Using classification and regression trees, liquid‐based cytology and nuclear morphometry for the discrimination of endometrial lesions

Abstract

'The objective of this study is to investigate the potential of classification and regression trees (CARTs) in discriminating benign from malignant endometrial nuclei and lesions. The study was performed on 222 histologically confirmed liquid based cytological smears, specifically: 117 benign cases, 62 malignant cases and 43 hyperplasias with or without atypia. About 100 nuclei were measured from each case using an image analysis system; in total, we collected 22783 nuclei. The nuclei from 50% of the cases (the training set) were used to construct a CART model that was used for knowledge extraction. The nuclei from the remaining 50% of cases (test set) were used to evaluate the stability and performance of the CART on unknown data. Based on the results of the CART for nuclei classification, we propose two classification methods to discriminate benign from malignant cases. The CART model had an overall accuracy for the classification of endometrial nuclei equal to 85%, specificity 90.68%, and sensitivity 72.05%. Both methods for case classification had similar performance: overall accuracy in the range 94-95%, specificity 95%, and sensitivity 91-94%. The results of the proposed system outperform the standard cytological diagnosis of endometrial lesions. This study highlights interesting diagnostic features of endometrial nuclear morphology and provides a new classification approach for endometrial nuclei and cases. The proposed method can be a useful tool for the everyday practice of the cytological laboratory.

Image analysis and multi‐layer perceptron artificial neural networks for the discrimination between benign and malignant endometrial lesions

“…The present results are encouraging in the context of supplementing the performance of cytology in the diagnosis of endometrial cancer . Nuclear morphological characteristics seem to play a central role in endometrial cytology, a finding which has been also observed in our previous studies . The rationale of the current study lied in the fact that carcinogenesis causes destruction of the nuclear‐skeletal structures and of the cytoskeleton, resulting in nuclear deformities.…”

“…[38][39][40][41] Nuclear morphological characteristics seem to play a central role in endometrial cytology, a finding which has been also observed in our previous studies. 12,29,38,42 The rationale of the current study lied in the fact that carcinogenesis causes destruction of the nuclear-skeletal structures and of the Nuclear morphological characteristics can be evaluated both by conventional and liquid-based cytology; nevertheless, the latter seems to overcome inherent difficulties of the conventional approach, such as remaining cells on the sampling device 9 or the frequent presence of protein, mucus and blood 10 using a standardized procedure regarding fixation, transfer and cytological preparation of the biological material. 7,11,12 Integrating the present findings into current clinical practice, endometrial cytology assisted by ANN-MPL could be an accurate tool, which could allow clinicians to decide which women with endometrial pathology would require more radical procedures, such as dilatation and curettage, and who not.…”

Microvessel Landscape Assessment in Pancreatic Ductal Adenocarcinoma

“…17,18 In brief, the image analysis system was a standard commercial computer and a Nikon Eclipse E600 (Nikon Corporation, Tokyo, Japan) microscope. 17,18 In brief, the image analysis system was a standard commercial computer and a Nikon Eclipse E600 (Nikon Corporation, Tokyo, Japan) microscope.…”

Classification and regression trees for the evaluation of thyroid cytomorphological characteristics: A study based on liquid based cytology specimens from thyroid fine needle aspirations

“…Moreover, in numerous cases the probability for malignancy is not very high, therefore a confident result is not assured. To resolve this issue, one could arbitrarily choose a single threshold, above which a case may be considered malignant in everyday routine …”

“…Such techniques have also been previously been applied in diagnostic cytology of different organs, for example, stomach, breast, urinary system, cervix, and thyroid . Classification and Regression Trees (CARTs) is a frequently used approach . CARTs are attractive, due to several reasons: they are relatively straightforward to construct, they can be interpreted as a set of rules or algorithms easily understood by physicians and therefore potentially smoothly integrated to medical decision support systems.…”