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Brogård MB, Nielsen PS, Christensen KB, Georgsen JB, Wandler A, Lade-Keller J, Steiniche T. Immunohistochemical double nuclear staining for cell-specific automated quantification of the proliferation index - A promising diagnostic aid for melanocytic lesions. Pathol Res Pract 2024; 255:155177. [PMID: 38330618 DOI: 10.1016/j.prp.2024.155177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
AIMS Pathologists often use immunohistochemical staining of the proliferation marker Ki67 in their diagnostic assessment of melanocytic lesions. However, the interpretation of Ki67 can be challenging. We propose a new workflow to improve the diagnostic utility of the Ki67-index. In this workflow, Ki67 is combined with the melanocytic tumour-cell marker SOX10 in a Ki67/SOX10 double nuclear stain. The Ki67-index is then quantified automatically using digital image analysis (DIA). The aim of this study was to optimise and test three different multiplexing methods for Ki67/SOX10 double nuclear staining. METHODS Multiplex immunofluorescence (mIF), multiplex immunohistochemistry (mIHC), and multiplexed immunohistochemical consecutive staining on single slide (MICSSS) were optimised for Ki67/SOX10 double nuclear staining. DIA applications were designed for automated quantification of the Ki67-index. The methods were tested on a pilot case-control cohort of benign and malignant melanocytic lesions (n = 23). RESULTS Using the Ki67/SOX10 double nuclear stain, malignant melanocytic lesions could be completely distinguished from benign lesions by the Ki67-index. The Ki67-index cut-offs were 1.8% (mIF) and 1.5% (mIHC and MICSSS). The AUC of the automatically quantified Ki67-index based on double nuclear staining was 1.0 (95% CI: 1.0;1.0), whereas the AUC of conventional Ki67 single-stains was 0.87 (95% CI: 0.71;1.00). CONCLUSIONS The novel Ki67/SOX10 double nuclear stain highly improved the diagnostic precision of Ki67 interpretation. Both mIHC and mIF were useful methods for Ki67/SOX10 double nuclear staining, whereas the MICSSS method had challenges in the current setting. The Ki67/SOX10 double nuclear stain shows potential as a valuable diagnostic aid for melanocytic lesions.
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Affiliation(s)
- Mette Bak Brogård
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Patricia Switten Nielsen
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kristina Bang Christensen
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark
| | - Jeanette Bæhr Georgsen
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Anne Wandler
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark
| | - Johanne Lade-Keller
- Department of Pathology, Aalborg University Hospital, Ladegårdsgade 3, 9000 Aalborg, Denmark
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Corbella-Bagot L, Luque-Luna M, Morgado-Carrasco D. RF - Reflectance Confocal Microscopy for the Diagnosis of Equivocal Pigmented Lesions. Actas Dermosifiliogr 2023; 114:816-817. [PMID: 36871817 DOI: 10.1016/j.ad.2022.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 03/06/2023] Open
Affiliation(s)
- L Corbella-Bagot
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, España
| | - M Luque-Luna
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, España.
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Corbella-Bagot L, Luque-Luna M, Morgado-Carrasco D. [Translated article] RF-Reflectance Confocal Microscopy for the Diagnosis of Equivocal Pigmented Lesions. Actas Dermosifiliogr 2023; 114:T816-T817. [PMID: 37506830 DOI: 10.1016/j.ad.2022.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/04/2022] [Indexed: 07/30/2023] Open
Affiliation(s)
- L Corbella-Bagot
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - M Luque-Luna
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain.
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Shi T, Zhang J, Bao Y, Gao X. [Deep learning-based fully automated intelligent and precise diagnosis for melanocytic lesions]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2022; 39:919-927. [PMID: 36310480 PMCID: PMC9927722 DOI: 10.7507/1001-5515.202203080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Melanocytic lesions occur on the surface of the skin, in which the malignant type is melanoma with a high fatality rate, seriously endangering human health. The histopathological analysis is the gold standard for diagnosis of melanocytic lesions. In this study, a fully automated intelligent diagnosis method based on deep learning was proposed to classify the pathological whole slide images (WSI) of melanocytic lesions. Firstly, the color normalization based on CycleGAN neural network was performed on multi-center pathological WSI; Secondly, ResNet-152 neural network-based deep convolutional network prediction model was built using 745 WSI; Then, a decision fusion model was cascaded, which calculates the average prediction probability of each WSI; Finally, the diagnostic performance of the proposed method was verified by internal and external test sets containing 182 and 54 WSI, respectively. Experimental results showed that the overall diagnostic accuracy of the proposed method reached 94.12% in the internal test set and exceeded 90% in the external test set. Furthermore, the color normalization method adopted was superior to the traditional color statistics-based and staining separation-based methods in terms of structure preservation and artifact suppression. The results demonstrate that the proposed method can achieve high precision and strong robustness in pathological WSI classification of melanocytic lesions, which has the potential in promoting the clinical application of computer-aided pathological diagnosis.
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Affiliation(s)
- Tianlei Shi
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, P. R. China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu 215163, P. R. China
| | - Jiayi Zhang
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, P. R. China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu 215163, P. R. China
- Jinan Guoke Medical Engineering and Technology Development Co., Ltd., Jinan 250101, P. R. China
| | - Yongyang Bao
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, P. R. China
| | - Xin Gao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu 215163, P. R. China
- Jinan Guoke Medical Engineering and Technology Development Co., Ltd., Jinan 250101, P. R. China
- Jiangsu Province Engineering Research Center of Diagnosis and Treatment of Children's Malignant Tumor, Suzhou, Jiangsu 215025, P. R. China
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Kalloniati E, Cavouras D, Plachouri KM, Geropoulou E, Sakellaropoulos G, Georgiou S. Clinical, dermoscopic and histological assessment of melanocytic lesions: a comparative study of the accuracy of the diagnostic methods. Hippokratia 2021; 25:156-161. [PMID: 36743868 PMCID: PMC9894303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Worldwide, the incidence of melanoma is increasing, while late diagnosis is related to poor prognosis. A significant risk marker for melanoma is the presence of atypical nevi; therefore, it is of outstanding importance to make accurate clinical classification of common benign nevi, atypical nevi, and melanomas. The non-invasive method of dermoscopy allowed for the visualization of structures invisible to the naked eye and undoubtedly advanced the assessment of melanocytic lesions to a new dimension. This study aimed to evaluate the sensitivity and specificity of naked-eye examination and dermoscopy in diagnosing melanocytic lesions compared to the histopathological results, constituting the gold standard of diagnosis. MATERIAL AND METHODS One hundred eighteen melanocytic lesions were clinically evaluated via the naked eye and dermoscopic examination, using Pattern Analysis Methodology, and afterward, they were excised. The histopathological results were correlated with the findings. RESULTS According to the final histopathological analysis, 63 common benign nevi, 41 dysplastic nevi, and 14 cutaneous melanomas were excised in total. Clinical examination via the naked eye showed 78.2 % sensitivity and 71.4 % specificity in identifying the clinical atypia, while dermoscopy demonstrated 89.1 % sensitivity and 93.7 % specificity. CONCLUSIONS The results of the present study indicate a higher sensitivity and specificity of dermoscopy in evaluating and diagnosing melanocytic lesions compared to the naked-eye examination. HIPPOKRATIA 2021, 25 (4):156-161.
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Affiliation(s)
- E Kalloniati
- Dermatology Department, University General Hospital of Patras, Rio, Greece
| | - D Cavouras
- Medical Image and Signal Processing Lab (MEDISP), Department of Biomedical Engineering, University of West Attica, Athens, Greece
| | - K M Plachouri
- Dermatology Department, University General Hospital of Patras, Rio, Greece
| | - E Geropoulou
- Department of Pathology, University General Hospital of Patras, Rio, Greece
| | - G Sakellaropoulos
- Department of Medical Physics, School of Health Sciences, Faculty of Medicine, University of Patras, Rio, Greece
| | - S Georgiou
- Dermatology Department, University General Hospital of Patras, Rio, Greece
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Gill P, Richards K, Cho WC, Nagarajan P, Aung PP, Ivan D, Curry JL, Prieto VG, Torres-Cabala CA. Localized cutaneous argyria: Review of a rare clinical mimicker of melanocytic lesions. Ann Diagn Pathol 2021; 54:151776. [PMID: 34214703 DOI: 10.1016/j.anndiagpath.2021.151776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022]
Abstract
Localized cutaneous argyria is a rare cutaneous disorder that has been associated with occupational exposure, dental procedures, topical agents, acupuncture, earrings, and nasal piercings. In this paper, we review the current literature on localized cutaneous argyria, highlight its clinical and histologic diagnostic features, and then discuss the clinical and histological differential diagnoses for blue-gray skin and black dermal pigment, respectively. We also discuss the utility of ancillary techniques, such as deeper histologic levels, special stains, darkfield microscopy, and advanced micro-analytical techniques in helping diagnose localized cutaneous argyria. Furthermore, we emphasize that a thorough clinical history and astute clinico-pathologic correlation can be the most important diagnostic techniques in correctly diagnosing this rare disorder. Our review aims serve as a reminder to clinicians and pathologists of the importance of including localized cutaneous argyria in the clinical and histological differential diagnosis of pigmented lesions.
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Affiliation(s)
- Pavandeep Gill
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Kristen Richards
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Woo Cheal Cho
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Doina Ivan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Onega T, Reisch LM, Frederick PD, Geller BM, Nelson HD, Lott JP, Radick AC, Elder DE, Barnhill RL, Piepkorn MW, Elmore JG. Use of Digital Whole Slide Imaging in Dermatopathology. J Digit Imaging 2017; 29:243-53. [PMID: 26546178 DOI: 10.1007/s10278-015-9836-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Digital whole slide imaging (WSI) is an emerging technology for pathology interpretation, with specific challenges for dermatopathology, yet little is known about pathologists' practice patterns or perceptions regarding WSI for interpretation of melanocytic lesions. A national sample of pathologists (N = 207) was recruited from 864 invited pathologists from ten US states (CA, CT, HI, IA, KY, LA, NJ, NM, UT, and WA). Pathologists who had interpreted melanocytic lesions in the past year were surveyed in this cross-sectional study. The survey included questions on pathologists' experience, WSI practice patterns and perceptions using a 6-point Likert scale. Agreement was summarized with descriptive statistics to characterize pathologists' use and perceptions of WSI. The majority of participating pathologists were between 40 and 59 years of age (62%) and not affiliated with an academic medical center (71%). Use of WSI was seen more often among dermatopathologists and participants affiliated with an academic medical center. Experience with WSI was reported by 41%, with the most common type of use being for education and testing (CME, board exams, and teaching in general, 71%), and clinical use at tumor boards and conferences (44%). Most respondents (77%) agreed that accurate diagnoses can be made with this technology, and 59% agreed that benefits of WSI outweigh concerns. However, 78% of pathologists reported that digital slides are too slow for routine clinical interpretation. The respondents were equally split as to whether they would like to adopt WSI (49%) or not (51%). The majority of pathologists who interpret melanocytic lesions do not use WSI, but among pathologists who do, use is largely for CME, licensure/board exams, and teaching. Positive perceptions regarding WSI slightly outweigh negative perceptions. Understanding practice patterns with WSI as dissemination advances may facilitate concordance of perceptions with adoption of the technology.
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Affiliation(s)
- Tracy Onega
- Department of Biomedical Data Science, Department of Epidemiology, Norris Cotton Cancer Center, Lebanon, NH, USA.
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
| | | | | | - Berta M Geller
- Department of Family Medicine, University of Vermont Burlington, Burlington, VT, USA
| | | | | | | | - David E Elder
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Raymond L Barnhill
- Department of Pathology, Institut Curie, Paris, France
- University of California, Los Angeles, CA, USA
| | - Michael W Piepkorn
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Dermatopathology Northwest, Bellevue, WA, USA
| | - Joann G Elmore
- Department of Medicine, University of Washington, Seattle, WA, USA
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Abstract
As cutaneous melanomas manifest a wide spectrum of clinical and pathologic presentations, several other lesions enter into their differential diagnosis. This article considers those entities, including melanocytic hyperplasia, cellular nodules in congenital nevi, atypical lentiginous melanocytic proliferations, "special site" nevi, epithelioid histiocytoma, neurothekeoma, cellular schwannoma, and proliferating scars.
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Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology and Cytopathology, University of Virginia Medical Center, Room 3020, 1215 Lee St, Charlottesville, Virginia 22908-0214.
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Linertová R, Valcárcel-Nazco C, Lacalle-Remigio JR. [Management of benign melanocytic lesions as a melanoma prevention. Systematic review]. Med Clin (Barc) 2016; 147:162-70. [PMID: 27026061 DOI: 10.1016/j.medcli.2016.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/17/2016] [Indexed: 11/24/2022]
Abstract
There is a growing concern and awareness of skin cancer. As a result, possibly unnecessary surgeries of melanocytic lesions are carried out as a prophylactic measure. We performed a systematic review of the medical literature to identify primary studies on the effectiveness and cost-effectiveness of surgery treatment of benign melanocytic lesions for melanoma prevention. We included 19 primary studies on surgical treatment of acquired melanocytic lesions and one economic evaluation. Indicators, such as number needed to treat and the malignancy ratio, depend on several factors such as specialty and experience of the physician, pressure from the patient or patient characteristics. Early diagnosis of melanoma is critical in preventing skin cancer. However, primary studies show through several indicators that there are factors that increase the proportion of lesions treated unnecessarily. Effectiveness can be improved by careful use of techniques to identify suspicious lesions and educational programs for physicians, especially in primary care.
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Boone MALM, Suppa M, Dhaenens F, Miyamoto M, Marneffe A, Jemec GBE, Del Marmol V, Nebosis R. In vivo assessment of optical properties of melanocytic skin lesions and differentiation of melanoma from non-malignant lesions by high-definition optical coherence tomography. Arch Dermatol Res 2015; 308:7-20. [PMID: 26563265 PMCID: PMC4713458 DOI: 10.1007/s00403-015-1608-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/11/2015] [Accepted: 10/19/2015] [Indexed: 12/03/2022]
Abstract
One of the most challenging problems in clinical dermatology is the early detection of melanoma. Reflectance confocal microscopy (RCM) is an added tool to dermoscopy improving considerably diagnostic accuracy. However, diagnosis strongly depends on the experience of physicians. High-definition optical coherence tomography (HD-OCT) appears to offer additional structural and cellular information on melanocytic lesions complementary to that of RCM. However, the diagnostic potential of HD-OCT seems to be not high enough for ruling out the diagnosis of melanoma if based on morphology analysis. The aim of this paper is first to quantify in vivo optical properties such as light attenuation in melanocytic lesions by HD-OCT. The second objective is to determine the best critical value of these optical properties for melanoma diagnosis. The technique of semi-log plot whereby an exponential function becomes a straight line has been implemented on HD-OCT signals coming from four successive skin layers (epidermis, upper papillary dermis, deeper papillary dermis and superficial reticular dermis). This permitted the HD-OCT in vivo measurement of skin entrance signal (SES), relative attenuation factor normalized for the skin entrance signal (µraf1) and half value layer (z1/2). The diagnostic accuracy of HD-OCT for melanoma detection based on the optical properties, µraf1, SES and z1/2 was high (95.6, 82.2 and 88.9 %, respectively). High negative predictive values could be found for these optical properties (96.7, 89.3 and 96.3 %, respectively) compared to morphologic assessment alone (89.9 %), reducing the risk of mistreating a malignant lesion to a more acceptable level (3.3 % instead of 11.1 %). HD-OCT seems to enable the combination of in vivo morphological analysis of cellular and 3-D micro-architectural structures with in vivo analysis of optical properties of tissue scatterers in melanocytic lesions. In vivo HD-OCT analysis of optical properties permits melanoma diagnosis with higher accuracy than in vivo HD-OCT analysis of morphology alone.
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Affiliation(s)
- M A L M Boone
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
| | - M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - F Dhaenens
- Research Department, Agfa HealthCare, Mortsel, Belgium
| | - M Miyamoto
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - A Marneffe
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - G B E Jemec
- Department of Dermatology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - R Nebosis
- Research Department, Agfa HealthCare, Munich, Germany
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Nielsen PS, Spaun E, Riber-Hansen R, Steiniche T. Automated quantification of MART1-verified Ki-67 indices: useful diagnostic aid in melanocytic lesions. Hum Pathol 2014; 45:1153-61. [PMID: 24704158 DOI: 10.1016/j.humpath.2014.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 01/02/2014] [Accepted: 01/07/2014] [Indexed: 12/29/2022]
Abstract
The MART1-verified Ki-67 proliferation index is a valuable aid to distinguish melanomas from nevi. Because such indices are quantifiable by image analysis, they may provide a novel automated diagnostic aid. This study aimed to validate the diagnostic performance of automated dermal Ki-67 indices and to explore the diagnostic capability of epidermal Ki-67 in lesions both with and without a dermal component. In addition, we investigated the automated indices' ability to predict sentinel lymph node (SLN) status. Paraffin-embedded tissues from 84 primary cutaneous melanomas (35 with SLN biopsy), 22 melanoma in situ, and 270 nevi were included consecutively. Whole slide images were captured from Ki-67/MART1 double stains, and image analysis computed Ki-67 indices for epidermis and dermis. In lesions with a dermal component, the area under the receiver operating characteristic (ROC) curve was 0.79 (95% confidence interval [CI], 0.72-0.86) for dermal indices. By excluding lesions with few melanocytic cells, this area increased to 0.93 (95% CI, 0.88-0.98). A simultaneous analysis of epidermis and dermis yielded an ROC area of 0.94 (95% CI, 0.91-0.96) for lesions with a dermal component and 0.98 (95% CI, 0.97-1.0) for lesions with a considerable dermal component. For all lesions, the ROC area of the simultaneous analysis was 0.89 (95% CI, 0.85-0.92). SLN-positive patients generally had a higher index than SLN-negative patients (P ≤ .003). Conclusively, an automated diagnostic aid seems feasible in melanocytic pathology. The dermal Ki-67 index was inferior to a combined epidermal and dermal index in diagnosis but valuable for predicting the SLN status of our melanoma patients.
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Affiliation(s)
- Patricia Switten Nielsen
- Department of Pathology, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark.
| | - Eva Spaun
- Department of Pathology, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark
| | - Rikke Riber-Hansen
- Department of Pathology, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark
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