Collins Brian T, Weimholt R Cody
Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
J Pathol Inform. 2015 Aug 31;6:47. doi: 10.4103/2153-3539.163986. eCollection 2015.
Whole slide images (WSIs) involve digitally capturing glass slides for microscopic computer-based viewing and these are amenable to quantitative image analysis. Bile duct (BD) brushing can show morphologic features that are categorized as indeterminate for malignancy. The study aims to evaluate quantitative morphologic features of atypical categories of BD brushing by WSI analysis for the identification of criteria predictive of malignancy.
Over a 3-year period, BD brush specimens with indeterminate diagnostic categorization (atypical to suspicious) were subjected to WSI analysis. Ten well-visualized groups with morphologic atypical features were selected per case and had the quantitative analysis performed for group area, individual nuclear area, the number of nuclei per group, N: C ratio and nuclear size differential.
There were 28 cases identified with 17 atypical and 11 suspicious. The average nuclear area was 63.7 µm(2) for atypical and 80.1 µm(2) for suspicious (+difference 16.4 µm(2); P = 0.002). The nuclear size differential was 69.7 µm(2) for atypical and 88.4 µm(2) for suspicious (+difference 18.8 µm(2); P = 0.009). An average nuclear area >70 µm(2) had a 3.2 risk ratio for suspicious categorization.
The quantitative criteria findings as measured by image analysis on WSI showed that cases categorized as suspicious had more nuclear size pleomorphism (+18.8 µm(2)) and larger nuclei (+16.4 µm(2)) than those categorized as atypical. WSI with morphologic image analysis can demonstrate quantitative statistically significant differences between atypical and suspicious BD brushings and provide objective criteria that support the diagnosis of carcinoma.
全玻片图像（WSIs）涉及对玻璃玻片进行数字捕捉以便基于计算机进行显微镜观察，并且适用于定量图像分析。胆管（BD）刷检可显示出形态特征，这些特征被归类为恶性不确定。本研究旨在通过WSI分析评估BD刷检非典型类别的定量形态特征，以确定预测恶性肿瘤的标准。
在3年期间，对诊断分类不确定（非典型至可疑）的BD刷检标本进行WSI分析。每例选取10个具有形态非典型特征且可视化良好的组，并对组面积、单个核面积、每组核数、N:C比和核大小差异进行定量分析。
共鉴定出28例，其中17例为非典型，11例为可疑。非典型组的平均核面积为63.7µm²，可疑组为80.1µm²（差异+16.4µm²；P = 0.002）。非典型组的核大小差异为69.7µm²，可疑组为88.4µm²（差异+18.8µm²；P = 0.009）。平均核面积>70µm²时，可疑分类的风险比为3.2。
通过WSI图像分析测量的定量标准结果显示，与非典型分类的病例相比，可疑分类的病例具有更多的核大小多形性（+18.8µm²）和更大的细胞核（+16.4µm²）。具有形态图像分析的WSI可以显示非典型和可疑BD刷检之间的定量统计学显著差异，并提供支持癌诊断的客观标准。
