Grading Pancreatic Neuroendocrine Tumors by Ki-67 Index Evaluated on Fine-Needle Aspiration Cell Block Material

Abi‐Raad, Rita; Lavik, John-Paul; Barbieri, Andrea; Zhang, Xuchen; Adeniran, Adebowale; Cai, Guoping

doi:10.1093/ajcp/aqz110

Cited by 23 publications

(26 citation statements)

References 22 publications

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“…The assistance of artificial intelligence in digital image analysis has shown increased efficiency with comparable results to manual mitotic counts in breast cancer and melanoma 23‐25 . Artificial intelligence has been used in cell block material of gastric neuroendocrine tumours in the calculation of the Ki‐67 proliferation index 26,27 . However, there is no set risk stratification in GISTs for the use of the Ki‐67 proliferation index and artificial intelligence for mitotic counts has not yet been studied in either GISTs or cytology cell block material.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Mitotic count of fine needle aspiration material of gastrointestinal stromal tumours of the stomach underestimates actual mitotic count

Christensen

Goldberg

2021

Cytopathology

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Introduction A mitotic count is required for histological grading in resections of gastrointestinal stromal tumours (GISTs). However, no consensus on the utility of mitotic count in fine needle aspiration (FNA) GIST material currently exists. This study examines the relationship between mitotic counts of FNAs and subsequent resections of GISTs of the stomach. Materials and methods We identified 39 cases of GISTs of the stomach diagnosed via FNA at our institution between January 1, 2014, and December 31, 2019, with subsequent resection. We noted if rapid on‐site evaluation (ROSE) was performed. Cell block (CB) material from FNAs was analysed for total area, percentage containing neoplastic cells, and number of mitoses. We compared the mitotic counts in CBs and subsequent resections with t tests. Results ROSE was performed in 82% of cases and called adequate every time. Mean values for total CB area, neoplastic material percentage, and area of neoplastic cells were 54.7 mm2 (range 1‐986), 45% (range 10%‐90%), and 19.2 mm2, respectively; 27 cases (69%) had greater than 50 high powered fields of GIST material in the CB. Mean numbers of mitoses per 5 mm2 were 0.38 (range 0‐11) for CBs versus 5.92 (range 0‐70) for resections (P < 0.05). Conclusion At our institution, ROSE adequacy of spindle cell lesions focuses on diagnosing GIST rather than obtaining adequate material for histological grading. Mitotic figures were statistically lower in FNA CB material than subsequent resections, and using mitotic counts from CB material may underestimate the histological grade of GISTs of the stomach.

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Section: Discussion/conclusionmentioning

confidence: 99%

Mitotic count of fine needle aspiration material of gastrointestinal stromal tumours of the stomach underestimates actual mitotic count

Christensen

Goldberg

2021

Cytopathology

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“…Given that the tissue annotation method did not appear to provide superior concordance, the added labour time for pathologists to annotate these cases does not appear to add significant benefit for CD8 quantification in small biopsies. In addition, we know that quantification by IA can be challenging, especially near the cut‐off values that are set and in cases with heterogeneity which is inherent in small biopsy sampling, and has been discussed in the literature extensively with respect to Ki67 grading in neuroendocrine tumours …”

Section: Discussionmentioning

confidence: 99%

Quantitative image analysis for CD8 score in lung small biopsies and cytology cell‐blocks

et al. 2020

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Introduction Immunotherapy has shown promising results in non‐small cell lung cancer (NSCLC), for which tumour‐infiltrating cytotoxic (CD8+) T cells play a critical role. We investigated the utility of image analysis (IA) to quantify CD8+ T cells in a series of matched small biopsies and resections of NSCLC. Methods CD8 immunohistochemistry was performed on cell‐blocks (CB), core needle biopsies (CNB) and corresponding resections from primary NSCLCs. Slides were digitised using an Aperio AT2 scanner (Leica) and annotated by whole slide image (WSI) or fields of view occupied by tissue spots (TS). Quantitative IA was performed with a customised Aperio algorithm (Leica). CD8 scores (number of T cells with 1‐3+ staining/total area) were then compared. Results Forty‐four cases with CB or CNB material and a corresponding resection were analysed. Average CD8 score was determined in CB (7.67 WSI, 77.67 TS) and/or CNB (47.35 WSI, 325.67 TS), and corresponding resections (190.35 WSI, 336.58 TS). CD8 score concordance was highest (78.6%) for CNBs using WSI annotation. Overall, small biopsies (CB or CNB) correlated with the resection in 71.4% cases using WSI and 63.3% cases using TS annotation. IA performed better for low CD8 scores. Conclusions These findings show that CD8 density in NSCLC can be quantified by IA in small biopsies and cell blocks, achieving the best concordance using WSI scores. Discrepancies were attributed to values near the cut‐off and background detection of staining. These data warrant future studies with more cases and follow‐up data to further investigate the clinical utility of IA for CD8 analysis in NSCLC.

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“…This is difficult to translate to cytological samples, since change in architecture in cell block sections will obviously have a significant impact on how mitotic activity will be assessed. In addition, studies on the use of immunohistochemical markers such as ki‐67 on cell blocks is still controversial, with most studies showing good concordance between low‐grade G1 tumors, but underestimation of higher grade lesions . Additional studies with larger comparisons of cell block and resection specimens may be needed to clarify the role of using grading in cytology and a possible incorporation of proposed guidelines in the future versions of classification systems.…”

Section: Future Perspectivesmentioning

confidence: 99%

Section: Future Perspectivesmentioning

confidence: 99%

“…tumors, but underestimation of higher grade lesions. 29,30 Additional studies with larger comparisons of cell block and resection specimens may be needed to clarify the role of using grading in cytology and a possible incorporation of proposed guidelines in the future versions of classification systems. Novel technologies such as computer-assisting assessment of the proliferation index using artificial intelligence may also impact this.…”

Section: Future Perspectivesmentioning

confidence: 99%

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Experience and future perspectives on the use of the Papanicolaou Society of Cytopathology Terminology System for reporting pancreaticobiliary cytology

Saieg

Pitman

2020

Diagnostic Cytopathology

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The Papanicolaou Society of Cytopathology developed a set of guidelines for reporting pancreaticobiliary cytology in 2014 (PB System), with a six‐tiered system: Nondiagnostic, Negative, Atypical, Neoplastic (Benign or Other), Suspicious, and Positive. This proposed scheme incorporates ancillary testing such as biochemical testing of cyst fluids for diagnosis and provides terminology that standardizes the category of the various diseases of the pancreas, some of which are difficult to diagnose specifically by cytology alone. Since its initial publication five and half years ago, several groups have published their experiences on the use of the PB System and have shown that most objectives proposed by the original publication have been achieved. They have shown that there is a better understanding and definition of the diagnostic categories with an associated distribution and risk of malignancy. The diagnostic categories of Neoplastic: Other, Suspicious, and Malignant show a high sensitivity and specificity for the diagnosis of malignancy. The System also provides a multi‐specialist view of pancreatic lesions, with biochemical and radiological findings being incorporated into the final pathological report. The present review summarizes these findings and discusses the future perspectives and foreseen changes that are to be incorporated to a second edition of the reporting System.

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Grading Pancreatic Neuroendocrine Tumors by Ki-67 Index Evaluated on Fine-Needle Aspiration Cell Block Material

Cited by 23 publications

References 22 publications

Mitotic count of fine needle aspiration material of gastrointestinal stromal tumours of the stomach underestimates actual mitotic count

Mitotic count of fine needle aspiration material of gastrointestinal stromal tumours of the stomach underestimates actual mitotic count

Quantitative image analysis for CD8 score in lung small biopsies and cytology cell‐blocks

Experience and future perspectives on the use of the Papanicolaou Society of Cytopathology Terminology System for reporting pancreaticobiliary cytology

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