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Demonstration of characteristic skin surface contours of extramammary Paget's disease and parapsoriasis en plaque by image analysis of negative impression replicas.

The surface contours of lesional skin of certain skin diseases, such as parapsoriasis en plaque (PEP) and extramammary Paget's disease (EMPD), in which there is a massive infiltration by non-epidermal cells, looks somewhat different from that of the adjacent normal skin, needless to state that they are apparently different from that of ordinary chronic inflammatory dermatoses where we found acanthotic epidermis accompanied by hyperkeratosis. We attempted to objectively characterize these unique skin surface changes qualitatively and quantitatively using non-invasive methods. Negative impression replicas were taken from the lesional skin of patients with EMPD or PEP as well as from the adjacent uninvolved skin. The findings were confirmed histologically. The replicas were examined by using computerized image analysis. Several parameters were analyzed that correlate with the changes in the anisotropy of the skin furrows (VC1), average skin roughness (KSD), average length of skin furrows (LEN), and number of skin furrows (NUM). There were significant decreases in KSD and NUM in EMPD, indicating a smoother skin surface in the lesional skin than in the adjacent normal skin. In contrast, the PEP lesion had an increase in VC1 and LEN and a decrease in NUM, which suggests larger skin ridges in the lesional skin than in the uninvolved skin. Thus the unique skin surface of the cutaneous disorders accompanied by epidermal invasion by non-epidermal cells, such as EMPD and PEP, was characterized both qualitatively and quantitatively using computerized image analysis of negative impression replicas.

Female↗

Image analysis of papillary thyroid carcinoma fine-needle aspirates: significant association between aneuploidy and death from disease.

BACKGROUND: Papillary thyroid carcinoma is the most common thyroid malignancy in the U.S. As many as half of patients with papillary carcinoma present with cervical lymph node metastases at the time of diagnosis. Metastatic disease involving cervical lymph node tissue has not historically been proven to correlate with a more aggressive course; however, distant metastases worsen prognosis. METHODS: Diagnostic fine-needle aspiration (FNA) smears from 26 primary and metastatic papillary carcinomas underwent Feulgen reaction and were studied by image analysis to determine DNA pattern, proliferation index, and the percentage of cells with DNA content >5C. The medical records of all the patients were reviewed for metastatic disease pattern and survival data. For metastatic pattern, two groups were defined: 1) confined to thyroid/local lymph node metastases/soft tissues of the neck involved by tumor, and 2) distant metastases. RESULTS: Among the 26 patients, 16 had "nonaggressive" DNA patterns described as diploid, abnormal diploid, or tetraploid, and 10 had "aggressive" DNA patterns described as aneuploid. Only 2 of the 16 patients in the "nonaggressive" DNA pattern group developed distant metastases, whereas 5 of the 10 patients in the aneuploid group developed distant metastatic disease. In addition, none of the 16 patients with "nonaggressive" DNA patterns died of disease, whereas 3 of the 10 individuals with DNA histograms interpreted as aneuploid did die of metastatic disease complications. CONCLUSIONS: Aneuploidy identified by image analysis of FNA of papillary thyroid carcinoma is significantly associated with death from papillary carcinoma (log rank test, P=0.027).

Adolescent↗

Computer-assisted image analysis to quantify regional and specific receptor ligand binding: upregulation of [3H]QNB and [3H]WB4101 binding in denervated hippocampus.

Quantitative regional analysis of receptor autoradiographs using the Nikon Magiscan image analysis system permits resolution of regional variations in specific binding in non-homogeneous CNS structures, such as the hippocampus. Cholinergic denervation, produced by fimbrial transections, elicits a 24% increase in atropine-displaceable [3H]QNB binding in whole coronal sections of the hippocampal formation, which is greatest in the dorsal subiculum, CA3 and dentate gyrus. This lesion also elicits a 69% increase in lower affinity [3H]WB4101 binding which is displaceable by phentolamine, but not by prazosin. This represents a sum of increases and decreases in binding in several subregions. Taken together, these findings serve to emphasize the need for normalized regional evaluation of subtracted images which have been calibrated, and linearized or transformed, to reveal binding specific to a single site.

Adrenergic alpha-Antagonists↗

Computerized image analysis of distinct cell marker parameters of glial fibrillary acidic protein: intensity of immunofluorescence and topography in human glioma cultures.

Glial fibrillary acidic protein (GFAP) is a 49 kDa component of 8 nanometers glial intermediate filaments. It is a definitive marker of both neoplastic and non-neoplastic glial cells. Malignant gliomas are heterogeneous in their structure and their expression of GFAP. Subjective visual impression of glioma cell cultures in early passage after explantation suggested two types of heterogeneity among the cells: 1) Indirect anti-GFAP immunofluorescence (IF) signal intensity appeared to vary among cells. 2). Sizes and shapes of cells appeared to vary. While many cultures lost GFAP+ cells by passage 2, some retained sufficient cells for study. Computerized microdensitometry and image analysis precisely assessed signal intensity, size and shape of glial cells from these latter cultures in passage 2 of cell culture. A Zeiss ICM 405 epi-illuminated fluorescent microscope with photographic interface to a Bio-Quant computerized microdensitometer measured IF signal intensity for GFAP. Normalized to the most intense reactivity, the mean intensity of GFAP expression of 26 glioma cells was 66.2%. The range of 5.2% to 100% around this mean reflected a high degree of heterogeneity of expression of GFAP by these cells. The effects of quenching of the fluorescent signal by the excitation beam were minimized in the following manner: a) Rhodamine anti-GFAP was substituted for more labile fluoresceine. b) A fluorescent filter and lens combination was selected to provide a high signal to quench ratio. c) The signal acquisition time was minimized and fixed to one standard interval. The image analysis system employed the described optics and computer.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers↗

Quantitative computerized image analysis of Tn and T (Thomsen-Friedenreich) epitopes in prognostication of human breast carcinoma.

The precursors of the blood group N and M-immunodominant structures, Tn and T (Thomsen-Friedenreich) epitopes (EPs) occur in approximately 90% of carcinomas (CAs) but are masked in benign-diseased and healthy tissues. We determined quantitatively on 55 primary invasive ductal breast CAs, stages I to IV, the prognostic value of extent of Tn and T EP expression over an observation period exceeding 5 years postoperatively. Classical, established pathological and histological prognostic characteristic indicators associated with survival were subdivided by standard criteria into favorable and unfavorable categories. Tissue sections were reacted with monoclonal anti-Tn and -T antibodies, followed by the streptavidin-biotin-peroxidase-DAB procedure; counterstain was methyl green. Tn and T EPs were then quantitated by computerized image analysis. Of the 55 CAs, 51 clearly expressed Tn and T, and four had traces. Strong Tn EP expression was statistically significantly associated with shortened 5-year disease-free interval, increasing pTNM stages, positive lymph node status, and increasing combined histological grades. T EPs were usually well expressed but showed no significant association with prognostic factors. Our results suggest that quantitative immunohistochemistry-image analysis of Tn EPs of primary breast CAs may add new parameters to prognostication.

Adult↗

Precision cell location and relocation techniques. An application for cell image analysis.

Two methods for precise cell location and relocation were developed at the Cell Image Analysis Laboratory, NASA, to increase the efficiency of the cell image acquisition process. The first method uses a Zeiss Zonax with a 10 micron scanning stage and automatically records cell coordinates on 5.25-inch floppy disks. The second method uses a Digital Positioning Device with a 10 micron scanning stage, and the cell coordinates displayed on light-emitting diodes (LEDs) are recorded manually. Because of its superior speed and automation, the Zonax was selected as the method of choice. By using a Zonax for off-line cell location and another Zonax for on-line cell relocation, more than three times the number of digitized images were collected in ten months than in the previous three years. Other beneficial applications of the cell location and relocation methods were realized in photomicrography, data base verification and cytopathology.

Computers↗

Proliferating cell nuclear antigen in normal urothelium and urothelial lesions of the urinary bladder: a quantitative assessment using a true color image analysis system.

To evaluate proliferating cell nuclear antigen (PCNA) staining for assessing proliferative activity in routine pathology specimens of urinary bladder, the bladder carcinoma cell line J82 and a total of 122 specimens of normal bladder and urothelial lesions were stained with the antibody clone PC10 against proliferating cell nuclear antigen. In in vitro plateau cultures the proportion of PCNA-positive cells exceeded that of Ki-67-positive cells, and only very few cells were negative. In formalin-fixed tissues, the PCNA staining pattern, which should be confined to replicon units in the nucleus, was optimized by 1 h postfixation in an organic solvent (methacarn). Sections showed positive nuclear staining confined to basal and some suprabasal cells in normal urothelium and grade 1 dysplasias, but more generalized nuclear staining in all other neoplastic lesions. In addition, stromal cells adjacent to invasive tumors showed nuclear positivity in some instances. Using quantitative true color image analysis of sections counterstained with hemalum, the degree of brown staining of the PCNA reaction product is contrasted with the blue staining of the nuclear area. With this method low contrast specific staining not appreciated optically can be reliably detected. Image analysis data confirmed observations made on noncounterstained sections and showed significant differences between grade 1 and 2 dysplasias as well as between grade 1 dysplasia and all grades of papillary tumor. Furthermore, a significant difference in PCNA staining indices was found between grade 1 and 3 bladder carcinomas. The results indicate that PCNA staining using the PC10 antibody is not confined to the proliferative fraction of neoplastic urothelium.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Neoplasm↗

Quantitative ultrasound image analysis of the supraspinatus muscle.

OBJECTIVE: To develop and validate a method, based on quantitative ultrasound image analysis, to objectively analyse and characterize the ultrasound images of m. supraspinatus. DESIGN: Quantitative ultrasonography was performed on the supraspinatus muscle of 14 healthy subjects. METHODS: A computerized analysis using first-order grey-scale statistics to evaluate the muscle tissue composition was developed and validated. RESULTS: Data from one scanning site were not representative for the whole muscle due to muscle inhomogenity. Using first-order grey-scale statistics the scanning direction was of no importance. By using a scanning session consisting of three different scanning sites along the muscle in two directions, longitudinally and transversely, to characterize the tissue composition of the muscle, a high day-to-day reproducibility was obtained. CONCLUSION: The described scanning session is a relatively sensitive and reproducible method for studying the muscle tissue composition. RelevanceQuantitative ultrasonography seems to be a potential clinical and occupational examination method to detect tissue composition of myalgic muscles compared to healthy muscles.

Adult↗

Quantitative enzymatic histophotometry of morphologic alterations caused by urologically relevant tubular kidney damages using computed image analysis device technique.

The tissue concentration of tubular marker enzymes were evaluated in sections of kidneys from 86 patients with various underlying diseases such as hydronephrosis, interstitial nephropathies, ischemia due to renal arterial stenosis and chronic allograft rejection. In addition, as an experimental model, kidney tissue sections of 166 Wistar rats were analyzed due to hydronephrosis caused by ureteral obstruction, ischemia and obstruction of the renal vein. The tissue concentration of indicator enzymes, such as alkaline phosphatase (AP) and alanine-aminopeptidase (AAP), was considered as a parameter describing the extent of kidney tubule damage. Quantitative evaluation of enzymatic activity was performed by histophotometry using a computed image analysis device technique. As compared to normal human kidney (enzyme activity 100%), the concentrations of brush border enzymes were significantly (p less than 0.001) lower under pathological conditions (AP less than 15%, AAP less than 55%). In similar manner investigations of kidneys in animal experiments with rats exhibited lower enzyme concentrations following kidney injury caused by ureteral obstruction for 10 and 21 days (AP less than 12%, AAP less than 65%; 2p less than 0.01). Kidneys after an ischemic period of 2 h and a subsequent 14-day recirculation period displayed a significant (2p less than 0.01) decrease of normally present indicator enzyme concentrations (AP less than 22%, AAP less than 77%) as compared to normal renal organs (100%). Computed image analysis of kidney tissue sections might be a useful aid in evaluating morphologic and enzymatic patterns of human and animal kidney alterations.

Alkaline Phosphatase↗

Image analysis of comet assay measurements.

In the last decade the 'comet assay' or 'single cell gel electrophoresis assay' has been established as a sensitive method for the detection of DNA damage and the measurement of its recovery. The results published in the literature have often been obtained with different methods for comet structure measurement. In most cases these data are not comparable with each other. Even when using similar systems for the analysis, it is difficult to obtain matching data. This presentation will describe some technical aspects of our measurement equipment and evaluation software. It focuses on necessary experimental conditions to minimize errors in obtaining such data. The software developed here allows the rapid analysis of the microscopic samples (< 2 s per image). The image analysis was designed with respect to the morphological shapes of comet cells, which were investigated with a confocal laser microscope. The system is built with standard components which are commercially available. As a measure of the amount of DNA damage the ratio of fluorescence intensity was used inside the comet tail and the fluorescence intensity of the comet head. Other parameters such as DNA content, comet area, head radius, tail length and tail moment are also determined. The reproducibility of the system has been evaluated in several experiments over a period of 5 years.

Ataxia Telangiectasia↗

[Image analysis and Sheimpflug photography of anterior segment of the eye--a review].

BACKGROUND: Light scattering properties of the cornea and lens change in relation to age. This process is influenced by noxious factors which may induce the formation of cataracts. Four different camera types based on the Scheimpflug principle have been developed for documentation and evaluation of light scattering in the eye. Topcon SL-45. Zeiss SLC, Oxford CASE 2000, Nidek EAS 1000. Only the SL-45 and EAS 1000, however, have found a wider application in clinical and experimental studies. MATERIAL AND METHODS: Documentation of the eye with a Scheimpflug system is performed in a dark room after mydriasis induction. The rotating axis of the camera is aligned to the optical axis of the eye with fixation devices. Four meridians have been found appropriate for routine documentation. Image analysis is based on peak height and distance evaluation of 2 layers in the cornea and 10 layers in the lens. Standardization devices allow correction of technical differences in the recording process. RESULTS: Evaluation of the ageing properties of the lens has evidenced typical density developments for each individual layer, the cortex increasing in density earlier than the nucleus. Cataract classification using a Scheimpflug camera provides an objective characterization of cataract type and progression. The outcome of surgical procedures changing the refractive power of the eye can be evaluated with a Scheimpflug camera as well. Its application in studies dealing with the ocular effects of Quinolones and HMG-CoA-reductase inhibitors, has demonstrated that Scheimpflug photography is the method of choice for establishment of a safety profile for a new drug. CONCLUSIONS: Scheimpflug photography has proven to be ideal for objective documentation of the anterior eye segment in human and animal eyes, although both documentation and image analysis demand technical expertise to be reproducible.

Adult↗

The teratogenic interaction of hydroxyurea and 5-bromodeoxyuridine examined with the aid of limb culture and image analysis.

Pregnant mice were treated on gestation Day 11 (E11) with a single dose of either hydroxyurea (HU, 250 mg/kg) or 5-bromo-2'deoxyuridine (BrdU, 500 mg/kg), or with a combination of the two agents. The dams were either allowed to go to term, when the fetuses were examined for cleft palate (CP) and digital anomalies, or killed 24 hr after the treatment. In the latter case, limbs from the embryos of control and treated dams were excised and cultured for 6 days in submerged culture. At the end of the culture period, the limb explants were stained for cartilage. The various cartilaginous components were subsequently analyzed using image analysis methods. CP was observed in 2.4 and 22.9% of the fetuses, respectively, after a single dose of HU or BrdU on E11. Simultaneous HU + BrdU treatment decreased the incidence of BrdU-induced CP to 3.6%, while treatment with BrdU 3 hr after HU resulted in 33.3% CP. In addition, syndactyly and ectrodactyly, not seen after the treatment with either HU or BrdU alone, were observed when the two agents were administered simultaneously, 1 hr apart or with a 3-hr delay. The teratogenic response was enhanced when limbs were cultured for 6 days. Digital anomalies were observed in the limb explants of BrdU-pretreated embryos; such abnormalities were not observed in vivo. Image analysis of cultured limb explants revealed that with HU-3 hr-BrdU pretreatment, the total limb area occupied by the long bones was increased at the cost of the paw area. However, no consistent changes in the shape or form of individual bones were observed. HU and BrdU given together produced a teratogenic response which was significantly different from that observed following the administration of HU or BrdU alone. This is considered to be due to an interference with the incorporation of BrdU in the DNA, since HU is known to block DNA synthesis. When HU was given before BrdU, the effects of BrdU were enhanced, probably due to the reported synchronizing action of HU on dividing cells. We also found that after a similar in utero exposure, the culture conditions themselves enhanced the frequency of teratogenic expression of BrdU.

Abnormalities, Drug-Induced↗

Computer-assisted image analysis of tumor sections for a new thrombospondin receptor.

BACKGROUND: A cell surface receptor (50 kd) has been recently identified in malignant cells that recognizes the tumor cell adhesive domain (ie, cysteine-serine-valine-threonine-cysteine-glycine [CSVTCG]) of thrombospondin (TSP). This CSVTCG-specific TSP receptor can be considered as a new tumor marker, and its concentration on the cell surface may correlate directly with the capacity of tumor cells to invade and metastasize. MATERIALS AND METHODS: Six patients with primary, stages III and IV squamous cell carcinomas of the head and neck were studied. Tumor sections were specifically stained for this receptor with immunohistochemical techniques. The stained specimens were then subjected to computer-assisted image analysis. The area of positive staining and the heterogeneity of the pattern of staining were compared to peritumoral angiogenesis and clinical outcome of the patients. RESULTS: The results indicate that those patients with a high and homogenous positive stain score (mean +/- standard error [SE] 78 +/- 5%) for the CSVTCG-specific TSP receptor had high microvessel density and died from metastatic disease within 12 months of initial treatment (correlation coefficients = 0.95 and 1, respectively). Patients with a low and heterogenous positive stain score for receptor (mean +/- SE 8 +/- 2%; P < 0.001) had low microvessel counts and remained disease-free for at least 2 years. There was no relationship between receptor density and histologic classification of the primary tumors. CONCLUSION: The CSVTCG-specific TSP receptor, quantified through image analysis of immunohistochemical stained tissue sections, is highly predictive of clinical outcome in patients with squamous cell carcinomas of the head and neck.

Adult↗

Optical devices used for image analysis of pigmented skin lesions: a proposal for quality assurance protocol using tissue-like phantoms.

Different technological tools have been developed to aid in the diagnosis of pigmented skin lesions, including cameras working with conventional RGB colour systems, epiluminescence microscopy and spectrophotometric methods using visible and near infrared wavelengths. All the different procedures should provide in an objective and reproducible fashion quantitative measurements of the colour and shape features of a given skin mole. At present, many devices have been introduced in experimental stages for clinical diagnosis, mainly used to provide to the clinicians an objective, computer-assisted second opinion. As for any diagnostic instruments, optical devices should also be subjected to a dedicated quality assurance protocol in order to evaluate the response repeatability of each device (intra-instrument agreement) and to check the accordance among the responses of different devices (inter-instrument agreement). The aim of this study was to design a quality assurance protocol for optical devices dedicated to image analysis of pigmented skin lesions and, in case, to detect cutaneous melanoma by using suitable tissue-like phantoms as standard references that enable testing of both hardware and software components. As an example, we report the results of intra-instrument and inter-instrument agreement when the protocol was applied on a series of 30 SpectroShade instruments, a novel optical device based on multi-spectral image analysis of colour and shape features of pigmented skin lesion.

Biophysical Phenomena↗

Retinal blood vessel width measured on color fundus photographs by image analysis.

The purpose of this paper was to develop a technique using computerized image analysis to measure the width of retinal arteries and veins on color fundus photographs. The width of the retinal vessel was determined from digitized fundus photographs by programs based on edge detection and boundary tracing. The average vessel width was determined at different distances or eccentricities from the center of the optic disc and using various lengths of vessel segment. Measurements of superior and inferior temporal vessel width for 20 eyes by 2 operators showed that about 75% of the measurements could be obtained without the use of plan points. The average percent coefficient of variation of the measurements was 2.17% for 3 measurements of each vessel. This technique provides a reproducible and objective method for obtaining the following parameters: the edges of the vessel, the length of the vessel segment to be measured, location of the measurement along the vessel and subsequent retinal vessel width. This technique is readily suitable for application to clinical studies particularly clinical trials.

Adult↗

Image analysis quantitation of immunoreactive retinoblastoma protein in human thyroid neoplasms with a streptavidin-biotin-peroxidase staining technique.

Studies investigating the molecular pathogenesis of common thyroid neoplasms have shown altered expression and/or structure of proto-oncogenes, G-proteins, and growth factors. Growth suppressor genes, genomic DNA segments that code for proteins believed to function as growth suppressors, have not been evaluated for a potential role in the pathogenesis of thyroid neoplasms. The retinoblastoma gene (RB1) maps to chromosome 13q14 and encodes a 110 kilodalton variably phosphorylated nuclear protein (Rb) that functions as a growth suppressor in a wide variety of human tissues. The frequent association of Rb protein loss with multiple neoplasms has prompted the authors to apply a specific and rapid immunohistochemical technique using streptavidin-biotin-peroxidase technology evaluated by image analysis that can be used to quantitate the level of immunoreactive Rb protein (iRb) in thyroid neoplasms. In utilizing streptavidin-biotin technology for nuclear iRb detection, artifacts that can be associated with the use of avidin such as nonspecific binding at physiologic pH and nonspecific complex formation with cellular components including chromatin are avoided. By this method, positive nuclear staining for iRb in the follicular cells of three follicular adenomas and in CV-1 control cells known to express Rb was demonstrated. Two papillary carcinomas, two medullary carcinomas and a SAOS-2 cell line known to produce a defective form of Rb stained at significantly lower levels (P less than .001). The authors conclude that the streptavidin-biotin-peroxidase staining technique evaluated by image analysis is a sensitive and specific detection system for nuclear iRb studies; has significant advantages over previously used techniques; and that thyroid neoplasms may variably express iRb which may, in part, reflect their variable pathogenesis.

Adenoma↗

Clinical features, image analysis, and laparoscopic and histological liver findings in Budd-Chiari syndrome.

BACKGROUND/AIMS: Clinical manifestations and histological features of the liver in Budd-Chiari syndrome (BCS), with or without idiopathic membranous obstruction of the inferior vena cava (MOVC), vary according to whether BCS is acute, subacute or chronic. We clarified the diagnostic features in 6 patients with MOVC and in 1 without MOVC. METHODOLOGY: Five patients with subacute or chronic type BCS with MOVC complaining of epigastric pain, hematemesis and encephalopathy, and signs of portal hypertension or collateral circulation were seen. There was 1 asymptomatic patient with MOVC. One patient with acute type BCS without MOVC revealed hepatic and multi-organ failure. Liver function tests in BCS with MOVC were similar to those in liver cirrhosis, and laboratory data in acute type without MOVC were quite the same as those seen in fulminant hepatitis. Non-invasive image analysis by US, CT and MRI showed thrombi and obstruction of the IVC, and extrahepatic vasculature or communication between hepatic veins and IVC. Vena cavography showed the length of obstruction in IVC and collateral circulation in the extrahepatic or intrahepatic veins. Liver biopsy demonstrated massive hemorrhagic necrosis in acute type without MOVC, and laparoscopy with liver biopsy in asymptomatic, subacute and chronic type with MOVC showed subcapsular hemorrhage, congestion, fibrosis, and cirrhotic features. CONCLUSIONS: The non-invasive image analysis was complementary to vena cavography, and liver biopsy with or without laparoscopy was essential not only for diagnosis of acute, subacute, and chronic BCS, but also for therapeutic decision-making.

Adult↗

Quantitative nuclear morphometry by image analysis for prediction of recurrence of ductal carcinoma in situ of the breast.

Clinical management of ductal carcinoma in situ (DCIS) remains a challenge because significant proportions of patients experience recurrence after conservative surgical treatment. Unfortunately, it is difficult to prospectively identify, using objective criteria, patients who are at high risk of recurrence and might benefit from additional treatment. We conducted a multi-institutional, collaborative case-control study to identify nuclear morphometric features that would be useful for identifying women with DCIS at the highest risk of recurrence. Tissue sections of archival breast tissue of 29 women with recurrent and 73 matched women with nonrecurrent DCIS were stained for DNA, and nuclei in the DCIS lesions were evaluated by image analysis. A clear correlation between mean fractal2_area (FA2) and nuclear grade was observed (P < 0.001), allowing an objective determination of nuclear grade. Several nuclear morphometric features, including mean and variance of variation of radius, mean area, mean and variance of frequency of high boundary harmonics (FQH), and variance in sphericity, were found to be useful in discriminating recurrent from nonrecurrent DCIS subjects. However, the nuclear features associated with recurrence differed between high- and low-grade lesions. For lesions with high FA2 (nuclear grade 3), mean variation of radius, mean FQH, and mean area alone yielded recurrence odds ratios of 4.55 [95% confidence interval (CI) 0.45-45.96], 3.86 (95% CI, 0.88-16.98), 2.90 (95% CI, 0.31-27.2), respectively. Using a summed feature model, high-FA2 lesions showing three poor prognostic features had an odds ratio of 15.63 (95% CI, 1.22-200), compared with those with zero or one poor prognostic feature. Lesions with low mean FA2 (nuclear grade 1 or 2) showing high variances in sphericity and FQH had an odds ratio of 7.71 (95% CI, 1.77-33.60). Addition of other features did not enhance the odds ratio or its significance. These results suggest that nuclear image analysis of DCIS lesions may provide an adjunctive tool to conventional pathological analysis, both for the objective assessment of nuclear grade and for the identification of features that predict patient outcome.

Adult↗