Image analysis is an excellent tool for quantifying Ki‐67 to predict the prognosis of gastrointestinal stromal tumor patients

Abstract

We investigated the quantification of Ki-67 staining using digital image analysis (IA) as a complementary prognostic factor to the modified National Institutes of Health (NIH) classification in patients with gastrointestinal stromal tumor (GIST). We examined 92 patients, focusing on the correlation between age, sex, primary tumor site, tumor size, predominant histologic type, mitotic index, modified NIH classification (low/intermediate vs high), Ki-67 quantitation, and recurrence-free survival (RFS). We compared two IA processes for whole slide imaging (WSI) and manually captured image (MCI) methods. A Ki-67 quantitation cutoff was determined by receiver operator characteristics curve analysis. In the survival analysis, the high-risk group of a modified NIH classification, a mitotic count >5 per 20 high-powered fields, and Ki-67 cutoffs of ≥6% and ≥8% obtained by IA of the WSI and MCI methods, respectively, had an adverse impact on RFS. On multivariate analysis, each Ki-67 quantitation method strongly predicted prognosis, more strongly than the modified NIH classification. In addition, Ki-67 quantitation using IA of the MCI method could stratify low or intermediate risk and high risk GIST patients. Thus, IA is an excellent tool for quantifying Ki-67 to predict the prognosis of GIST patients, and this semiautomated approach may be preferable for patient care.

CT Radiomics for the Preoperative Prediction of Ki67 Index in Gastrointestinal Stromal Tumors: A Multi-Center Study

“…And Sugita et al have found that 8% cutoff was a good supplementary prognostic factor for NIH risk stratification. Ki67 greater than 8% would indicate poor prognosis in both low -and intermediate-risk groups (14). Raut et al also concluded that Ki67 was one of the reference markers for imatinib's adjuvant treatment time after surgery (15).…”

Tumor Digital Masking Allows Precise Patient Triaging: A Study Based on Ki-67 Scoring in Gastrointestinal Stromal Tumors

“…The most newly published paper by Sugita et al applied a methodology similar to ours reaching an 8% score for whole slide scanning and Ki-67 labelling. The authors concluded that whole slide analysis raises the Ki-67 score in high-grade tumors to 8% and assume our study in hotspots could reach 10% or more [ 36 ].…”

Correlation Between Digital and Manual Determinations of Ki-67/MIB-1 Proliferative Indices in Human Meningiomas

“…Thus, data are scarce regarding digital determinations of MIB-1 PIs in human meningiomas. However, similar studies have been performed in other tumors, such as breast cancer, 19 gliomas, 20 gastrointestinal stromal tumors, 21 and prostate cancer. 22 In those studies, a generally good correlation was established between manual and digital determinations of MIB-1 PIs, but the prognostic aspects varied.…”

“…22 In those studies, a generally good correlation was established between manual and digital determinations of MIB-1 PIs, but the prognostic aspects varied. [19][20][21][22] Accordingly, more studies are needed to establish reliable clinical data on MIB-1 PIs for various tumors.…”