Nuclear morphometry as an adjunct to cytopathologic examination of endometrial brushings on LBC samples: A prospective approach to combined evaluation in endometrial neoplasms and look alikes

Abstract

Objective: In this study, we aimed to retrospectively investigate and confirm whether atypical nuclear findings in endometrial cytology are useful when assessed by image morphometry in liquid-based cytology (LBC) and compared with microscopic evaluation. Methods: In total, 53 cases were selected for this study, including 11 presenting proliferative endometrium, 12 with surface papillary syncytial change with endometrial glandular and stromal breakdown (EGBD-SPSC), 10 endometrioid carcinoma grade 1 (G1-EEC), 10 EEC grade 3 (G3-EEC), and 10 endometrial serous carcinomas (ESC). Nuclear image morphometry for nuclear geometric features (area, grey value, aspect ratio, internuclear distance, nucleolar diameter) was performed using ImageJ computer software. For assessing nucleoli, 3861 nuclei were measured, and for nuclear findings, except for nucleoli, 4036 nuclei were measured in total. Results: (a) Compared with G1-EEC, G3-EEC and ESC presented a marked increase in all six parameters (nuclear enlargement, anisonucleosis, nuclear shade, nuclear shape, irregularity of nuclear arrangement, and nucleolar size). (b) EGBD-SPSC presented a marked increase in two parameters (nuclear shade, nuclear shape) when compared with G1/G3-EEC and ESC. (c) Compared with EGBD-SPSC, EEC and ESC demonstrated a marked increase in nucleolar size (≥2.0 μm). (d) ESC presented a marked increase in nucleolar size (≥3.0 μm) when compared with G3-EEC. Conclusions: Here we confirmed that atypical nuclear findings evaluated by image morphometry are as useful as microscopic evaluations in endometrial cytology. We believe that the objective evaluation of nucleolar size could contribute to an accurate diagnosis of endometrial-LBC samples.

Morphometrical Differences among Endometrial Endometrioid Carcinoma Grade 1, Grade 3, and Serous Carcinoma in Endometrial Liquid-Based Cytology Preparations

“…Particularly, nearly a two-fold difference was observed between G1 and Serous. According to image analysis using Image J of endometrial LBC (SurePath) specimens obtained by Brush sampling, the area of nucleus was 39.46 ± 11.64 μm 2 in G1, 58.65 ± 26.48 μm 2 in G3, and 72.86 ± 29.44 μm 2 in Serous, similar to our results [19]. These observations suggest that differentiation among G1, G3, and Serous is possible by examination of the area and perimeter of nucleus, and their examination is considered to contribute to the evaluation of histological types in routine microscopic examination.…”

“…The area of nucleolus was 2.67 ± 0.03 μm 2 in G1, 3.27 ± 0.06 μm 2 in G3, and 4.70 ± 0.09 μm 2 in Serous with significant differences among the groups and was G1<G3<Serous. The diameter of nucleolus has also been reported to be G1<G3<Serous [19]. There is also a similar report that the area of nucleolus was G1 (2.57 ± 0.08 μm 2 )<G3 (3.27 ± 0.12 μm 2 ) [20].…”

“…However, by these methods, malignant neoplasms are lumped together as adenocarcinoma, and histological distinction among different grades of EC and Serous is not made. Recently, morphological differences of the nucleus and nucleolus in G1, G3, and Serous by image analysis using endometrial LBC specimens collected by the brush [19] and morphological differences of the cell cluster, nucleus, and nucleolus in G1 and G3 by image analysis using endometrial LBC specimens collected by the Softcyte device [20] have been reported. We, therefore, conducted this study to objectively clarify morphometrical differences of the cell cluster, nucleus, and nucleolus of G1, G3, and Serous in endometrial LBC by analyzing whole slide images.…”

DeepRePath: Identifying the Prognostic Features of Early-Stage Lung Adenocarcinoma Using Multi-Scale Pathology Images and Deep Convolutional Neural Networks

“…In addition to heatmap visualization analysis, morphometric analysis of the nucleus was performed using ImageJ software (National Institutes of Health, Bethesda, MD, USA) [29,30]. We selected 30 representative patches at a magnification of 400×.…”

Application of Pelvic Magnetic Resonance Imaging Scan Combined with Serum Pyruvate Kinase Isozyme M2, Neutrophil Gelatinase‐Associated Lipocalin, and Soluble Leptin Receptor Detection in Diagnosing Endometrial Carcinoma

“…Endometrial carcinoma (EC) is an epithelial malignancy that occurs in the endometrium of women, which is classified into mucinous adenocarcinoma, endometrioid adenocarcinoma, papillary serous endometrial adenocarcinoma, adenocarcinoma with squamous cell differentiation, squamous carcinoma, and clear cell carcinoma [ 1 , 2 ]. Relevant literature has pointed out that EC is one of the malignant tumors with high incidence worldwide, accounting for approximately 25% of malignant diseases of the female reproductive system [ 3 ].…”