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Elmas H, Diel R, Önal B, Sauter G, Stellmacher F, Welker L. Recommendations for immunocytochemistry in lung cancer typing: An update on a resource-efficient approach with large-scale comparative Bayesian analysis. Cytopathology 2021; 33:65-76. [PMID: 34402101 DOI: 10.1111/cyt.13051] [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: 05/02/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The majority of lung cancer cases are of advanced stage and diagnosis is usually made using minimally invasive small biopsies and cytological specimens. The WHO 2015 classification recommends limiting immunocytochemistry (ICC) to lung cancer typing and molecular testing drives for personalised therapies. An algorithm using Bayes' theorem could be useful for defining antibody profiles. This study aims to assess the impact of different antibody profiles for cytological samples on the accuracy of lung cancer typing with a large-scale Bayesian analysis. METHODS A retrospective examination of 3419 consecutive smears and/or cytospins diagnosed over 2011-2016 found 1960 primary lung cancer tumours: 972 adenocarcinomas (ADC), 256 squamous carcinomas (SQC), 268 neuroendocrine tumours (NET), and 464 non-small cell cancer-not otherwise specified (NSCC-NOS). The a priori and a posteriori probabilities, before and after ICC using antibodies singly or in combination, were calculated for different lung cancer types. RESULTS TTF-1 or CK7 alone improved the a posteriori probabilities of correct cytological typing for ADC to 86.5% and 95.8%, respectively. For SQC, using p40 (∆Np63) or CK5/6 together with CK5/14 led to comparable results (78.3% and 90.3%). With synaptophysin or CD56 alone, improvements in a posteriori probabilities to 87.5 and 90.3% for the correct recognition of NET could be achieved. CONCLUSIONS Based on morphological and clinical data, the use of two antibodies appears sufficient for reliable detection of the different lung cancer types. This applies to diagnoses that were finalised following ICC both on a clinical or cytological basis and on a histological basis.
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Affiliation(s)
- Hatice Elmas
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Diel
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Hamburg, Germany.,Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany
| | - Binnur Önal
- Department of Pathology & Cytology, School of Medicine, Duzce University, Duzce, Turkey
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Lutz Welker
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Berho M, Bejarano PA. Judging pathological assessment in cancer specimens. J Surg Oncol 2014; 110:543-50. [PMID: 25132357 DOI: 10.1002/jso.23738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 07/08/2014] [Indexed: 11/08/2022]
Abstract
The pathologist plays a critical role in the multidisciplinary team in charge of treating cancer patients, as many of the therapeutic decisions rely on the information conveyed through the pathology reports. The task of the pathologist includes not only an accurate assessment of pathological T and N categories, but also the evaluation of other indicators of prognosis including quality of surgery, margins of resection, as well as additional histopathological and molecular markers that influence prognosis and could predict response to therapy.
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Affiliation(s)
- Mariana Berho
- Department of Pathology and Laboratory Medicine, Cleveland Clinic Florida
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Shin D, Arthur G, Popescu M, Korkin D, Shyu CR. Uncovering influence links in molecular knowledge networks to streamline personalized medicine. J Biomed Inform 2014; 52:394-405. [PMID: 25150201 DOI: 10.1016/j.jbi.2014.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 08/04/2014] [Accepted: 08/08/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We developed Resource Description Framework (RDF)-induced InfluGrams (RIIG) - an informatics formalism to uncover complex relationships among biomarker proteins and biological pathways using the biomedical knowledge bases. We demonstrate an application of RIIG in morphoproteomics, a theranostic technique aimed at comprehensive analysis of protein circuitries to design effective therapeutic strategies in personalized medicine setting. METHODS RIIG uses an RDF "mashup" knowledge base that integrates publicly available pathway and protein data with ontologies. To mine for RDF-induced Influence Links, RIIG introduces notions of RDF relevancy and RDF collider, which mimic conditional independence and "explaining away" mechanism in probabilistic systems. Using these notions and constraint-based structure learning algorithms, the formalism generates the morphoproteomic diagrams, which we call InfluGrams, for further analysis by experts. RESULTS RIIG was able to recover up to 90% of predefined influence links in a simulated environment using synthetic data and outperformed a naïve Monte Carlo sampling of random links. In clinical cases of Acute Lymphoblastic Leukemia (ALL) and Mesenchymal Chondrosarcoma, a significant level of concordance between the RIIG-generated and expert-built morphoproteomic diagrams was observed. In a clinical case of Squamous Cell Carcinoma, RIIG allowed selection of alternative therapeutic targets, the validity of which was supported by a systematic literature review. We have also illustrated an ability of RIIG to discover novel influence links in the general case of the ALL. CONCLUSIONS Applications of the RIIG formalism demonstrated its potential to uncover patient-specific complex relationships among biological entities to find effective drug targets in a personalized medicine setting. We conclude that RIIG provides an effective means not only to streamline morphoproteomic studies, but also to bridge curated biomedical knowledge and causal reasoning with the clinical data in general.
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Affiliation(s)
- Dmitriy Shin
- University of Missouri, School of Medicine, Department of Pathology and Anatomical Sciences, Columbia, MO 65212, United States; University of Missouri, Graduate School, MU Informatics Institute, Columbia, MO 65211, United States.
| | - Gerald Arthur
- University of Missouri, School of Medicine, Department of Pathology and Anatomical Sciences, Columbia, MO 65212, United States; University of Missouri, Graduate School, MU Informatics Institute, Columbia, MO 65211, United States
| | - Mihail Popescu
- University of Missouri, School of Medicine, Department of Health Management and Informatics, Columbia, MO 65212, United States; University of Missouri, Graduate School, MU Informatics Institute, Columbia, MO 65211, United States; University of Missouri, College of Engineering, Department of Computer Science, Columbia, MO 65211, United States
| | - Dmitry Korkin
- Worcester Polytechnic Institute, Department of Computer Science, Department of Biology and Biotechnology, Department of Applied Math, Worcester, MA 01609, United States
| | - Chi-Ren Shyu
- University of Missouri, Graduate School, MU Informatics Institute, Columbia, MO 65211, United States; University of Missouri, College of Engineering, Department of Electrical and Computer Engineering, Columbia, MO 65211, United States
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Shin D, Arthur G, Caldwell C, Popescu M, Petruc M, Diaz-Arias A, Shyu CR. A pathologist-in-the-loop IHC antibody test selection using the entropy-based probabilistic method. J Pathol Inform 2012; 3:1. [PMID: 22439121 PMCID: PMC3307231 DOI: 10.4103/2153-3539.93393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 11/21/2011] [Indexed: 01/16/2023] Open
Abstract
Background: Immunohistochemistry (IHC) is an important tool to identify and quantify expression of certain proteins (antigens) to gain insights into the molecular processes in a diseased tissue. However, it is a challenge for pathologists to remember the discriminative characteristics of the growing number of such antigens across multiple diseases. The complexity of their expression patterns, fueled by continuous discoveries in molecular pathology, gives rise to a combinatorial explosion that places an unprecedented burden on a practicing pathologist and therefore increases cost and variability of IHC studies. Materials and Methods: To tackle these issues, we have developed antibody test optimized selection method, a novel informatics tool to help pathologists in improving the IHC antibody selection process. The method uses extensions of Shannon's information entropies and Bayesian probabilities to dynamically build an efficient diagnostic tree. Results: A comparative analysis of our method with the expert and World Health Organization classification guidelines showed that the proposed method brings threefold reduction in number of antibody tests required to reach a diagnostic conclusion. Conclusion: The developed method can significantly streamline the antibody test selection process, decrease associated costs and reduce inter- and intrapathologist variability in IHC decision-making.
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Affiliation(s)
- Dmitriy Shin
- Department of Pathology and Anatomical Sciences, University of Missouri
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Vollmer RT. Primary lung cancer vs metastatic breast cancer: a probabilistic approach. Am J Clin Pathol 2009; 132:391-5. [PMID: 19687315 DOI: 10.1309/ajcpdip12iugvrqr] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
In this study, a mathematical and probabilistic model is used to study the probability that a lung tumor is a primary vs a metastasis from cancer of the breast. The model uses information from immunohistochemical stains for thyroid transcription factor (TTF)-1, mammaglobin, p63, and estrogen receptor and epidemiologic data about primary lung and metastatic breast cancers in women. The results demonstrate that these 4 stains can yield nearly certain diagnoses in approximately 80% of tumors falling into the pool of this differential diagnosis. Nevertheless, uncertainty of diagnosis remains for the 19% of tumors in the pool that are negative for TTF-1, mammaglobin, and p63.
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Affiliation(s)
- Robin T. Vollmer
- Laboratory Medicine, Veterans Affairs and Duke University Medical Centers, Durham, NC
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