Comparison of the Papanicolaou and Feulgen staining methods for DNA quantification by image analysis

Cytoplasmic SIRT1 promotes paclitaxel resistance in ovarian carcinoma through increased formation and survival of polyploid giant cancer cells

Therapeutic resistance is a notable cause of death in patients with ovarian carcinoma. Polyploid giant cancer cells (PGCCs), commonly arising in tumor tissues following chemotherapy, have recently been considered to contribute to drug resistance. As a type III deacetylase, Sirtuin1 (SIRT1) plays essential roles in the cell cycle, cellular senescence, and drug resistance. Accumulating evidence has suggested that alteration in its subcellular localization via nucleocytoplasmic shuttling is a critical process influencing the functions of SIRT1. However, the roles of SIRT1 subcellular localization in PGCC formation and subsequent senescence escape remain unclear. In this study, we compared the differences in the polyploid cell population and senescence state of PGCCs following paclitaxel treatment between tumor cells overexpressing wild-type SIRT1 (WT SIRT1) and those expressing nuclear localization sequence (NLS)-mutated SIRT1 (SIRT1NLSmt ). We investigated the involvement of cytoplasmic SIRT1 in biological processes and signaling pathways, including the cell cycle and cellular senescence, in ovarian carcinoma cells' response to paclitaxel treatment. We found that the SIRT1NLSmt tumor cell population contained more polyploid cells and fewer senescent PGCCs than the SIRT1-overexpressing tumor cell population. Comparative proteomic analyses using co-immunoprecipitation (Co-IP) combined with liquid chromatography-mass spectrometry (LC-MS)/MS showed the differences in the differentially expressed proteins related to PGCC formation, cell growth, and death, including CDK1 and CDK2, between SIRT1NLSmt and SIRT1 cells or PGCCs. Our results suggested that ovarian carcinoma cells utilize polyploidy formation as a survival mechanism during exposure to paclitaxel-based treatment via the effect of cytoplasmic SIRT1 on PGCC formation and survival, thereby boosting paclitaxel resistance. © 2023 The Pathological Society of Great Britain and Ireland.

ThinPrep® imaging system-assisted vs manual screening of urinary cytology slides in the detection of the "suspicious for high-grade urothelial carcinoma" category

BACKGROUND

The ThinPrep® Imaging System (TIS) is a Food and Drug Administration-approved review system for cervical cytopathology, where it has been shown to increase performance over manually reviewed slides. Application of the TIS to urinary cytology has only been reported in a single study, in 2013.

METHODS

We aimed to compare the agreement of two cytotechnologists' and a pathologist's manual screening (dots) with the fields of view (FOVs) selected by the TIS. We also aimed to track cases in which the TIS could identify missed abnormals and reduce the false-negative fraction. Electronically marked TIS fields (EMTFs) suspicious for high-grade urothelial carcinoma (SHGUC) were controlled by follow-up cystoscopy and histology, where available.

RESULTS

A total of 826 consecutive specimens were studied. Of those, 94 (11.4%) were unreadable by the TIS. There were 710 possible comparisons, of which 380 (53.5%) received no dot after manual screening. Of the 330 remaining slides, 149 (45.1%) had at least one dot matching with the TIS FOVs. After TIS reading, EMTFs were noted in 13 of 636 (2.0%) negative cytology cases. Surveillance showed that 3/13 (23.1%, 0.4% of the 710 possible comparisons) of those cases matched with high grade urothelial carcinoma (HGUC), whereas 6/13 (46.1%, 0.8% of the 710 possible comparisons) had negative follow-up at 24 months, and 4/13 (30.8%) were lost for follow-up.

CONCLUSION

The TIS increases the detection rate of SHGUC cells, potentially leading to a slight decrease in the false-negative fraction, but at the expense of a slight but larger increase in the number of false-positive cases. These findings stress the importance of a careful approach to the evaluation of the FOVs.

What is the state of the art of computer vision-assisted cytology? A Systematic Literature Review

Cytology is a low-cost and non-invasive diagnostic procedure employed to support the diagnosis of a broad range of pathologies. Cells are harvested from tissues by aspiration or scraping, and it is still predominantly performed manually by medical or laboratory professionals extensively trained for this purpose. It is a time-consuming and repetitive process where many diagnostic criteria are subjective and vulnerable to human interpretation. Computer Vision technologies, by automatically generating quantitative and objective descriptions of examinations' contents, can help minimize the chances of misdiagnoses and shorten the time required for analysis. To identify the state-of-art of computer vision techniques currently applied to cytology, we conducted a Systematic Literature Review, searching for approaches for the segmentation, detection, quantification, and classification of cells and organelles using computer vision on cytology slides. We analyzed papers published in the last 4 years. The initial search was executed in September 2020 and resulted in 431 articles. After applying the inclusion/exclusion criteria, 157 papers remained, which we analyzed to build a picture of the tendencies and problems present in this research area, highlighting the computer vision methods, staining techniques, evaluation metrics, and the availability of the used datasets and computer code. As a result, we identified that the most used methods in the analyzed works are deep learning-based (70 papers), while fewer works employ classic computer vision only (101 papers). The most recurrent metric used for classification and object detection was the accuracy (33 papers and 5 papers), while for segmentation it was the Dice Similarity Coefficient (38 papers). Regarding staining techniques, Papanicolaou was the most employed one (130 papers), followed by H&E (20 papers) and Feulgen (5 papers). Twelve of the datasets used in the papers are publicly available, with the DTU/Herlev dataset being the most used one. We conclude that there still is a lack of high-quality datasets for many types of stains and most of the works are not mature enough to be applied in a daily clinical diagnostic routine. We also identified a growing tendency towards adopting deep learning-based approaches as the methods of choice.

Evaluation of Viral Genome Copies Within Viral Factories on Different DNA Viruses

This article describes a simple method of measuring the number of viral genomes within viral factories. For this purpose, we use three DNA viruses replicating in the cytoplasm of the infected cells: wild-type African swine fever virus (ASFV)-Georgia 2007, culture-adapted type ASFV-BA71V, and Vaccinia virus (VV). The measurements are conducted in three steps. In the first step, after DNA staining, we evaluate Integrated Optical Density (IOD) of total DNA for each viral factory. The second step involves the calculations of the mass of DNA in the viral factories in picograms (pg). And, in the third step, by dividing the mass of DNA within viral factory by the weight of a single viral genome, we obtain the number of viral genomes within the factory.

Combined use of urinary Survivin detection and liquid-based cytology for the early diagnosis of bladder urothelial carcinoma

To assess the possibility of combined using urine Survivin and liquid-based cytology (LBC) tests to improve the diagnosis of bladder urothelial carcinoma (BUC), the present study analyzed urine from 36 patients with bladder cancer and 36 benign cases as control individuals. The Survivin content in the patient's morning urine was assessed by ELISA. When the sample value exceeded double of the average of the control group, it was defined as positive and the patient was diagnosed as bladder cancer. Meanwhile, LBC was performed for the same sample. Urinary Survivin detection combined with LBC test showed a sensitivity of 91.7%, a specificity of 91.7% and accuracy of 91.7% for the diagnosis of BUC. Compared with each test individually, although the specificity decreased, the sensitivity and accuracy of the combined detection improved significantly (P<0.05). The data presented in the current study identified that the LBC test is a novel diagnostic method for urinary tract tumors and its detection rate was superior to the conventional urine cytology test. Additionally, Survivin detection combined with LBC could significantly improve the detection rate of BUC. In addition, this method is non-invasive, economical, simple and precise.

Cytological and cytomorphometric evaluation of the oral mucosa in HIV-infected patients undergoing antiretroviral therapy

BACKGROUND

To evaluate HIV infection-induced alterations in the oral mucosa by comparing inflammation, cell maturation, and cytomorphometric changes in oral mucosal cells between HIV-infected patients undergoing highly active antiretroviral therapy (HAART) and non-HIV-infected patients.

METHODS

Thirty HIV-infected patients undergoing HAART and 30 non-HIV-infected patients were studied. Four smears were obtained from the lateral border of the tongue and floor of the mouth with a cytobrush. One sample was stained by the Papanicolaou technique, and three samples were processed for Feulgen staining. Papanicolaou-stained smears were analyzed by light microscopy, and the cytoplasmic (CA) and nuclear (NA) area were measured with the Software AxioVision 4.7.

RESULTS

The Wilcoxon signed-rank test showed a significant difference in intermediate epithelial cell types between the HIV-infected and non-HIV-infected groups (P=.005). However, this difference was not observed for superficial epithelial cell types with (P=.672) and without a nucleus (P=.069). Comparative analysis revealed no significant difference in CA (P=.604), NA (P=.298) or NA/CA (P=.456) between the HIV-infected and non-HIV-infected groups. Keratohyalin granules were more frequent in the non-HIV-infected group (P=.0001).

CONCLUSIONS

The results showed alterations in cell maturation in HIV-infected patients undergoing HAART with undetectable viral load, but no morphometric changes were observed.

Can Feulgen Stain be a Reliable Biomarker over PAP Stain for Estimation of Micronuclei Score?

INTRODUCTION

Malignant transformation of the Potentially Malignant Lesions (PML) in the oral cavity is associated with elevated mortality rate because of its aggressive and exceedingly invasive nature. Meticulous diagnosis and prompt therapy of PML may help prevent malignant conversion in oral lesions. Carcinogenic insult to oral cells results in chromosomal damage and formation of Micronuclei (Mn), before the development of clinical symptoms.

AIM

To determine the genotoxic effect of smoking and chewing tobacco on target tissue using Mn assay and to evaluate the prevalence of other nuclear anomalies associated with it and to determine the reliability of feulgen stain for Mn assay over Papaincolau (PAP) stain.

MATERIALS AND METHODS

PAP and feulgen staining was done to study Mn in individuals who were having tobacco habits (smoking and chewing) without lesion (n=30), individuals who were having tobacco habit (smoking and chewing) with PML (n=30) and apparently healthy subjects (n=30). Data was analysed for statistical significance using SPSS 17.0 by Kruskal - Wallis Test and Bonferronii test.

RESULTS

Tobacco habits in the form of smoking and chewing have mutagenic effects on human chromosomes which is indicated by increased frequency of Mn in oral exfoliative cells. The mean Mn frequency using feulgen stain was found to be 12.27 with lesion, 10.23 with without lesion and 3.87 in controls. Whereas, metanucleated analysis revealed no significant correlation with the formation of Mn. Non-specific DNA stain (PAP) showed high numbers of Mn cells in all the groups compared to feulgen. Statistically significant difference (p<0.0001) was observed when both the stains were compared for Mn numbers.

CONCLUSION

These findings indicate that the individuals having tobacco habits (smoking and chewing) with lesion have high number of Mn cells, thus supporting the assay to be used as a reliable biomarker to assess the genotoxic effect of tobacco in the oral mucosa. The reason for almost twice as high Mn in PAP stained smears is suggestive of cell injury which is collimated by formation of keratin bodies, resulting in its misinterpretation as Mn, leading to false positive results. Hence, it was concluded that PAP stain can be used to identify abnormal cytological changes resulting from mutagenic agent but not to interpret Mn.

Three-dimensional DNA image cytometry by optical projection tomographic microscopy for early cancer diagnosis

Aneuploidy is typically assessed by flow cytometry (FCM) and image cytometry (ICM). We used optical projection tomographic microscopy (OPTM) for assessing cellular DNA content using absorption and fluorescence stains. OPTM combines some of the attributes of both FCM and ICM and generates isometric high-resolution three-dimensional (3-D) images of single cells. Although the depth of field of the microscope objective was in the submicron range, it was extended by scanning the objective's focal plane. The extended depth of field image is similar to a projection in a conventional x-ray computed tomography. These projections were later reconstructed using computed tomography methods to form a 3-D image. We also present an automated method for 3-D nuclear segmentation. Nuclei of chicken, trout, and triploid trout erythrocyte were used to calibrate OPTM. Ratios of integrated optical densities extracted from 50 images of each standard were compared to ratios of DNA indices from FCM. A comparison of mean square errors with thionin, hematoxylin, Feulgen, and SYTOX green was done. Feulgen technique was preferred as it showed highest stoichiometry, least variance, and preserved nuclear morphology in 3-D. The addition of this quantitative biomarker could further strengthen existing classifiers and improve early diagnosis of cancer using 3-D microscopy.

Improving accuracy in astrocytomas grading by integrating a robust least squares mapping driven support vector machine classifier into a two level grade classification scheme

Grading of astrocytomas is an important task for treatment planning; however, it suffers from significantly great inter-observer variability. Computer-assisted diagnosis systems have been propose to assist towards minimizing subjectivity, however, these systems present either moderate accuracy or utilize specialized staining protocols and grading systems that are difficult to apply in daily clinical practice. The present study proposes a robust mathematical formulation by integrating state-of-art technologies (support vector machines and least squares mapping) in a cascade classification scheme for separating low from high and grade III from grade IV astrocytic tumours. Results have indicated that low from high-grade tumours can be correctly separated with a certainty as high as 97.3%, whereas grade III from grade IV tumours with 97.8%. The overall performance was 95.2%. These high rates have been a result of applying the least squares mapping technique to features prior to classification. A significant byproduct of least squares mapping is that the number of support vectors of the SVM classifiers dropped dramatically from about 80% when no mapping was used to less than 5% when mapping was used. The latter is a clear indication that the SVM classifier has a greater potential to generalize well to new data. In this way, digital image analysis systems for automated grading of astrocytomas are brought closer to clinical practice.

Effect of cytological fixative and environmental conditions on nuclear morphometric characteristics of squamous epithelial cells in sputum

BACKGROUND

Sputum samples for lung cancer screening trials are typically collected at home into specimen containers prefilled with cytologic fixative. Collection, transit, and storage expose samples to environmental conditions that may introduce artifacts that could confound evaluation. We examined whether the type of cytological fixative and exposure to different environmental conditions introduces artifacts that affect cytological analysis.

METHODS

Sputum fixed in Saccomanno fluid (SAC), containing methyl, ethyl, and propyl alcohols and polyethylene glycol, or CytoRich Red solution (CRR), containing methyl and isopropyl alcohols and ethylene glycol, plus formaldehyde, was aliquoted and exposed for 8 h to the following conditions: (a) -20 degrees C freezer, (b) 60 degrees C oven, (3) direct sunlight, and (4) room temperature. Cell morphometry was evaluated using computer-assisted image analysis (CAIA).

RESULTS

The values obtained for CAIA analysis of sputum were affected by the type of fixative used. Temperature extremes and sunlight dramatically altered nuclear morphometry of SAC-fixed cells. Artifacts were not observed in CRR-fixed cells.

CONCLUSIONS

The effects of environmental exposures were minimized if sputum was placed in a formalin-containing fixative such as CRR. If an alcohol-based fixative such as SAC is used, sample handling, transport, and storage must be monitored to prevent the introduction of artifacts.

A decision support system to detect morphologic changes of chromatin arrangement in normal-appearing cells

Several studies have described malignancy-associated changes (MACs) of chromatin arrangement in the nuclei of apparently normal cells adjacent to and distant from an invasive cancer area. MAC assessment is a hard task, since it requires a deep knowledge of morphologic features of chromatin arrangement. The aim of this work is to verify the reproducibility of the subjective evaluation of the expert on the basis of a decision support system (DSS) that automatically and objectively reproduces MAC diagnosis. A set of 61 patients with suspected clinical diagnosis for lung cancer has been taken into account. The scientist who first described MAC defined each patient as MAC positive or negative on the basis of the MAC diagnosis performed on all cells of the related cytologic sample. A DSS based on an artificial neural network has been set up to learn the relation between 14 morphometric and texture parameters, computed on each nucleus by image processing techniques, with the MAC diagnosis of the expert on each cell. The results show that an objective automatic assessment on MAC by the DSS can effectively support the MAC diagnosis. The method adopted in this approach may be also appropriate for other problems, where an automatic classification of visually inspected patterns of biological micro- and submicrostructure is needed.

Using Nuclear Morphometry to Discriminate the Tumorigenic Potential of Cells: A Comparison of Statistical Methods

Despite interest in the use of nuclear morphometry for cancer diagnosis and prognosis as well as to monitor changes in cancer risk, no generally accepted statistical method has emerged for the analysis of these data. To evaluate different statistical approaches, Feulgen-stained nuclei from a human lung epithelial cell line, BEAS-2B, and a human lung adenocarcinoma (non-small cell) cancer cell line, NCI-H522, were subjected to morphometric analysis using a CAS-200 imaging system. The morphometric characteristics of these two cell lines differed significantly. Therefore, we proceeded to address the question of which statistical approach was most effective in classifying individual cells into the cell lines from which they were derived. The statistical techniques evaluated ranged from simple, traditional, parametric approaches to newer machine learning techniques. The multivariate techniques were compared based on a systematic cross-validation approach using 10 fixed partitions of the data to compute the misclassification rate for each method. For comparisons across cell lines at the level of each morphometric feature, we found little to distinguish nonparametric from parametric approaches. Among the linear models applied, logistic regression had the highest percentage of correct classifications; among the nonlinear and nonparametric methods applied, the Classification and Regression Trees model provided the highest percentage of correct classifications. Classification and Regression Trees has appealing characteristics: there are no assumptions about the distribution of the variables to be used, there is no need to specify which interactions to test, and there is no difficulty in handling complex, high-dimensional data sets containing mixed data types.

Evaluation of diagnostic efficiency of computerized image analysis based quantitative nuclear parameters in papillary and follicular thyroid tumors using paraffin-embedded tissue sections

Computerized image analysis (IA) system has emerged in recent years as a very powerful tool for objective and reproducible quantification of histological features. It has shown considerable potential for diagnostic application in diverse histological situations. The objectives of the present study were to evaluate the discriminatory diagnostic efficiency of computerized image analysis based quantitative subvisual nuclear parameters in papillary and follicular neoplasms of thyroid. A total of 60 cases were studied. Forty-four cases belonged to training set and 16 cases belonged to a test set. A minimum of 100 nuclei was analyzed in each case using uniform 5 m mm thick hematoxylin stained sections. The IA workstation comprised of an Olympus microscope, a 10 bit digital video camera, an image grabber card and a pentium 120 MHz computer. Optimas 5.2 software was utilized for data collection on 8 morphometric and 8 densitometric parameters. Multivariate stepwise discriminant statistical analysis of data was done with the help of BMDP statistical software release 7.0. Results from a training set revealed correct classification rates of 98.0%, 84.5% and 61.2% for the histological groups of hyperplastic papillae versus papillae of papillary carcinoma (group I), follicular variant of papillary carcinoma versus the broad category of follicular neoplasms consisting of both follicular adenoma and follicular carcinoma (group II) and follicular adenoma versus follicular carcinoma (group III), respectively. Results of test set revealed correct classification rates of 100%, 80% and 50% for groups I, II and III respectively. It was concluded that computerized nuclear IA parameters have potential usefulness for discriminating benign versus malignant papillary lesions of thyroid, follicular variant of papillary carcinoma versus follicular adenoma and/or follicular carcinoma but are of no value in discriminating between follicular adenoma and follicular carcinoma.

Flow cytometric and quantitative image cell analysis of DNA ploidy in renal chromophobe cell carcinoma

Flow cytometry and quantitative image cell analyses were performed on a series of 31 chromophobe cell carcinoma and the findings were compared with those from 14 clear cell carcinomas. Thirty of 31 chromophobe cell carcinomas had significant hypodiploid cell clones with both techniques. By contrast, none of the 14 clear cell carcinomas was hypodiploid. Using quantitative image cell analyses, four groups of nuclei with hypodiploid, diploid, hyperdiploid, and tetraploid/hypertetraploid DNA patterns were identified, and their relative proportions were compared. In most of the chromophobe cell carcinomas, the predominant nuclear pattern was hypodiploid, and in clear cell carcinoma, diploid nuclei were most frequent. The number of binucleated cells in chromophobe cell carcinomas varied from 1.40% to 23% (mean, 10.8%) whereas, in clear cell carcinoma, these varied from 0.4% to 9.2% (mean, 2.5%). Evaluation of DNA content of double hypodiploid nuclei in chromophobe cell carcinomas showed that their combined DNA content was essentially similar to that of single hyperdiploid nuclei, thus suggesting polyploidy resulting from the fusion of these nuclei. Polyploidy may indeed be the basis for nuclear heterogeneity in chromophobe cell carcinoma. Scatterplots generated by plotting nuclear DNA mass against nuclear area produced patterns that were distinctive for the two types of carcinoma. We believe that the comparative findings in this study provide a comprehensive understanding of the ploidy status of chromophobe carcinoma and that these findings may be used as supportive evidence for establishing the diagnosis of chromophobe cell carcinoma.

Induction of apoptosis in cardiac myocytes by an A3 adenosine receptor agonist

The effects of the selective adenosine (ADO) A3 receptor agonist IB-MECA (N6-(3-iodobenzyl)adenosine-5'-N-methylcarboxamide) on cultured newborn rat cardiomyocytes were examined in comparison with ADO, the ADO A1 receptor-selective agonist R-PIA (N6-R-phenylisopropyladenosine), or the ADO A3 selective antagonist MRS 1191 (3-ethyl-5-benzyl-2-methyl-6-phenyl-4-phenylethynyl-1, 4-(+/-)-dihydropyridine-3,5 dicarboxylate), using digital image analysis of Feulgen-stained nuclei. At high concentration, IB-MECA (>/=10 microM ) and ADO (200 microM) induced apoptosis; however, R-PIA or MRS 1191 did not have any detectable effects on cardiac cells. In addition, DNA breaks in cardiomyocytes undergoing apoptosis following treatment by IB-MECA were identified in situ using the nick end labeling of DNA ("TUNEL"-like) assay. In the presence of >/=10 microM IB-MECA, disorder in the contraction waves appeared, and a decrease in the frequency of beats was observed. Analysis with light microscopy revealed that the number of contracting cells decreased in a concentration-dependent manner. The A3 receptor agonist IB-MECA caused an increase in intracellular free calcium concentration ([Ca2+]i). The drug produced a rapid rise followed by a sustained increase in [Ca2+]i, which lasted for 40-60 s. Finally, cessation of beating and Ca2+ transients were observed. Full recovery of contractile activity and rhythmical Ca2+ transients were observed 15-20 min after IB-MECA treatment. The induction of apoptosis in the cardiocytes by IB-MECA led to the appearance of features of apoptotic nuclei: the onset of condensation, compacting, and margination of nuclear chromatin. These effects were accompanied by the disintegration of the structural framework of the nucleus and nuclear breakdown. The results suggest that activation of the A3 adenosine receptor may participate in the process of apoptosis in cardiomyocytes.

Image analysis combined with visual cytology in the early detection of recurrent bladder carcinoma

BACKGROUND

Early detection of recurrent transitional cell carcinoma of the bladder (TCC) is important to permit early treatment, which produces maximal preservation of the bladder and maximum survival.

METHODS

This retrospective cohort study attempted to determine the period of time over which urinary DNA image analysis combined with visual cytology is useful in the early detection of recurrent TCC of the bladder. The authors believe this study is unique in that it measured the effectiveness of this test (image analysis plus visual cytology combined) at varying times before clinical diagnosis of recurrence was made. The cohort was comprised of 175 urologic patients from urologic practices across the U.S. Data, collected between January 1991 and February 1994, included cystoscopy, biopsy, DNA image analysis, and visual cytologic reports.

RESULTS

Sixty patients in the cohort were found to have active TCC whereas 115 patients had a history of, but no active, disease during the follow-up period. As expected, the sensitivity and specificity of DNA image analysis in combination with visual cytology, and DNA image analysis alone, were greatest when urinary samples were obtained close to the time of diagnosis. In general, the longer the interval from the combined tests to the time of diagnosis, the lower the sensitivity. The combined tests had predictive value up to 3 months prior to clinical diagnosis when any detectable cytologic abnormality was considered positive. At the optimal cutoff points as determined from receiver operating characteristic curves, sensitivity increased when DNA image analysis was supplemented with visual cytology.

CONCLUSIONS

The combination of DNA image analysis and visual cytology provides a better method for the early detection of recurrent TCC than DNA image analysis alone. This test potentially may be useful in providing information regarding bladder tumor recurrence up to 3 months prior to clinical evidence of disease.

Prognostic impact of DNA content and AUER classification in primary fallopian tube carcinoma

DNA ploidy has been studied in 61 primary fallopian tube carcinomas using image-cytometry. The investigation also included survival analysis, and ploidy classification according to AUER was performed in order to evaluate its prognostic impact for fallopian tube carcinoma. A high number of aneuploid cases were observed (79% aneuploid vs. 21% euploid tumors). The high incidence of aneuploid tumors was consistently observed among all FIGO-stages as well as all groups of histologic grading. There was no correlation between ploidy and FIGO-stage or histologic grading. Patients with euploid DNA content showed a median survival of 34 months compared to 24 months for aneuploid cases (log-rank, P = 0.83). No correlation between the AUER classification and FIGO-stage or histologic grading could be observed. Tumors with an AUER type I and II (75th quantile 41 months) showed a better outcome than tumors with AUER III and IV (75th quantile 19 months). Although these results did not reach statistical significance (P = 0.07), a trend could be observed. Therefore AUER classification may be useful as an objective prognostic parameter. The high incidence of aneuploid tumors could be an expression of the high biologic aggressiveness of primary fallopian tube cancer which has been repeatedly mentioned in the past.

Morphologic and morphometric features of low grade serous tumours of the ovary

Peritoneal washings from twelve patients with serous tumours of the ovary were studied. Six patients had borderline serous tumours (BSTs), and six had grade one adenocarcinomas. Papanicolaou stained slides were assessed for nine morphologic parameters; background, single cells, size of papillary fragments, contour of papillary fragments, psamomma bodies, cytoplasmic vacuoles, nuclear pleomorphism, nuclear membrane contour, and nucleoli. The slides were destained and restained by the Feulgen method for assessment, with a computer based image analysis system (CAS100, Cell Analysis Systems, Inc., Elmhurst, IL), of DNA content, nuclear size, and nuclear roundness. The contour of the papillary fragments (P = 0.004) and the presence of nuclear pleomorphism (0.019) were distinguishing characteristics. All six BSTs were diploid while three of the six adenocarcinomas had aneuploidy. Two exhibited polyploid DNA distribution and one exhibited diploid DNA distribution. The pooled data for the nuclear size and roundness showed little difference in the modal values, although the nuclei of the adenocarcinoma cells were slightly larger than those of the borderline cells (54 sq. microns vs. 46 sw. microns). However, the coefficients of variation (CVs) for each of these parameters were larger in the adenocarcinoma group than in the borderline group (59.7 vs. 36.4% for size and 33.5 vs. 17.8% for roundness). Although the sample size is small, the data suggest that aneuploidy is rare in borderline tumours. In addition, the presence of papillary groups with irregular contours and nuclear pleomorphism (reflected in higher CVs for nuclear size and roundness) both occur more commonly in adenocarcinomas than in borderline tumours and may be of predictive value in distinguishing the two groups.

Dna ploidy of pheochromocytoma on cytology specimen by image analysis

Pheochromocytoma usually shows prominent nuclear atypia, but the presence of such atypical cells is known to be an unreliable predictor of malignancy. DNA ploidy of pheochromocytomas has been analyzed by flow cytometry or photospectrometry on paraffinem-bedded tissue, but the results were controversial. We performed DNA analysis on cytology specimens of 11 pheochromocytomas using an image analysis system. All tumors had a mixed pattern of a large population of diploid cells and a small population of polyploid cells. DNA content correlated with nuclear size, and larger cells had more DNA content. Such larger tumor cells had polyploid nuclei, such as 4 C, 8 C, 16 C, and 32 C, in both malignant and benign pheochromocytomas. The larger polyploid nuclei may result from difficulty of duplication at the mitotic phase of the cell cycle.

DNA cytometry in postirradiation cervical-vaginal smears

Benign radiation change (BRC) in cervical-vaginal smears may be difficult to distinguish from postirradiation dysplasia (PRD) or recurrent cervical carcinoma. The utility of DNA analysis in postirradiation smears was evaluated retrospectively in 71 patients. Representative Papanicolaou smears were restained with a Feulgen method and 100 to 250 cells were analyzed for DNA content using the CAS 200 image analysis system. Thirty-three control irradiated patients had negative smears with a minimum 3-year follow-up. Thirty controls (91%) had diploid histograms with a mean coefficient of variation of 8.2% and an average of 6.8% of cells in S and G2/M phase. Three control patients had atypical nondiagnostic histograms. Twenty-three patients had abnormal smears and subsequent local recurrence; 21 (91%) had abnormal histograms, with seven showing polyploidy and 14 showing aneuploidy. The remaining 15 patients had abnormal smears diagnosed as PRD but no evidence of recurrent carcinoma. Five were polyploid, six were aneuploid, one was diploid, and three were atypical but nondiagnostic. Interactive DNA cytometry is useful in differentiating BRC from PRD and recurrent cancer. Aneuploidy is rarely, if ever, seen in negative smears with BRC. However, BRC may be associated with broad diploid peaks and increased proliferating cells. An abnormal histogram can be seen with PRD and does not always correlate with recurrent disease.

Ploidy analysis of epithelial ovarian cancers using image cytometry

We used a computerized image analysis system to determine the DNA content of 103 epithelial ovarian cancers using touch imprints of frozen tumor samples. Similar to prior studies of ploidy using flow cytometry, we found that most ovarian cancers (78%) were aneuploid while a minority (22%) were diploid. There was no relationship between ploidy and stage, histologic grade, or the ability to perform optimal cytoreductive surgery. Also, like prior studies using flow cytometry, negative second-look laparotomy and survival were somewhat more common in advanced-stage patients with diploid cancers than in those with aneuploid cancers. We conclude that ploidy of ovarian cancers can be determined using a computerized image analysis system to quantitate feulgen staining of cells in touch imprints. Ploidy is unlikely to play a role in treatment planning for patients with advanced-stage disease. Larger studies of patients with early-stage disease are needed, however, to determine whether ploidy is a more accurate means of predicting which patients are most likely to benefit from adjuvant therapy.