstract
PURPOSE Gain of chromosome 6p has been associated with poor ocular survival in retinoblastoma and histopathologic grading of anaplasia with increased risk of metastatic spread and death. This study examined the correlation between these factors and other chromosomal abnormalities as well as results of whole genome sequencing, digital morphometry, and progression-free survival. DESIGN Retrospective cohort study from 2 United States tertiary referral centers. PARTICIPANTS Forty-two children who had undergone enucleation for retinoblastoma from January 2000 through December 2017. METHODS Status of chromosomes 6p, 1q, 9q, and 16q was evaluated with fluorescence in situ hybridization, the degree of anaplasia and presence of histologic high-risk features were assessed by ocular pathologists, digital morphometry was performed on scanned tumor slides, and whole genome sequencing was performed on a subset of tumors. Progression-free survival was defined as absence of distant or local metastases or tumor growth beyond the cut end of the optic nerve. MAIN OUTCOME MEASURES Correlation between each of chromosomal abnormalities, anaplasia, morphometry and sequencing results, and survival. RESULTS Forty-one of 42 included patients underwent primary enucleation and 1 was treated first with intra-arterial chemotherapy. Seven tumors showed mild anaplasia, 19 showed moderate anaplasia, and 16 showed severe anaplasia. All tumors had gain of 1q, 18 tumors had gain of 6p, 6 tumors had gain of 9q, and 36 tumors had loss of 16q. Tumors with severe anaplasia were significantly more likely to harbor 6p gains than tumors with nonsevere anaplasia (P < 0.001). Further, the hematoxylin staining intensity was significantly greater and that of eosin staining significantly lower in tumors with severe anaplasia (P < 0.05). Neither severe anaplasia (P = 0.10) nor gain of 6p (P = 0.21) correlated with histologic high-risk features, and severe anaplasia did not correlate to RB1, CREBBP, NSD1, or BCOR mutations in a subset of 14 tumors (P > 0.5). Patients with gain of 6p showed significantly shorter progression-free survival (P = 0.03, Wilcoxon test). CONCLUSIONS Gain of chromosome 6p emerges as a strong prognostic biomarker in retinoblastoma because it correlates with severe anaplasia, quantifiable changes in tumor cell staining characteristics, and extraocular spread.
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Affiliation(s)
- Gustav Stålhammar
- Ocular Pathology Service, St. Erik Eye Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Aaron Yeung
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Pia Mendoza
- Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Sander R. Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - J. William Harbour
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Hans E. Grossniklaus
- Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, Georgia
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26
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Dovmark TH, Kvist PH, Mølck AM, Hvid H. Quantitative Assessment of Epithelial Proliferation in Rat Mammary Gland Using Artificial Intelligence Independent of Choice of Proliferation Marker. J Histochem Cytochem 2022; 70:237-250. [PMID: 35057663 PMCID: PMC8832631 DOI: 10.1369/00221554221075327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Epithelial proliferation in the rat mammary gland is recommended in regulatory guidelines as an endpoint for assessment of the in vivo carcinogenic potential of insulin analogues. Epithelial proliferation is traditionally assessed by immunohistochemical staining of a proliferation marker, for example, 5-bromo-2'-deoxyuridine (BrdU) or Ki67, followed by labor-intensive manual counting of positive and negative cells. The aim of this study was to develop and validate an approach for image analysis based on artificial intelligence, which can be used for quantification of proliferation in rat mammary gland, independent of the choice of proliferation marker. Furthermore, the aim was to compare the markers BrdU, Ki67, and phosphorylated histone H3 (PHH3). A sequence of image analysis applications were developed, which allowed for quantification of proliferative activity in the mammary gland epithelium. These endpoints agreed well with manually counted labeling indices, with correlation coefficients in the range ≈0.92-0.93. In addition, all three proliferation markers were significantly correlated and could detect the variation in epithelial proliferation during the estrous cycle. In conclusion, image analysis can be used to quantify epithelial proliferation in the rat mammary gland and thereby replace time-consuming manual counting. Furthermore, BrdU, Ki67, and PHH3 can be used interchangeably to assess proliferation.
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Affiliation(s)
- Tobias H. Dovmark
- Pathology & Imaging, Global Drug Discovery, Novo Nordisk A/S, Måløv, Denmark
| | - Peter H. Kvist
- Pathology & Imaging, Global Drug Discovery, Novo Nordisk A/S, Måløv, Denmark
| | - Anne-Marie Mølck
- Toxicology Development Projects, Global Drug Discovery, Novo Nordisk A/S, Måløv, Denmark
| | - Henning Hvid
- Henning Hvid, Pathology & Imaging, Global Drug Discovery, Novo Nordisk A/S, Novo Nordisk Park, N/A 2760 Måløv, Denmark. E-mail:
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27
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Boyaci C, Sun W, Robertson S, Acs B, Hartman J. Independent Clinical Validation of the Automated Ki67 Scoring Guideline from the International Ki67 in Breast Cancer Working Group. Biomolecules 2021; 11:1612. [PMID: 34827609 PMCID: PMC8615770 DOI: 10.3390/biom11111612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022] Open
Abstract
Ki67 is an important biomarker with prognostic and potential predictive value in breast cancer. However, the lack of standardization hinders its clinical applicability. In this study, we aimed to investigate the reproducibility among pathologists following the guidelines of the International Ki67 in Breast Cancer Working Group (IKWG) for Ki67 scoring and to evaluate the prognostic potential of this platform in an independent cohort. Four algorithms were independently built by four pathologists based on our study cohort using an open-source digital image analysis (DIA) platform (QuPath) following the detailed guideline of the IKWG. The algorithms were applied on an ER+ breast cancer study cohort of 157 patients with 15 years of follow-up. The reference Ki67 score was obtained by a DIA algorithm trained on a subset of the study cohort. Intraclass correlation coefficient (ICC) was used to measure reproducibility. High interobserver reliability was reached with an ICC of 0.938 (CI: 0.920-0.952) among the algorithms and the reference standard. Comparing each machine-read score against relapse-free survival, the hazard ratios were similar (2.593-4.165) and showed independent prognostic potential (p ≤ 0.018, for all comparisons). In conclusion, we demonstrate high reproducibility and independent prognostic potential using the IKWG DIA instructions to score Ki67 in breast cancer. A prospective study is needed to assess the clinical utility of the IKWG DIA Ki67 instructions.
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Affiliation(s)
- Ceren Boyaci
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, 11883 Stockholm, Sweden; (C.B.); (W.S.); (S.R.)
- Department of Oncology and Pathology, Karolinska Institute, 17177 Stockholm, Sweden
| | - Wenwen Sun
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, 11883 Stockholm, Sweden; (C.B.); (W.S.); (S.R.)
- Department of Oncology and Pathology, Karolinska Institute, 17177 Stockholm, Sweden
| | - Stephanie Robertson
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, 11883 Stockholm, Sweden; (C.B.); (W.S.); (S.R.)
- Department of Oncology and Pathology, Karolinska Institute, 17177 Stockholm, Sweden
| | - Balazs Acs
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, 11883 Stockholm, Sweden; (C.B.); (W.S.); (S.R.)
- Department of Oncology and Pathology, Karolinska Institute, 17177 Stockholm, Sweden
| | - Johan Hartman
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, 11883 Stockholm, Sweden; (C.B.); (W.S.); (S.R.)
- Department of Oncology and Pathology, Karolinska Institute, 17177 Stockholm, Sweden
- Medtech Lab, Bioclinicum, Karolinska University Hospital, 17164 Stockholm, Sweden
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28
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Dénes L, Horváth DG, Duran O, Ratkhjen PH, Kraft C, Acs B, Szász AM, Rümenapf T, Papp M, Ladinig A, Balka G. In Situ Hybridization of PRRSV-1 Combined with Digital Image Analysis in Lung Tissues of Pigs Challenged with PRRSV-1. Vet Sci 2021; 8:235. [PMID: 34679065 PMCID: PMC8540710 DOI: 10.3390/vetsci8100235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
Betaarterivirus suid 1 and 2 are the causative agents of porcine reproductive and respiratory syndrome (PRRS), which is one of the most significant diseases of the swine industry, causing significant economic losses in the main pig producing countries. Here, we report the development of a novel, RNA-based in situ hybridization technique (RNAscope) to detect PRRS virus (PRRSV) RNA in lung tissues of experimentally infected animals. The technique was applied to lung tissues of 20 piglets, which had been inoculated with a wild-type, highly pathogenic PRRSV-1 strain. To determine the RNAscope's applicability as a semi-quantitative method, we analysed the association between the proportion of the virus-infected cells measured with an image analysis software (QuPath) and the outcome of the real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) tests performed in parallel. The results of the quantitative approach of these two molecular biological methods show significant association (pseudo R2 = 0.3894, p = 0.004). This is the first time RNAscope assay has been implemented for the detection of PRRSV-1 in experimental animals.
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Affiliation(s)
- Lilla Dénes
- Department of Pathology, University of Veterinary Medicine, István u. 2, 1078 Budapest, Hungary; (L.D.); (D.G.H.)
| | - Dávid G. Horváth
- Department of Pathology, University of Veterinary Medicine, István u. 2, 1078 Budapest, Hungary; (L.D.); (D.G.H.)
| | - Oliver Duran
- Boehringer Ingelheim Vetmedica GmbH, 55218 Ingelheim am Rhein, Germany; (O.D.); (P.H.R.); (C.K.)
| | - Poul H. Ratkhjen
- Boehringer Ingelheim Vetmedica GmbH, 55218 Ingelheim am Rhein, Germany; (O.D.); (P.H.R.); (C.K.)
| | - Christian Kraft
- Boehringer Ingelheim Vetmedica GmbH, 55218 Ingelheim am Rhein, Germany; (O.D.); (P.H.R.); (C.K.)
| | - Balazs Acs
- Department of Oncology and Pathology, Karolinska Institutet, CCK R8:04, 17176 Stockholm, Sweden;
- Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Building 70, Level-2, 11883 Stockholm, Sweden
| | - Attila M. Szász
- Department of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor u. 2/a, 1083 Budapest, Hungary;
| | - Till Rümenapf
- Institute of Virology, Department of Pathobiology, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210 Vienna, Austria;
| | - Marton Papp
- Centre for Bioinformatics, University of Veterinary Medicine, István u. 2, 1078 Budapest, Hungary;
| | - Andrea Ladinig
- University Clinic for Swine, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210 Vienna, Austria;
| | - Gyula Balka
- Department of Pathology, University of Veterinary Medicine, István u. 2, 1078 Budapest, Hungary; (L.D.); (D.G.H.)
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29
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Placke JM, Soun C, Bottek J, Herbst R, Terheyden P, Utikal J, Pföhler C, Ulrich J, Kreuter A, Pfeiffer C, Mohr P, Gutzmer R, Meier F, Dippel E, Weichenthal M, Zimmer L, Livingstone E, Becker JC, Lodde G, Sucker A, Griewank K, Horn S, Hadaschik E, Roesch A, Schadendorf D, Engel DR, Ugurel S. Digital Quantification of Tumor PD-L1 Predicts Outcome of PD-1-Based Immune Checkpoint Therapy in Metastatic Melanoma. Front Oncol 2021; 11:741993. [PMID: 34621681 PMCID: PMC8491983 DOI: 10.3389/fonc.2021.741993] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background PD-1-based immune checkpoint blockade (ICB) is a highly effective therapy in metastatic melanoma. However, 40-60% of patients are primarily resistant, with valid predictive biomarkers currently missing. This study investigated the digitally quantified tumor PD-L1 expression for ICB therapy outcome prediction. Patients and Methods Tumor tissues taken prior to PD-1-based ICB for unresectable metastatic disease were collected within the prospective multicenter Tissue Registry in Melanoma (TRIM). PD-L1 expression (clone 28-8; cut-off=5%) was determined by digital and physician quantification, and correlated with therapy outcome (best overall response, BOR; progression-free survival, PFS; overall survival, OS). Results Tissue samples from 156 patients were analyzed (anti-PD-1, n=115; anti-CTLA-4+anti-PD-1, n=41). Patients with PD-L1-positive tumors showed an improved response compared to patients with PD-L1-negative tumors, by digital (BOR 50.5% versus 32.2%; p=0.026) and physician (BOR 54.2% versus 36.6%; p=0.032) quantification. Tumor PD-L1 positivity was associated with a prolonged PFS and OS by either digital (PFS, 9.9 versus 4.6 months, p=0.021; OS, not reached versus 13.0 months, p=0.001) or physician (PFS, 10.6 versus 5.6 months, p=0.051; OS, not reached versus 15.6 months, p=0.011) quantification. Multivariable Cox regression revealed digital (PFS, HR=0.57, p=0.007; OS, HR=0.44, p=0.001) and physician (OS, HR=0.54, p=0.016) PD-L1 quantification as independent predictors of survival upon PD-1-based ICB. The combination of both methods identified a patient subgroup with particularly favorable therapy outcome (PFS, HR=0.53, p=0.011; OS, HR=0.47, p=0.008). Conclusion Pre-treatment tumor PD-L1 positivity predicted a favorable outcome of PD-1-based ICB in melanoma. Herein, digital quantification was not inferior to physician quantification, and should be further validated for clinical use.
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Affiliation(s)
- Jan-Malte Placke
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Camille Soun
- Institute of Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
| | - Jenny Bottek
- Institute of Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
| | - Rudolf Herbst
- Department of Dermatology, Medical Hospital, Erfurt, Germany
| | | | - Jochen Utikal
- Department of Dermatology, Venerology, and Allergology, University Medical Center, Ruprecht-Karls University of Heidelberg, Mannheim, Germany.,German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical School, Homburg, Germany
| | - Jens Ulrich
- Department of Dermatology, Medical Hospital of Quedlinburg, Quedlinburg, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, Helios St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany
| | - Christiane Pfeiffer
- Department of Dermatology, Venereology, and Allergology University Ulm, Ulm, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe-Kliniken, Buxtehude, Germany
| | - Ralf Gutzmer
- Skin Cancer Center, Department of Dermatology, Hannover Medical School, Hannover, Germany
| | - Friedegund Meier
- German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Dermatology, University Hospital Dresden, Dresden, Germany
| | - Edgar Dippel
- Hautklinik, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Ludwigshafen, Germany
| | | | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jürgen C Becker
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Translationale Hautkrebsforschung, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - Georg Lodde
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Antje Sucker
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Klaus Griewank
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Susanne Horn
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Eva Hadaschik
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexander Roesch
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Robert Engel
- Institute of Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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30
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Noh KW, Buettner R, Klein S. Shifting Gears in Precision Oncology-Challenges and Opportunities of Integrative Data Analysis. Biomolecules 2021; 11:biom11091310. [PMID: 34572523 PMCID: PMC8465238 DOI: 10.3390/biom11091310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 02/07/2023] Open
Abstract
For decades, research relating to modification of host immunity towards antitumor response activation has been ongoing, with the breakthrough discovery of immune-checkpoint blockers. Several biomarkers with potential predictive value have been reported in recent studies for these novel therapies. However, with the plethora of therapeutic options existing for a given cancer entity, modern oncology is now being confronted with multifactorial interpretation to devise “the best therapy” for the individual patient. Into the bargain come the multiverse guidelines for established and emerging diagnostic biomarkers, as well as the complex interplay between cancer cells and tumor microenvironment, provoking immense challenges in the therapy decision-making process. Through this review, we present various molecular diagnostic modalities and techniques, such as genomics, immunohistochemistry and quantitative image analysis, which have the potential of becoming powerful tools in the development of an optimal treatment regime when analogized with patient characteristics. We will summarize the underlying complexities of these methods and shed light upon the necessary considerations and requirements for data integration. It is our hope to provide compelling evidence to emphasize on the need for inclusion of integrative data analysis in modern cancer therapy, and thereupon paving a path towards precision medicine and better patient outcomes.
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Affiliation(s)
- Ka-Won Noh
- Institute for Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (K.-W.N.); (R.B.)
| | - Reinhard Buettner
- Institute for Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (K.-W.N.); (R.B.)
| | - Sebastian Klein
- Gerhard-Domagk-Institute of Pathology, University Hospital Münster, 48149 Münster, Germany
- Correspondence: ; Tel.: +49-251-83-57670
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31
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Finkelman BS, Meindl A, LaBoy C, Griffin B, Narayan S, Brancamp R, Siziopikou KP, Pincus JL, Blanco LZ. Correlation of manual semi-quantitative and automated quantitative Ki-67 proliferative index with OncotypeDXTM recurrence score in invasive breast carcinoma. Breast Dis 2021; 41:55-65. [PMID: 34397396 DOI: 10.3233/bd-201011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ki-67 immunohistochemistry (IHC) staining is a widely used cancer proliferation assay; however, its limitations could be improved with automated scoring. The OncotypeDXTM Recurrence Score (ORS), which primarily evaluates cancer proliferation genes, is a prognostic indicator for breast cancer chemotherapy response; however, it is more expensive and slower than Ki-67. OBJECTIVE To compare manual Ki-67 (mKi-67) with automated Ki-67 (aKi-67) algorithm results based on manually selected Ki-67 "hot spots" in breast cancer, and correlate both with ORS. METHODS 105 invasive breast carcinoma cases from 100 patients at our institution (2011-2013) with available ORS were evaluated. Concordance was assessed via Cohen's Kappa (κ). RESULTS 57/105 cases showed agreement between mKi-67 and aKi-67 (κ 0.31, 95% CI 0.18-0.45), with 41 cases overestimated by aKi-67. Concordance was higher when estimated on the same image (κ 0.53, 95% CI 0.37-0.69). Concordance between mKi-67 score and ORS was fair (κ 0.27, 95% CI 0.11-0.42), and concordance between aKi-67 and ORS was poor (κ 0.10, 95% CI -0.03-0.23). CONCLUSIONS These results highlight the limits of Ki-67 algorithms that use manual "hot spot" selection. Due to suboptimal concordance, Ki-67 is likely most useful as a complement to, rather than a surrogate for ORS, regardless of scoring method.
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Affiliation(s)
- Brian S Finkelman
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amanda Meindl
- Department of Pathology, Great Lakes Pathologists, West Allis, WI, USA
| | - Carissa LaBoy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brannan Griffin
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Suguna Narayan
- Department of Pathology, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Ryan Brancamp
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kalliopi P Siziopikou
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer L Pincus
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Luis Z Blanco
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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32
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Lara H, Li Z, Abels E, Aeffner F, Bui MM, ElGabry EA, Kozlowski C, Montalto MC, Parwani AV, Zarella MD, Bowman D, Rimm D, Pantanowitz L. Quantitative Image Analysis for Tissue Biomarker Use: A White Paper From the Digital Pathology Association. Appl Immunohistochem Mol Morphol 2021; 29:479-493. [PMID: 33734106 PMCID: PMC8354563 DOI: 10.1097/pai.0000000000000930] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/12/2021] [Indexed: 01/19/2023]
Abstract
Tissue biomarkers have been of increasing utility for scientific research, diagnosing disease, and treatment response prediction. There has been a steady shift away from qualitative assessment toward providing more quantitative scores for these biomarkers. The application of quantitative image analysis has thus become an indispensable tool for in-depth tissue biomarker interrogation in these contexts. This white paper reviews current technologies being employed for quantitative image analysis, their application and pitfalls, regulatory framework demands, and guidelines established for promoting their safe adoption in clinical practice.
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Affiliation(s)
- Haydee Lara
- GlaxoSmithKline-R&D, Cellular Biomarkers, Collegeville, PA
| | - Zaibo Li
- The Ohio State University, Columbus, OH
| | | | - Famke Aeffner
- Translational Safety and Bioanalytical Sciences, Amgen Research, Amgen Inc
| | | | | | | | | | | | | | | | - David Rimm
- Yale University School of Medicine, New Haven, CT
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33
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Lea D, Gudlaugsson EG, Skaland I, Lillesand M, Søreide K, Søreide JA. Digital Image Analysis of the Proliferation Markers Ki67 and Phosphohistone H3 in Gastroenteropancreatic Neuroendocrine Neoplasms: Accuracy of Grading Compared With Routine Manual Hot Spot Evaluation of the Ki67 Index. Appl Immunohistochem Mol Morphol 2021; 29:499-505. [PMID: 33758143 PMCID: PMC8354564 DOI: 10.1097/pai.0000000000000934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/22/2021] [Indexed: 02/01/2023]
Abstract
Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare epithelial neoplasms. Grading is based on mitotic activity or the percentage of Ki67-positive cells in a hot spot. Routine methods have poor intraobserver and interobserver consistency, and objective measurements are lacking. This study aimed to evaluate digital image analysis (DIA) as an objective assessment of proliferation markers in GEP-NENs. A consecutive cohort of patients with automated DIA measurement of Ki67 (DIA Ki67) and phosphohistone H3 (DIA PHH3) on immunohistochemical slides was analyzed using Visiopharm image analysis software (Hoersholm, Denmark). The results were compared with the Ki67 index from routine pathology reports (pathology Ki67). The study included 159 patients (57% males). The median pathology Ki67 was 2.0% and DIA Ki67 was 4.1%. The interclass correlation coefficient of the DIA Ki67 compared with the pathology Ki67 showed an excellent agreement of 0.96 [95% confidence interval (CI): 0.94-0.96]. The observed kappa value was 0.86 (95% CI: 0.81-0.91) when comparing grades based on the same methods. PHH3 was measured in 145 (91.2%) cases. The observed kappa value was 0.74. (95% CI: 0.65-0.83) when comparing grade based on the DIA PHH3 and the pathology Ki67. The DIA Ki67 shows excellent agreement with the pathology Ki67. The DIA PHH3 measurements were more varied and cannot replace other methods for grading GEP-NENs.
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Affiliation(s)
- Dordi Lea
- Departments of Pathology
- Gastrointestinal Translational Research Unit, Molecular Laboratory, Hillevåg, Stavanger University Hospital, Stavanger
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | | | | | - Kjetil Søreide
- Gastrointestinal Surgery
- Gastrointestinal Translational Research Unit, Molecular Laboratory, Hillevåg, Stavanger University Hospital, Stavanger
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jon A. Søreide
- Gastrointestinal Surgery
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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34
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Meuten DJ, Moore FM, Donovan TA, Bertram CA, Klopfleisch R, Foster RA, Smedley RC, Dark MJ, Milovancev M, Stromberg P, Williams BH, Aubreville M, Avallone G, Bolfa P, Cullen J, Dennis MM, Goldschmidt M, Luong R, Miller AD, Miller MA, Munday JS, Roccabianca P, Salas EN, Schulman FY, Laufer-Amorim R, Asakawa MG, Craig L, Dervisis N, Esplin DG, George JW, Hauck M, Kagawa Y, Kiupel M, Linder K, Meichner K, Marconato L, Oblak ML, Santos RL, Simpson RM, Tvedten H, Whitley D. International Guidelines for Veterinary Tumor Pathology: A Call to Action. Vet Pathol 2021; 58:766-794. [PMID: 34282984 DOI: 10.1177/03009858211013712] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Standardization of tumor assessment lays the foundation for validation of grading systems, permits reproducibility of oncologic studies among investigators, and increases confidence in the significance of study results. Currently, there is minimal methodological standardization for assessing tumors in veterinary medicine, with few attempts to validate published protocols and grading schemes. The current article attempts to address these shortcomings by providing standard guidelines for tumor assessment parameters and protocols for evaluating specific tumor types. More detailed information is available in the Supplemental Files, the intention of which is 2-fold: publication as part of this commentary, but more importantly, these will be available as "living documents" on a website (www.vetcancerprotocols.org), which will be updated as new information is presented in the peer-reviewed literature. Our hope is that veterinary pathologists will agree that this initiative is needed, and will contribute to and utilize this information for routine diagnostic work and oncologic studies. Journal editors and reviewers can utilize checklists to ensure publications include sufficient detail and standardized methods of tumor assessment. To maintain the relevance of the guidelines and protocols, it is critical that the information is periodically updated and revised as new studies are published and validated with the intent of providing a repository of this information. Our hope is that this initiative (a continuation of efforts published in this journal in 2011) will facilitate collaboration and reproducibility between pathologists and institutions, increase case numbers, and strengthen clinical research findings, thus ensuring continued progress in veterinary oncologic pathology and improving patient care.
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Affiliation(s)
| | | | | | - Christof A Bertram
- Freie Universität Berlin, Berlin, Germany.,University of Veterinary Medicine, Vienna, Austria
| | | | | | | | | | | | | | | | | | | | - Pompei Bolfa
- Ross University, Basseterre, Saint Kitts and Nevis
| | - John Cullen
- North Carolina State University, Raleigh, NC, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nick Dervisis
- VA-MD College of Veterinary Medicine, Blacksburg, VA, USA
| | | | | | | | | | | | - Keith Linder
- North Carolina State University, Raleigh, NC, USA
| | | | | | | | - Renato L Santos
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - R Mark Simpson
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Harold Tvedten
- Swedish University of Agricultural Sciences, Uppsala, Sweden
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35
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Quantifying intraepithelial lymphocytes and subepithelial collagen band in microscopic colitis, extracting insights into the interrelationship of lymphocytic and collagenous colitis. Ann Diagn Pathol 2021; 52:151741. [PMID: 33865186 DOI: 10.1016/j.anndiagpath.2021.151741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/11/2021] [Accepted: 03/28/2021] [Indexed: 01/10/2023]
Abstract
Microscopic colitis (MC) is the umbrella term for the conditions termed lymphocytic colitis (LC) and collagenous colitis (CC). LC with thickening of the subepithelial collagen band or CC with increased number of intraepithelial T- lymphocytes (IELs) is often seen in MC and may lead to difficulties in correct histological classification. We investigated the extent of overlapping features of CC and LC in 60 cases of MC by measuring the exact thickness of the subepithelial collagen band in Van Gieson stained slides and quantifying number of IELs in CD3 stained slides by digital image analysis. A thickened collagen band was observed in nine out of 29 cases with LC (31%) and an increased number of IELs in all 23 cases of CC (100%). There was no correlation between the thickness of the collagen band and number of IELs. Due to the increased number of IELs in all cases of CC we consider the lymphocytic inflammatory infiltration of the mucosa to be the essential histopathological feature of MC. However, although LC and CC are related due to the lymphocytic inflammation, the non-linear correlation of number of IELs and thickness of the collagenous band indicate differences in their pathogenesis.
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36
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Intratumor Heterogeneity in Uveal Melanoma BAP-1 Expression. Cancers (Basel) 2021; 13:cancers13051143. [PMID: 33800007 PMCID: PMC7962103 DOI: 10.3390/cancers13051143] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 01/22/2023] Open
Abstract
Malignant tumors are rarely homogenous on the morphological, genome, transcriptome or proteome level. In this study, we investigate the intratumor heterogeneity of BAP-1 expression in uveal melanoma with digital image analysis of 40 tumors. The proportion of BAP-1 positive cells was measured in full tumor sections, hot spots, cold spots and in scleral margins. The mean difference between hot spots and cold spots was 41 percentage points (pp, SD 29). Tumors with gene expression class 1 (associated with low metastatic risk) and 2 (high metastatic risk) had similar intratumor heterogeneity. Similarly, the level of intratumor heterogeneity was comparable in tumors from patients that later developed metastases as in patients that did not. BAP-1 measured in any tumor region added significant prognostic information to both American Joint Committee on Cancer (AJCC) tumor size category (p ≤ 0.001) and gene expression class (p ≤ 0.04). We conclude that there is substantial intratumor heterogeneity in uveal melanoma BAP-1 expression. However, it is of limited prognostic importance. Regardless of region, analysis of BAP-1 expression adds significant prognostic information beyond tumor size and gene expression class.
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37
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Paik S, Kwon Y, Lee MH, Kim JY, Lee DK, Cho WJ, Lee EY, Lee ES. Systematic evaluation of scoring methods for Ki67 as a surrogate for 21-gene recurrence score. NPJ Breast Cancer 2021; 7:13. [PMID: 33579950 PMCID: PMC7881194 DOI: 10.1038/s41523-021-00221-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 01/07/2021] [Indexed: 02/03/2023] Open
Abstract
Although Ki67 labeling index is a potential predictive marker for chemotherapy benefit, its clinical utility has been limited by the lack of a standard scoring method resulting in poor interobserver reproducibility. Especially, there is no consensus on the use of average versus hotspot score for reporting. In order to determine the best method for Ki67 scoring and validate manual scoring method proposed by the International Ki67 Working Group (IKWG), we systematically compared average versus hotspot score in 240 cases with a public domain image analysis program QuPath. We used OncotypeDx Recurrence Score (RS) as a benchmark to compare the potential clinical utility of each scoring methods. Both average and hotspot scores showed statistically significant but only modest correlation with OncotypeDx RS. Only hotspot score could meaningfully distinguish RS low-risk versus high-risk patients. However, hotspot score was less reproducible limiting its clinical utility. In summary, our data demonstrate that utility of the Ki67 labeling index is influenced by the choice of scoring method.
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Affiliation(s)
- Soonmyung Paik
- Institute for Personalized Cancer Therapy, Yonsei University College of Medicine, Seoul, South Korea.
| | - Youngmee Kwon
- Department of Pathology, National Cancer Center, Goyang, South Korea
| | - Moo Hyun Lee
- Department of Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Ji Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Da Kyung Lee
- Institute for Personalized Cancer Therapy, Yonsei University College of Medicine, Seoul, South Korea.,Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Jeong Cho
- Institute for Personalized Cancer Therapy, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Young Lee
- Institute for Personalized Cancer Therapy, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Sook Lee
- Department of Surgery, National Cancer Center, Goyang, South Korea.
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39
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A completely annotated whole slide image dataset of canine breast cancer to aid human breast cancer research. Sci Data 2020; 7:417. [PMID: 33247116 PMCID: PMC7699627 DOI: 10.1038/s41597-020-00756-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/29/2020] [Indexed: 01/10/2023] Open
Abstract
Canine mammary carcinoma (CMC) has been used as a model to investigate the pathogenesis of human breast cancer and the same grading scheme is commonly used to assess tumor malignancy in both. One key component of this grading scheme is the density of mitotic figures (MF). Current publicly available datasets on human breast cancer only provide annotations for small subsets of whole slide images (WSIs). We present a novel dataset of 21 WSIs of CMC completely annotated for MF. For this, a pathologist screened all WSIs for potential MF and structures with a similar appearance. A second expert blindly assigned labels, and for non-matching labels, a third expert assigned the final labels. Additionally, we used machine learning to identify previously undetected MF. Finally, we performed representation learning and two-dimensional projection to further increase the consistency of the annotations. Our dataset consists of 13,907 MF and 36,379 hard negatives. We achieved a mean F1-score of 0.791 on the test set and of up to 0.696 on a human breast cancer dataset. Measurement(s) | Mitotic Figure • Slide Image • non-mitotic structures • anatomical phenotype annotation | Technology Type(s) | Pathology Report • hematoxylin and eosin stain • machine learning | Factor Type(s) | breast cancer tissue | Sample Characteristic - Organism | Canis |
Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.13182857
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40
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Daniela Maier A, Brøchner CB, Bartek Jr. J, Eriksson F, Ugleholdt H, Broholm H, Mathiesen T. Mitotic and Proliferative Indices in WHO Grade III Meningioma. Cancers (Basel) 2020; 12:cancers12113351. [PMID: 33198268 PMCID: PMC7697885 DOI: 10.3390/cancers12113351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Malignant meningiomas are rare primary intracranial tumors associated with considerable morbidity and mortality. The diagnosis is based on the number of mitotic figures (mitotic index, MI). Consequently, the quantification of mitotic figures is prone to inter- and intraobserver variability. The mitotic marker, phosphohistone-H3 (PHH3), has been shown to be a more robust mitotic marker. Despite the prognostic value of MI across all meningioma grades, little is known of the prognostic value of the MI within malignant meningioma. Therefore, this study investigates the MI in a series of malignant meningiomas to analyze the association to progression-free survival and mitotic and proliferative indices. Furthermore, we investigated the precision (repeatability) of mitotic counts and the agreement between MI and PHH3 MI. Abstract Meningiomas with inherently high mitotic indices and poor prognosis, such as WHO grade III meningiomas, have not been investigated separately to establish interchangeability between conventional mitotic index counted on H&E stained slides (MI) and mitotic index counted on phosphohistone-H3 stained slides (PHH3 MI). This study investigates the agreement of MI and PHH3 MI and to analyze the association of progression-free survival (PFS) and MI, PHH3 MI, and the proliferative index (PI, Ki-67) in WHO grade III meningioma. Tumor specimens from 24 consecutive patients were analyzed for expression of Ki-67, PHH3 MI, and MI. Quantification was performed independently by two observers who made replicate counts in hot spots and overall tumor staining. Repeatability in replicate counts from MI and PHH3 MI was low in both observers. Consequently, we could not report the agreement. MI, PHH3 MI and hot spot counts of Ki-67 were associated with PFS (MI hot spot HR = 1.61, 95% CI 1.12–2.31, p = 0.010; PHH3 MI hot spot HR = 1.59, 95% CI 1.15–2.21, p = 0.006; Ki-67 hot spot HR = 1.06, 95% CI 1.02–1.11. p = 0.004). We found markedly low repeatability of manually counted MI and PHH3 MI in WHO grade III meningioma, and we could not conclude that the two methods agreed. Subsequently, quantification with better repeatability should be sought. All three biomarkers were associated with PFS.
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Affiliation(s)
- Andrea Daniela Maier
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark; (J.B.J.); (T.M.)
- Pathology Department, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark; (C.B.B.); (H.U.); (H.B.)
- Correspondence: ; Tel.: +45-25825824
| | - Christian Beltoft Brøchner
- Pathology Department, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark; (C.B.B.); (H.U.); (H.B.)
| | - Jiri Bartek Jr.
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark; (J.B.J.); (T.M.)
- Department of Neurosurgery, Karolinska University Hospital, Solnavägen 1, Solna, 17176 Stockholm, Sweden
- Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Solnavägen 1, Solna, 17176 Stockholm, Sweden
| | - Frank Eriksson
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark;
| | - Heidi Ugleholdt
- Pathology Department, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark; (C.B.B.); (H.U.); (H.B.)
| | - Helle Broholm
- Pathology Department, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark; (C.B.B.); (H.U.); (H.B.)
| | - Tiit Mathiesen
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark; (J.B.J.); (T.M.)
- Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Solnavägen 1, Solna, 17176 Stockholm, Sweden
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark
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Niță I, Nițipir C, Toma ȘA, Limbău AM, Pîrvu E, Bădărău IA, Suciu I, Suciu G, Manolescu LSC. Histological Aspects and Quantitative Assessment of Ki67 as Prognostic Factors in Breast Cancer Patients: Result from a Single-Center, Cross Sectional Study. ACTA ACUST UNITED AC 2020; 56:medicina56110600. [PMID: 33182401 PMCID: PMC7698204 DOI: 10.3390/medicina56110600] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022]
Abstract
Background and objectives: Our aim is to explore the relationship between the levels of protein encoded by Ki67 and the histopathological aspects regarding the overall survival and progression-free survival in a single university center. A secondary objective was to examine other factors that can influence these endpoints. New approaches to the prognostic assessment of breast cancer have come from molecular profiling studies. Ki67 is a nuclear protein associated with cell proliferation. Together with the histological type and tumor grade, it is used to appreciate the aggressiveness of the breast tumors. Materials and Methods: We conducted a retrospective single-institution study, at Elias University Emergency Hospital, Bucharest, Romania, in which we enrolled women with stage I to III breast cancer. The protocol was amended to include the immunohistochemistry determination of Ki67 and the histological aspects. The methodology consisted in using a Kaplan-Meier analysis for the entire sample and restricted mean survival time up to 36 months. Results: Both lower Ki67 and low tumor grade are associated with better prognosis in terms of overall survival (OS) and progression-free survival (PFS) for our patients' cohort. In our group, the histological type did not impact the time to progression or survival. Conclusions: Both overall survival and progression-free survival may be influenced by the higher value of Ki67 and less differentiated tumors. Further studies are needed in order to establish if the histologic type may impact breast cancer prognostic, probably together with other histologic and molecular markers.
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Affiliation(s)
- Irina Niță
- Faculty of Medicine, Faculty of Midwifery and Nursing, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.N.); (I.A.B.)
- Clinic of Oncology, Elias Universitary Emergency Hospital, 011461 Bucharest, Romania
- Correspondence: (I.N.); (L.S.C.M.); Tel.: +40-722515917 (I.N.); +40-723699253 (L.S.C.M.)
| | - Cornelia Nițipir
- Faculty of Medicine, Faculty of Midwifery and Nursing, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.N.); (I.A.B.)
- Clinic of Oncology, Elias Universitary Emergency Hospital, 011461 Bucharest, Romania
| | | | - Alexandra Maria Limbău
- Dermatology Department, Municipal Hospital Curtea de Argeș, 115300 Curtea de Argeș, Romania;
| | - Edvina Pîrvu
- Medical Oncology Department, Clinical Hospital Colţea, 927180 Bucharest, Romania;
| | - Ioana Anca Bădărău
- Faculty of Medicine, Faculty of Midwifery and Nursing, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.N.); (I.A.B.)
| | - Ioana Suciu
- BEIA consult International, Peroni 16, 041386 Bucharest, Romania; (I.S.); (G.S.)
| | - George Suciu
- BEIA consult International, Peroni 16, 041386 Bucharest, Romania; (I.S.); (G.S.)
| | - Loredana Sabina Cornelia Manolescu
- Faculty of Medicine, Faculty of Midwifery and Nursing, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.N.); (I.A.B.)
- Correspondence: (I.N.); (L.S.C.M.); Tel.: +40-722515917 (I.N.); +40-723699253 (L.S.C.M.)
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Aubreville M, Bertram CA, Marzahl C, Gurtner C, Dettwiler M, Schmidt A, Bartenschlager F, Merz S, Fragoso M, Kershaw O, Klopfleisch R, Maier A. Deep learning algorithms out-perform veterinary pathologists in detecting the mitotically most active tumor region. Sci Rep 2020; 10:16447. [PMID: 33020510 PMCID: PMC7536430 DOI: 10.1038/s41598-020-73246-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 09/15/2020] [Indexed: 01/13/2023] Open
Abstract
Manual count of mitotic figures, which is determined in the tumor region with the highest mitotic activity, is a key parameter of most tumor grading schemes. It can be, however, strongly dependent on the area selection due to uneven mitotic figure distribution in the tumor section. We aimed to assess the question, how significantly the area selection could impact the mitotic count, which has a known high inter-rater disagreement. On a data set of 32 whole slide images of H&E-stained canine cutaneous mast cell tumor, fully annotated for mitotic figures, we asked eight veterinary pathologists (five board-certified, three in training) to select a field of interest for the mitotic count. To assess the potential difference on the mitotic count, we compared the mitotic count of the selected regions to the overall distribution on the slide. Additionally, we evaluated three deep learning-based methods for the assessment of highest mitotic density: In one approach, the model would directly try to predict the mitotic count for the presented image patches as a regression task. The second method aims at deriving a segmentation mask for mitotic figures, which is then used to obtain a mitotic density. Finally, we evaluated a two-stage object-detection pipeline based on state-of-the-art architectures to identify individual mitotic figures. We found that the predictions by all models were, on average, better than those of the experts. The two-stage object detector performed best and outperformed most of the human pathologists on the majority of tumor cases. The correlation between the predicted and the ground truth mitotic count was also best for this approach (0.963–0.979). Further, we found considerable differences in position selection between pathologists, which could partially explain the high variance that has been reported for the manual mitotic count. To achieve better inter-rater agreement, we propose to use a computer-based area selection for support of the pathologist in the manual mitotic count.
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Affiliation(s)
- Marc Aubreville
- Pattern Recognition Lab, Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Christof A Bertram
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Christian Marzahl
- Pattern Recognition Lab, Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Corinne Gurtner
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Martina Dettwiler
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Anja Schmidt
- Vet Med Labor GmbH - Division of IDEXX Laboratories, Ludwigsburg, Germany
| | | | - Sophie Merz
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Marco Fragoso
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Olivia Kershaw
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Tendl-Schulz KA, Rössler F, Wimmer P, Heber UM, Mittlböck M, Kozakowski N, Pinker K, Bartsch R, Dubsky P, Fitzal F, Filipits M, Eckel FC, Langthaler EM, Steger G, Gnant M, Singer CF, Helbich TH, Bago-Horvath Z. Factors influencing agreement of breast cancer luminal molecular subtype by Ki67 labeling index between core needle biopsy and surgical resection specimens. Virchows Arch 2020; 477:545-555. [PMID: 32383007 PMCID: PMC7508960 DOI: 10.1007/s00428-020-02818-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/20/2020] [Accepted: 04/16/2020] [Indexed: 11/09/2022]
Abstract
Reliable determination of Ki67 labeling index (Ki67-LI) on core needle biopsy (CNB) is essential for determining breast cancer molecular subtype for therapy planning. However, studies on agreement between molecular subtype and Ki67-LI between CNB and surgical resection (SR) specimens are conflicting. The present study analyzed the influence of clinicopathological and sampling-associated factors on agreement. Molecular subtype was determined visually by Ki67-LI in 484 pairs of CNB and SR specimens of invasive estrogen receptor (ER)-positive, human epidermal growth factor (HER2)-negative breast cancer. Luminal B disease was defined by Ki67-LI > 20% in SR. Correlation of molecular subtype agreement with age, menopausal status, CNB method, Breast Imaging Reporting and Data System imaging category, time between biopsies, type of surgery, and pathological tumor parameters was analyzed. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. CNB had a sensitivity of 77.95% and a specificity of 80.97% for identifying luminal B tumors in CNB, compared with the final molecular subtype determination after surgery. The correlation of Ki67-LI between CNB and SR was moderate (ROC-AUC 0.8333). Specificity and sensitivity for CNB to correctly define molecular subtype of tumors according to SR were significantly associated with tumor grade, immunohistochemical progesterone receptor (PR) and p53 expression (p < 0.05). Agreement of molecular subtype did not significantly impact RFS and OS (p = 0.22 for both). The identified factors likely mirror intratumoral heterogeneity that might compromise obtaining a representative CNB. Our results challenge the robustness of a single CNB-driven measurement of Ki67-LI to identify luminal B breast cancer of low (G1) or intermediate (G2) grade.
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Affiliation(s)
- Kristina A Tendl-Schulz
- Department of Pathology and Comprehensive Cancer Center, Medical University of Vienna, 18-20 Waehringer Guertel, A-1090, Vienna, Austria
| | - Fabian Rössler
- Department of Surgery and Transplantation, University Hospital and University of Zurich, Zurich, Switzerland
| | - Philipp Wimmer
- Department of Pathology and Comprehensive Cancer Center, Medical University of Vienna, 18-20 Waehringer Guertel, A-1090, Vienna, Austria
| | - Ulrike M Heber
- Department of Pathology and Comprehensive Cancer Center, Medical University of Vienna, 18-20 Waehringer Guertel, A-1090, Vienna, Austria
| | - Martina Mittlböck
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Clinical Biometrics, Medical University of Vienna, Vienna, Austria
| | - Nicolas Kozakowski
- Department of Pathology and Comprehensive Cancer Center, Medical University of Vienna, 18-20 Waehringer Guertel, A-1090, Vienna, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rupert Bartsch
- Department for Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Peter Dubsky
- Department of Surgery and Breast Health Center, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Hirslanden Klinik St. Anna Brustzentrum, Lucerne, Switzerland
| | - Florian Fitzal
- Department of Surgery and Breast Health Center, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Martin Filipits
- Institute of Cancer Research and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Fanny Carolina Eckel
- Department of Surgery and Breast Health Center, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Eva-Maria Langthaler
- Department of Pathology and Comprehensive Cancer Center, Medical University of Vienna, 18-20 Waehringer Guertel, A-1090, Vienna, Austria
| | - Günther Steger
- Department for Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynaecology and Breast Health Center, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Zsuzsanna Bago-Horvath
- Department of Pathology and Comprehensive Cancer Center, Medical University of Vienna, 18-20 Waehringer Guertel, A-1090, Vienna, Austria.
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Murase Y, Iwata H, Takahara T, Tsuzuki T. The highest Fuhrman and WHO/ISUP grade influences the Ki-67 labeling index of those of grades 1 and 2 in clear cell renal cell carcinoma. Pathol Int 2020; 70:984-991. [PMID: 32997867 DOI: 10.1111/pin.13025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/06/2020] [Indexed: 12/27/2022]
Abstract
Nuclear grade is one of the most important prognostic factors in clear cell renal cell carcinoma (CCRCC). Although CCRCCs usually have intratumoral heterogeneity with various nuclear atypia including nucleolar prominence, it is unclear whether a similar degree of nuclear grade component demonstrates the same proliferative activity. We aimed to reveal whether the presence of a higher nuclear grade has an effect on proliferative activity among each assigned nuclear grade in CCRCCs. We enrolled 129 CCRCC patients containing at least two different nuclear grades. We separately assessed nuclear grade using the Fuhrman and World Health Organization and International Society of Urologic Pathologists (WHO/ISUP) grading systems. In addition, we selected blocks containing different nuclear grade and assessed the Ki-67 labeling index (LI) for each using a computer-based analysis system. Ki-67 LIs significantly correlated with both Fuhrman and WHO/ISUP grades (P < 0.001 and P < 0.001). Of note, the LIs among Fuhrman and WHO/ISUP grades 1 and 2 were also statistically significant according to the highest nuclear grade (P < 0.01 for both grades 1 and 2). Our data suggests that the highest nuclear grade influences the proliferative activity in tumor components regardless of the morphologically assigned nuclear grades. The exact evaluation of Ki-67 LI in CCRCC can provide a more precise information of the malignant potential.
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Affiliation(s)
- Yota Murase
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan.,Department of Pathology, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Hidehiro Iwata
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan.,Department of Pathology, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | | | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
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Zhang H, Kalirai H, Acha-Sagredo A, Yang X, Zheng Y, Coupland SE. Piloting a Deep Learning Model for Predicting Nuclear BAP1 Immunohistochemical Expression of Uveal Melanoma from Hematoxylin-and-Eosin Sections. Transl Vis Sci Technol 2020; 9:50. [PMID: 32953248 PMCID: PMC7476670 DOI: 10.1167/tvst.9.2.50] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. Monosomy 3 and BAP1 mutation are strong prognostic factors predicting metastatic risk in UM. Nuclear BAP1 (nBAP1) expression is a close immunohistochemical surrogate for both genetic alterations. Not all laboratories perform routine BAP1 immunohistochemistry or genetic testing, and rely mainly on clinical information and anatomic/morphologic analyses for UM prognostication. The purpose of our study was to pilot deep learning (DL) techniques to predict nBAP1 expression on whole slide images (WSIs) of hematoxylin and eosin (H&E) stained UM sections. Methods One hundred forty H&E-stained UMs were scanned at 40 × magnification, using commercially available WSI image scanners. The training cohort comprised 66 BAP1+ and 74 BAP1− UM, with known chromosome 3 status and clinical outcomes. Nonoverlapping areas of three different dimensions (512 × 512, 1024 × 1024, and 2048 × 2048 pixels) for comparison were extracted from tumor regions in each WSI, and were resized to 256 × 256 pixels. Deep convolutional neural networks (Resnet18 pre-trained on Imagenet) and auto-encoder-decoders (U-Net) were trained to predict nBAP1 expression of these patches. Trained models were tested on the patches cropped from a test cohort of WSIs of 16 BAP1+ and 28 BAP1− UM cases. Results The trained model with best performance achieved area under the curve values of 0.90 for patches and 0.93 for slides on the test set. Conclusions Our results show the effectiveness of DL for predicting nBAP1 expression in UM on the basis of H&E sections only. Translational Relevance Our pilot demonstrates a high capacity of artificial intelligence-related techniques for automated prediction on the basis of histomorphology, and may be translatable into routine histology laboratories.
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Affiliation(s)
- Hongrun Zhang
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Helen Kalirai
- Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Amelia Acha-Sagredo
- Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Xiaoyun Yang
- Chinese Academy of Sciences (CAS) IntelliCloud Technology Co., Ltd., Shanghai, China
| | - Yalin Zheng
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Sarah E Coupland
- Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Hvid H, Skydsgaard M, Jensen NK, Viuff BM, Jensen HE, Oleksiewicz MB, Kvist PH. Artificial Intelligence-Based Quantification of Epithelial Proliferation in Mammary Glands of Rats and Oviducts of Göttingen Minipigs. Toxicol Pathol 2020; 49:912-927. [PMID: 32840183 DOI: 10.1177/0192623320950633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Quantitative assessment of proliferation can be an important endpoint in toxicologic pathology. Traditionally, cell proliferation is quantified by labor-intensive manual counting of positive and negative cells after immunohistochemical staining for proliferation markers (eg, Ki67, bromo-2'-deoxyuridine, or proliferating cell nuclear antigen). Currently, there is a lot of interest in replacing manual evaluation of histology end points with image analysis tools based on artificial intelligence. The aim of the present study was to explore if a commercially available image analysis software can be used to quantify epithelial proliferative activity in rat mammary gland and minipig oviduct. First, algorithms based on artificial intelligence were trained to detect epithelium in each tissue. Areas of BrdU- or Ki67-positive nuclei and negative nuclei were subsequently quantified with threshold analysis. Artificial intelligence-based and manually counted labelling indices were strongly correlated and equally well detected the estrous cycle influence on proliferation in mammary gland and oviduct epithelium, as well as the dramatically increased proliferation in rat mammary glands after treatment with estradiol and progesterone. In conclusion, quantification of epithelial proliferation in two reproductive tissues can be achieved in a reliable fashion using image analysis software based on artificial intelligence, thus avoiding time- and labor-intensive manual counting, requiring trained operators.
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Affiliation(s)
- Henning Hvid
- Pathology & Imaging, 1450Novo Nordisk A/S, Måløv, Denmark
| | | | | | | | - Henrik E Jensen
- Section of Pathology, University of Copenhagen, Kobenhavn, Denmark
| | | | - Peter H Kvist
- Pathology & Imaging, 1450Novo Nordisk A/S, Måløv, Denmark
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Robertson S, Acs B, Lippert M, Hartman J. Prognostic potential of automated Ki67 evaluation in breast cancer: different hot spot definitions versus true global score. Breast Cancer Res Treat 2020; 183:161-175. [PMID: 32572716 PMCID: PMC7376512 DOI: 10.1007/s10549-020-05752-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/13/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The proliferation-associated biomarker Ki67 has potential utility in breast cancer, including aiding decisions based on prognosis, but has unacceptable inter- and intralaboratory variability. The aim of this study was to compare the prognostic potential for Ki67 hot spot scoring and global scoring using different digital image analysis (DIA) platforms. METHODS An ER+/HER2- breast cancer cohort (n = 139) with whole slide images of sequential sections stained for hematoxylin-eosin, pancytokeratin and Ki67, was analyzed using two DIA platforms. For hot spot analysis virtual dual staining was applied, aligning pancytokeratin and Ki67 images and 22 hot spot algorithms with different features were designed. For global Ki67 scoring an automated QuPath algorithm was applied on Ki67-stained whole slide images. Clinicopathological data included overall survival (OS) and recurrence-free survival (RFS) along with PAM50 molecular subtypes. RESULTS We show significant variations in Ki67 hot spot scoring depending on number of included tumor cells, hot spot size, shape and location. The higher the number of scored tumor cells, the higher the reproducibility of Ki67 proliferation values. Hot spot scoring had greater prognostic potential for RFS in high versus low Ki67 subgroups (hazard ratio (HR) 6.88, CI 2.07-22.87, p = 0.002), compared to global scoring (HR 3.13, CI 1.41-6.96, p = 0.005). Regarding OS, global scoring (HR 7.46, CI 2.46-22.58, p < 0.001) was slightly better than hot spot scoring (HR 6.93, CI 1.61-29.91, p = 0.009). In adjusted multivariate analysis, only global scoring was an independent prognostic marker for both RFS and OS. In addition, global Ki67-based surrogate subtypes reached higher concordance with PAM50 molecular subtype for luminal A and B tumors (66.3% concordance rate, κ = 0.345), than using hot spot scoring (55.8% concordance rate, κ = 0.250). CONCLUSIONS We conclude that the automated global Ki67 scoring is feasible and shows clinical validity, which, however, needs to be confirmed in a larger cohort before clinical implementation.
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Affiliation(s)
- Stephanie Robertson
- Department of Oncology and Pathology, CCK, Karolinska Institutet, R8:04, 17176, Stockholm, Sweden.
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Stockholm, Sweden.
| | - Balazs Acs
- Department of Oncology and Pathology, CCK, Karolinska Institutet, R8:04, 17176, Stockholm, Sweden
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Stockholm, Sweden
| | | | - Johan Hartman
- Department of Oncology and Pathology, CCK, Karolinska Institutet, R8:04, 17176, Stockholm, Sweden
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Stockholm, Sweden
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Egeland NG, Jonsdottir K, Lauridsen KL, Skaland I, Hjorth CF, Gudlaugsson EG, Hamilton-Dutoit S, Lash TL, Cronin-Fenton D, Janssen EAM. Digital Image Analysis of Ki-67 Stained Tissue Microarrays and Recurrence in Tamoxifen-Treated Breast Cancer Patients. Clin Epidemiol 2020; 12:771-781. [PMID: 32801916 PMCID: PMC7383278 DOI: 10.2147/clep.s248167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/05/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The proliferation marker Ki-67 has been used as a prognostic marker to separate low- and high-risk breast cancer subtypes and guide treatment decisions for adjuvant chemotherapy. The association of Ki-67 with response to tamoxifen therapy is unclear. High-throughput automated scoring of Ki-67 might enable standardization of quantification and definition of clinical cut-off values. We hypothesized that digital image analysis (DIA) of Ki-67 can be used to evaluate proliferation in breast cancer tumors, and that Ki-67 may be associated with tamoxifen resistance in early-stage breast cancer. Patients and Methods Here, we apply DIA technology from Visiopharm using a custom designed algorithm for quantifying the expression of Ki-67, in a case–control study nested in the Danish Breast Cancer Group clinical database, consisting of stages I, II, or III breast cancer patients of 35–69 years of age, diagnosed during 1985–2001, in the Jutland peninsula, Denmark. We assessed DIA-Ki-67 score on tissue microarrays (TMAs) from breast cancer patients in a case–control study including 541 ER-positive and 300 ER-negative recurrent cases and their non-recurrent controls, matched on ER-status, cancer stage, menopausal status, year of diagnosis, and county of residence. We used logistic regression to estimate odds ratios and associated 95% confidence intervals to determine the association of Ki-67 expression with recurrence risk, adjusting for matching factors, chemotherapy, type of surgery, receipt of radiation therapy, age category, and comorbidity. Results Ki-67 was not associated with increased risk of recurrence in tamoxifen-treated patients (ORadj =0.72, 95% CI 0.54, 0.96) or ER-negative patients (ORadj =0.85, 95% CI 0.54, 1.34). Conclusion Our findings suggest that Ki-67 digital image analysis in TMAs is not associated with increased risk of recurrence among tamoxifen-treated ER-positive breast cancer or ER-negative breast cancer patients. Overall, our findings do not support an increased risk of recurrence associated with Ki-67 expression.
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Affiliation(s)
- Nina Gran Egeland
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Kristin Jonsdottir
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | | | - Ivar Skaland
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - Cathrine F Hjorth
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Timothy L Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Rollins School of Public Health and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | - Emiel A M Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
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Serna G, Simonetti S, Fasani R, Pagliuca F, Guardia X, Gallego P, Jimenez J, Peg V, Saura C, Eppenberger-Castori S, Ramon Y Cajal S, Terracciano L, Nuciforo P. Sequential immunohistochemistry and virtual image reconstruction using a single slide for quantitative KI67 measurement in breast cancer. Breast 2020; 53:102-110. [PMID: 32707454 PMCID: PMC7375667 DOI: 10.1016/j.breast.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/12/2020] [Accepted: 07/08/2020] [Indexed: 12/22/2022] Open
Abstract
Objective Ki67 is a prognostic and predictive marker in breast cancer (BC). However, manual scoring (MS) by visual assessment suffers from high inter-observer variability which limits its clinical use. Here, we developed a new digital image analysis (DIA) workflow, named KiQuant for automated scoring of Ki67 and investigated its equivalence with standard pathologist's assessment. Methods Sequential immunohistochemistry of Ki67 and cytokeratin, for precise tumor cell recognition, were performed in the same section of 5 tissue microarrays containing 329 tumor cores from different breast cancer subtypes. Slides were digitalized and subjected to DIA and MS for Ki67 assessment. The intraclass correlation coefficient (ICC) and Bland-Altman plot were used to evaluate inter-observer reproducibility. The Kaplan-Meier analysis was used to determine the prognostic potential. Results KiQuant showed an excellent correlation with MS (ICC:0.905,95%CI:0.878–0.926) with satisfactory inter-run (ICC:0.917,95%CI:0.884–0.942) and inter-antibody reproducibilities (ICC:0.886,95%CI:0.820–0.929). The distance between KiQuant and MS increased with the magnitude of Ki67 measurement and positively correlated with analyzed tumor area and breast cancer subtype. Agreement rates between KiQuant and MS within the clinically relevant 14% and 30% cut-off points ranged from 33% to 44% with modest interobserver reproducibility below the 20% cut-off (0.606, 95%CI:0.467–0.727). High Ki67 by KiQuant correlated with worse outcome in all BC and in the luminal subtype (P = 0.028 and P = 0.043, respectively). For MS, the association with survival was significant only in 1 out of 3 observers. Conclusions KiQuant represents an easy and accurate methodology for Ki67 measurement providing a step toward utilizing Ki67 in the clinical setting. Automated Ki67 scoring workflow improved reproducibility. Sequential immunohistochemistry in the same section for precise cell recognition. Use of a tumor mask for automatic tumor region selection. Outperform pathologist-based Ki67 scoring in prognostic prediction.
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Affiliation(s)
- Garazi Serna
- Molecular Oncology Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Sara Simonetti
- Molecular Oncology Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Roberta Fasani
- Molecular Oncology Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Francesca Pagliuca
- University of Naples Federico II, Department of Advanced Biomedical Sciences, Pathology Section, Naples, Italy
| | - Xavier Guardia
- Molecular Oncology Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Paqui Gallego
- Molecular Oncology Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Jose Jimenez
- Molecular Oncology Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Vicente Peg
- Department of Pathology, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Cristina Saura
- Breast Cancer and Melanoma Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | - Luigi Terracciano
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain.
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