Document Type : Original Research
Authors
Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
Abstract
Background & Objective: An accurate Ki-67 labeling index assessment is critical for managing a few tumors, like breast carcinomas and neuroendocrine tumors. We aimed to determine the degree of agreement between digital image analysis (DIA) & eye-rolling assessment (EE) and DIA & manual count (MC) for Ki-67 LI scoring.
Methods: A total of 120 cases (Both tru-cut biopsies and resected specimens) were selected during the study period from the institutional database wherein the Ki-67 labeling index was performed. The selected cases were divided into two groups, i.e., breast neoplasms and other neoplasms. The correlation between DIA & EE and DIA & MC for Ki-67 LI scoring was calculated in both groups.
Results: A total of 113 cases were analyzed for Ki-67 LI by three different methods (EE, MC, & DIA); 7 cases were rejected because of poor image quality. Ki-67 LI scoring by DIA & EE was highly correlated in both the study groups with a Spearman's rank correlation coefficient of 0.809 (P=0.01) and 0.904 (P=0.01), respectively. Correlation between DIA & MC methods was also found to be almost perfect in both study groups with a Spearman's rank correlation coefficient of 0.974 (P=0.01) and 0.955 (P=0.01), respectively.
Conclusion: ImmunoRatio is a free web-based digital image analysis application that can be used for Ki-67 LI assessment with considerable reliability and reproducibility. Yet, it carries a few limitations and demands a careful approach and final confirmation by an expert.
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Main Subjects
- Kwon AY, Park HY, Hyeon J, Nam SJ, Kim SW, Lee JE, et al. Practical approaches to automated digital image analysis of Ki-67 labeling index in 997 breast carcinomas and causes of discordance with visual assessment. PLoS One. 2019;14(2):e0212309. [DOI:10.1371/journal.pone.0212309] [PMID]
- Perren A, Couvelard A, Scoazec JY, Costa F, Borbath I, Delle Fave G, et al. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Pathology: Diagnosis and Prognostic Stratification. Neuroendocrinology. 2017;105(3):196-200. [DOI:10.1159/000457956] [PMID]
- Davey MG, Hynes SO, Kerin MJ, Miller N, Lowery AJ. Ki-67 as a Prognostic Biomarker in Invasive Breast Cancer. Cancers (Basel). 2021;13(17):4455. [DOI:10.3390/cancers13174455] [PMID]
- Owens R, Gilmore E, Bingham V, Cardwell C, McBride H, McQuaid S, et al. Comparison of different anti-Ki67 antibody clones and hot-spot sizes for assessing proliferative index and grading in pancreatic neuroendocrine tumours using manual and image analysis. Histopathology. 2020;77(4):646-58. [DOI:10.1111/his.14200] [PMID]
- Kroneman TN, Voss JS, Lohse CM, Wu TT, Smyrk TC, Zhang L. Comparison of Three Ki-67 Index Quantification Methods and Clinical Significance in Pancreatic Neuroendocrine Tumors. Endocr Pathol. 2015;26(3):255-62. [DOI:10.1007/s12022-015-9379-2] [PMID]
- Dowsett M, Nielsen TO, A'Hern R, Bartlett J, Coombes RC, Cuzick J, et al. Assessment of Ki67 in breast cancer: recommendations from the International Ki67 in Breast Cancer working group. J Natl Cancer Inst. 2011;103(22):1656-64. [DOI:10.1093/jnci/djr393] [PMID]
- Sundara Rajan S, Horgan K, Speirs V, Hanby AM. External validation of the ImmunoRatio image analysis application for ERα determination in breast cancer. J Clin Pathol. 2014;67(1):72-5. [DOI:10.1136/jclinpath-2013-201680] [PMID]
- Remes SM, Tuominen VJ, Helin H, Isola J, Arola J. Grading of neuroendocrine tumors with Ki-67 requires high-quality assessment practices. Am J Surg Pathol. 2012;36(9):1359-63. [DOI:10.1097/PAS.0b013e3182632038] [PMID]
- Fulawka L, Halon A. Proliferation Index Evaluation in Breast Cancer Using ImageJ and ImmunoRatio Applications. Anticancer Res. 2016;36(8):3965-72.
- Yeo MK, Kim HE, Kim SH, Chae BJ, Song BJ, Lee A. Clinical usefulness of the free web-based image analysis application ImmunoRatio for assessment of Ki-67 labeling index in breast cancer. J Clin Pathol. 2017;70(8):715-9. [DOI:10.1136/jclinpath-2016-204162] [PMID]
- Yamazaki Y, Nakamura Y, Shibahara Y, Konosu-Fukaya S, Sato N, Kubota-Nakayama F et al. Comparison of the methods for measuring the Ki-67 labeling index in adrenocortical carcinoma: manual versus digital image analysis. Hum Pathol. 2016;53:41-50. [DOI:10.1016/j.humpath.2015.10.017] [PMID]
- Xue T, Yu BH, Yan WH, Jiang XN, Tian T, Zhou XY et al. Prognostic significance of histologic grade and Ki-67 proliferation index in follicular lymphoma. Hematol Oncol. 2020;38(5):665-72. [DOI:10.1002/hon.2778] [PMID]
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