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Makhlouf S, Wahab N, Toss M, Ibrahim A, Lashen AG, Atallah NM, Ghannam S, Jahanifar M, Lu W, Graham S, Mongan NP, Bilal M, Bhalerao A, Snead D, Minhas F, Raza SEA, Rajpoot N, Rakha E. Evaluation of tumour infiltrating lymphocytes in luminal breast cancer using artificial intelligence. Br J Cancer 2023; 129:1747-1758. [PMID: 37777578 PMCID: PMC10667537 DOI: 10.1038/s41416-023-02451-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Tumour infiltrating lymphocytes (TILs) are a prognostic parameter in triple-negative and human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). However, their role in luminal (oestrogen receptor positive and HER2 negative (ER + /HER2-)) BC remains unclear. In this study, we used artificial intelligence (AI) to assess the prognostic significance of TILs in a large well-characterised cohort of luminal BC. METHODS Supervised deep learning model analysis of Haematoxylin and Eosin (H&E)-stained whole slide images (WSI) was applied to a cohort of 2231 luminal early-stage BC patients with long-term follow-up. Stromal TILs (sTILs) and intratumoural TILs (tTILs) were quantified and their spatial distribution within tumour tissue, as well as the proportion of stroma involved by sTILs were assessed. The association of TILs with clinicopathological parameters and patient outcome was determined. RESULTS A strong positive linear correlation was observed between sTILs and tTILs. High sTILs and tTILs counts, as well as their proximity to stromal and tumour cells (co-occurrence) were associated with poor clinical outcomes and unfavourable clinicopathological parameters including high tumour grade, lymph node metastasis, large tumour size, and young age. AI-based assessment of the proportion of stroma composed of sTILs (as assessed visually in routine practice) was not predictive of patient outcome. tTILs was an independent predictor of worse patient outcome in multivariate Cox Regression analysis. CONCLUSION AI-based detection of TILs counts, and their spatial distribution provides prognostic value in luminal early-stage BC patients. The utilisation of AI algorithms could provide a comprehensive assessment of TILs as a morphological variable in WSIs beyond eyeballing assessment.
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Affiliation(s)
- Shorouk Makhlouf
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Noorul Wahab
- Tissue Image Analytics Centre, University of Warwick, Coventry, UK
| | - Michael Toss
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Histopathology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Asmaa Ibrahim
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ayat G Lashen
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Pathology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Nehal M Atallah
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Pathology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Suzan Ghannam
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Histology and cell biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Wenqi Lu
- Tissue Image Analytics Centre, University of Warwick, Coventry, UK
| | - Simon Graham
- Tissue Image Analytics Centre, University of Warwick, Coventry, UK
| | - Nigel P Mongan
- Biodiscovery Institute, School of Veterinary Medicine and Sciences, University of Nottingham, Nottingham, UK
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Mohsin Bilal
- Tissue Image Analytics Centre, University of Warwick, Coventry, UK
| | - Abhir Bhalerao
- Tissue Image Analytics Centre, University of Warwick, Coventry, UK
| | - David Snead
- University Hospital Coventry and Warwickshire, Coventry, UK
| | - Fayyaz Minhas
- Tissue Image Analytics Centre, University of Warwick, Coventry, UK
| | | | - Nasir Rajpoot
- Tissue Image Analytics Centre, University of Warwick, Coventry, UK.
| | - Emad Rakha
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Department of Pathology, Hamad Medical Corporation, Doha, Qatar.
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Atallah NM, Wahab N, Toss MS, Makhlouf S, Ibrahim AY, Lashen AG, Ghannam S, Mongan NP, Jahanifar M, Graham S, Bilal M, Bhalerao A, Ahmed Raza SE, Snead D, Minhas F, Rajpoot N, Rakha E. Deciphering the Morphology of Tumor-Stromal Features in Invasive Breast Cancer Using Artificial Intelligence. Mod Pathol 2023; 36:100254. [PMID: 37380057 DOI: 10.1016/j.modpat.2023.100254] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/02/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023]
Abstract
Tumor-associated stroma in breast cancer (BC) is complex and exhibits a high degree of heterogeneity. To date, no standardized assessment method has been established. Artificial intelligence (AI) could provide an objective morphologic assessment of tumors and stroma, with the potential to identify new features not discernible by visual microscopy. In this study, we used AI to assess the clinical significance of (1) stroma-to-tumor ratio (S:TR) and (2) the spatial arrangement of stromal cells, tumor cell density, and tumor burden in BC. Whole-slide images of a large cohort (n = 1968) of well-characterized luminal BC cases were examined. Region and cell-level annotation was performed, and supervised deep learning models were applied for automated quantification of tumor and stromal features. S:TR was calculated in terms of surface area and cell count ratio, and the S:TR heterogeneity and spatial distribution were also assessed. Tumor cell density and tumor size were used to estimate tumor burden. Cases were divided into discovery (n = 1027) and test (n = 941) sets for validation of the findings. In the whole cohort, the stroma-to-tumor mean surface area ratio was 0.74, and stromal cell density heterogeneity score was high (0.7/1). BC with high S:TR showed features characteristic of good prognosis and longer patient survival in both the discovery and test sets. Heterogeneous spatial distribution of S:TR areas was predictive of worse outcome. Higher tumor burden was associated with aggressive tumor behavior and shorter survival and was an independent predictor of worse outcome (BC-specific survival; hazard ratio: 1.7, P = .03, 95% CI, 1.04-2.83 and distant metastasis-free survival; hazard ratio: 1.64, P = .04, 95% CI, 1.01-2.62) superior to absolute tumor size. The study concludes that AI provides a tool to assess major and subtle morphologic stromal features in BC with prognostic implications. Tumor burden is more prognostically informative than tumor size.
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Affiliation(s)
- Nehal M Atallah
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Department of Pathology, Faculty of Medicine, Menoufia University, Egypt
| | - Noorul Wahab
- Tissue Image Analytics Centre, University of Warwick, Conventry, UK
| | - Michael S Toss
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Histopathology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Shorouk Makhlouf
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Department of Pathology, Faculty of Medicine, Assiut University, Egypt
| | - Asmaa Y Ibrahim
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Department of Pathology, Faculty of Medicine, Suez Canal University, Egypt
| | - Ayat G Lashen
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Department of Pathology, Faculty of Medicine, Menoufia University, Egypt
| | - Suzan Ghannam
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Egypt
| | - Nigel P Mongan
- Biodiscovery Institute, School of Veterinary Medicine and Sciences, University of Nottingham, Sutton Bonington, UK; Department of Pharmacology, Weill Cornell Medicine, New York
| | | | - Simon Graham
- Tissue Image Analytics Centre, University of Warwick, Conventry, UK
| | - Mohsin Bilal
- Tissue Image Analytics Centre, University of Warwick, Conventry, UK
| | - Abhir Bhalerao
- Tissue Image Analytics Centre, University of Warwick, Conventry, UK
| | | | - David Snead
- Cellular Pathology, University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - Fayyaz Minhas
- Tissue Image Analytics Centre, University of Warwick, Conventry, UK
| | - Nasir Rajpoot
- Tissue Image Analytics Centre, University of Warwick, Conventry, UK.
| | - Emad Rakha
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Department of Pathology, Faculty of Medicine, Menoufia University, Egypt; Pathology Department, Hamad Medical Corporation, Doha, Qatar.
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Ghannam S, McDonnell J, Weller K, Hsieh F. P046 CHRONIC URTICARIA TREATMENT OUTCOMES IN SUBJECTS WITH UNDETECTABLE SERUM IGE TREATED WITH OMALIZUMAB. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jhaveri J, Ghannam S, Kalantarova N, Randhawa J, Kashanian J, LaJeune J, Shabsigh R. Can anorgasmia be linked to emotional dissatisfaction in relationships? Journal of Men's Health 2010. [DOI: 10.1016/j.jomh.2010.09.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Jhaveri J, Ghannam S, Ghosh P, Pagala M, Prabhu K, Lee M, Shabsigh R. Does Race have an association with income or education? Journal of Men's Health 2010. [DOI: 10.1016/j.jomh.2010.09.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jhaveri J, Ghannam S, Pinkhasov R, Hakimian P, Lindsay G, Friedman S, Shabsigh R. Are salivary cotinine levels associated with erectile dysfunction or anorgasmia? Journal of Men's Health 2010. [DOI: 10.1016/j.jomh.2010.09.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Pinkhasov R, Jhaveri J, Ghannam S, Kashanian J, Nehra A, Miner M, Shabsigh R. Research Funding by the National Institutes of Health: Does Gender Matter? Journal of Men's Health 2010. [DOI: 10.1016/j.jomh.2010.09.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Jhaveri J, Ghannam S, Normatov Y, Malakov D, Gadayev A, Kashanian J, Silver D, Shabsigh R. Prospective Observational Longitudinal Descriptive Data: Men's Health Study, Brooklyn, NY. Journal of Men's Health 2010. [DOI: 10.1016/j.jomh.2010.09.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Jhaveri J, Ghannam S, Schulman A, Prabhu K, Hakimian P, Lindsay G, Shabsigh R. Emotional support and Sexual satisfaction: Is there a Correlation? Journal of Men's Health 2010. [DOI: 10.1016/j.jomh.2010.09.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kalantarova N, Ghannam S, Jhaveri J, Pinkhasov R, Ghosh P, Shabsigh R. Attitudes Towards Infidelity: A Gender Based Comparison of Older-Aged American Men and Women. Journal of Men's Health 2010. [DOI: 10.1016/j.jomh.2010.09.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Jhaveri J, Ghannam S, Chan S, Friedman S, Silver D, Shabsigh R. Obesity prevalence rates in a non-patient representative sample of the United States population. Journal of Men's Health 2010. [DOI: 10.1016/j.jomh.2010.09.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Pinkhasov R, Ghannam S, Jhaveri J, Normatov Y, Malakov D, Shabsigh R. Does simultaneous administration of the IIEF and AMS (sexual component) have a significant role as screening tools for the detection of occult clinical hypogonadism? Journal of Men's Health 2010. [DOI: 10.1016/j.jomh.2010.09.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ghannam S, Shehata O, Deeb S, al-Alily H. The effect of vitamin A depletion on the vasa deferentia of young bulls. Res Vet Sci 1969; 10:79-82. [PMID: 5806716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Ghannam S, Fayez M, Khadr OS, al-ALILY H. The effect of different levels of vitamin A on the anterior pituitary of young bulls. Res Vet Sci 1968; 9:481-5. [PMID: 5684097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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