Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Hematology-Oncology Division, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Cancer Cytopathol. 2022 Feb;130(2):128-135. doi: 10.1002/cncy.22520. Epub 2021 Oct 11.
The Mitosis-Karyorrhexis Index (MKI) score is important in neuroblastoma evaluation and in the application of the International Neuroblastoma Pathology Classification (INPC). Currently, it is not standardized for smears. Hence, the aim of this study was to devise and validate methods for MKI evaluation in fine-needle aspiration biopsy (FNAB) of neuroblastoma.
A total of 50 cases of neuroblastoma diagnosed by FNAB from January 2017 to December 2019 were retrieved, and detailed cytomorphological evaluations were performed. The MKI was evaluated, and the eyeball visual assessment score (EVAS) was compared with the digital image visual analysis score (DIVAS) on cytology smears and corresponding histology sections of cell blocks. The interobserver reproducibility and concordance were calculated. INPC subtyping into favorable and unfavorable groups was performed by the collation of age, MKI, and cytomorphology and was correlated to clinical outcomes.
Neuroblastoma was categorized as undifferentiated (22 of 50) or poorly differentiated (28 of 50) on cytomorphology. The overall concordance for the MKI by 3 observers was 86% (κ = 0.85), and this increased to 98% in the high MKI category. MKI evaluations on smears showed 96% concordance with cell block histology, and the EVAS was concordant with the DIVAS in 86% of the cases. Overall, the MKI was high in 39 cases, intermediate in 4 cases, and low in 7 cases. The INPC category was unfavorable in 90% (n = 45) and favorable in 10% (n = 5) and had significant correlations with outcomes (P = .029).
An MKI assessment on smears by digital image visual analysis is accurate, reproducible, and objective and should be incorporated into the routine reporting of neuroblastoma FNAB for diagnostic schemas as per the INPC.
有丝分裂-核碎解指数（MKI）评分在神经母细胞瘤评估和国际神经母细胞瘤病理分类（INPC）的应用中非常重要。目前，它在涂片方面尚未标准化。因此，本研究旨在设计和验证用于神经母细胞瘤细针抽吸活检（FNAB）中 MKI 评估的方法。
共检索了 2017 年 1 月至 2019 年 12 月间通过 FNAB 诊断的 50 例神经母细胞瘤病例，并进行了详细的细胞形态学评估。评估了 MKI，并比较了细胞学涂片和相应细胞块组织学切片的眼球视觉评估评分（EVAS）与数字图像视觉分析评分（DIVAS）。计算了观察者间的可重复性和一致性。通过年龄、MKI 和细胞形态学的整理，将 INPC 亚型分为有利和不利组，并与临床结果相关联。
细胞形态学上，神经母细胞瘤分为未分化型（22/50）或低分化型（28/50）。3 名观察者的 MKI 总体一致性为 86%（κ=0.85），在高 MKI 类别中增加到 98%。涂片上的 MKI 评估与细胞块组织学具有 96%的一致性，在 86%的病例中，EVAS 与 DIVAS 一致。总体而言，39 例 MKI 较高，4 例 MKI 中等，7 例 MKI 较低。INPC 类别为不利型 90%（n=45）和有利型 10%（n=5），与结局有显著相关性（P=0.029）。
通过数字图像视觉分析对涂片进行 MKI 评估是准确、可重复和客观的，应纳入神经母细胞瘤 FNAB 的常规报告，以符合 INPC 的诊断方案。
