Digital morphometry of cytologic aspirate endometrial samples

Mahovlić, Vesna and Ovanin-Rakić, Ana and Škopljanac-Mačina, Lada and Barišić, Ana and Rajhvajn, Sanda and Jurič, Danijela and Šamija Projić, Ivana and Ilić-Forko, Jadranka and Babić, Damir and Škrablin-Kučić, Snježana and Božikov, Jadranka (2010) Digital morphometry of cytologic aspirate endometrial samples. Collegium Antropologicum, 34 (1). pp. 45-51. ISSN 0350-6134

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Abstract

Unlike cervical cytology, morphological cytology criteria in the differential diagnosis of endometrium have not yet been clearly defined, and methods to allow for more precise evaluation of endometrium status have been searched for. The aim of the present study was to assess the value of morphometric nucleus analysis of cytologic aspirate endometrial samples in proliferative, hyperplastic and malignant endometrium by use of digital image analysis. Morphometric analysis was performed on archival cytologic aspirate endometrial samples (at least 10 per group) stained according to Papanicolaou (n=77) and May-Grünwald-Giemsa (MGG; n=80) with the following histopathologic diagnoses: proliferative endometrium, hyperplasia simplex, hyperplasia complex, hyperplasia complex atypica, and adenocarcinoma endometriodes endometrii (grade I, II and III). Interactive image analysis (nuclear area, convex area, perimeter, maximum and minimum radius, length and breadth, as well as nucleus form factor and elongation factor) was performed by use of the SFORM software (VAMSTEC, Zagreb) on at least 50 (Papanicolaou stain) and 100 (MGG stain) well preserved endometrial epithelial cell nuclei without overlapping, at magnification of ´1000. Statistical data analysis was done by use of the Statistica Ver. 6 statistical package. Multivariate analysis (ANOVA) distinguished malignant, hyperplastic and proliferative endometrium according to all morphometric variables with both staining methods (p<0.05). However, on interactive testing of the groups (Kruskal-Wallis test), hyperplasias without atypia yielded no significant differences (p>0.05) from atypical hyperplasia, adenocarcinoma and proliferative endometrium only according to the nucleus form factor and elongation factor (Papanicolaou stain), whereas malignant and atypical hyperplastic endometrium (MGG stain) differed statistically significantly (p<0.05) from proliferative and hyperplastic endometrium without atypia according to all study parameters except for the nucleus form factor (p>0.05). According to the cytologic staining method, morphometric parameters were considerably higher in MGG stained endometrial samples, reaching the level of statistical significance (p<0.05) except for the nucleus form factor and elongation factor (p>0.05) in the groups of hyperplasia simplex and complex, well differentiated adenocarcinoma (form factor) and atypical hyperplasia (elongation factor). A combination of cytomorphology and the morphometric variables assessed in this study can yield useful information on the cytologic state of endometrium, with special reference to the possible differentiation of the group of hyperplasia without atypia from the group of adenocarcinoma and atypical hyperplasia.

Abstract in Croatian

DIGITALNA MORFOMETRIJSKA ANALIZA CITOLOŠKIH UZORAKA ASPIRATA ENDOMETRIJA ----- Za razliku od cervikalne citologije, nema jasno definiranih morfoloških citoloških kriterija u diferencijalnoj dijagnostici endometrija, te se traga za metodama koje bi omogućile precizniju evaluaciju endometralnog statusa. Cilj rada bio je procijeniti vrijednost morfometrijske analize jezgara u citološkim uzorcima aspirata materišta kod proliferativnog, hiperplastičnog i malignog endometrija putem digitalne analize slikovnog prikaza. Morfometrijska analiza primijenjena je na arhivskim citološkim uzorcima aspirata endometrija (najmanje 10 po skupini) obojenim metodom po Papanicolaou (n=77) i May-Grünwald-Giemsi (MGG; n=80) sa slijedećim patohistološkim dijagnozama: proliferativni endometrij, hyperplasia simplex, hyperplasia complex, hyperplasia complex atypica i adenocarcinoma endometriodes endometrii (I., II. i III. stadij). Interaktivna analiza slikovnog prikaza (površina, konveksnost površine, opseg, najveći i najmanji polumjer, duljina i širina jezgre te »fakor pravilnosti« i »faktor izduženosti« jezgre) izvršena je programom Sform (Vamstec, Zagreb) na najmanje 50 (bojenje po Papanicolaou) odnosno 100 (bojenje po MGG) dobro očuvanih jezgara epitelnih endometralnih stanica bez preklapanja, pri povećanju od x1000. Statistička analiza podataka učinjena je primjenom statističkog paketa Statistica ver. 6. Multivarijatnom analizom (ANOVA) razlikuje se maligni, hiperplastični i proliferativni endometrij po svim morfometrijskim varijablama u oba bojenja (p<0,05). Međutim, međusobnim testiranjem skupina (Kruskal-Wallisov test) hiperplazije bez atipija značajno se ne razlikuju jedino po faktoru pravilnosti i izduženosti (p>0,05) od atipične hiperplazije, adenokarcinoma i proliferativnog endometrija (bojenje po Papanicolaouu), odnosno maligni i atipični hiperplastični endometrij (bojenje MGG) statistički se značajno razlikuje (p<0,05) s obzirom na sve mjerene parametre od proliferativnog i hiperplastičnog endometrija bez atipija, osim za faktor pravilnosti jezgre (p>0,05). S obzirom na citološko bojenje, morfometrijski parametri su znatno veći u aspiratima materišta obojenim MGG metodom, što je i statistički značajno (p<0,05), osim za faktor pravilnosti i faktor izduženosti jezgre (p>0,05) za skupinu hiperplazije simpleks i kompleks, odnosno dobro diferencirani adenokarcinom (faktor pravilnosti) i atipičnu hiperplaziju (faktor izduženosti) uspoređujući oba bojenja. Kombinacijom citomorfologije i ispitivanih morfometrijskih varijabli mogu se dobiti korisne informacije o citološkom statusu endometrija s naglaskom na mogućnost odvajanja skupine hiperplazija bez atipija od skupine adenokarcinoma i atipične hiperplazije.

Item Type: Article
MeSH: Adenocarcinoma/pathology ; Biopsy, Needle ; Carcinoma, Endometrioid/pathology ; Cell Division ; Endometrial Hyperplasia/pathology ; Endometrium/pathology ; Eosine Yellowish-(YS) ; Female ; Humans ; Image Processing, Computer-Assisted/methods ; Methylene Blue ; Uterine Cervical Neoplasms/pathology ; Vaginal Smears
Departments: Katedra za ginekologiju i opstetriciju
Katedra za patologiju
Katedra za medicinsku statistiku, epidemiologiju i medicinsku informatiku
Depositing User: Marijan Šember
Status: Published
Creators:
CreatorsEmail
Mahovlić, VesnaUNSPECIFIED
Ovanin-Rakić, AnaUNSPECIFIED
Škopljanac-Mačina, LadaUNSPECIFIED
Barišić, AnaUNSPECIFIED
Rajhvajn, SandaUNSPECIFIED
Jurič, DanijelaUNSPECIFIED
Šamija Projić, IvanaUNSPECIFIED
Ilić-Forko, JadrankaUNSPECIFIED
Babić, DamirUNSPECIFIED
Škrablin-Kučić, SnježanaUNSPECIFIED
Božikov, JadrankaUNSPECIFIED
Date: March 2010
Date Deposited: 21 May 2010
Last Modified: 23 Sep 2011 16:11
Subjects: /
Related URLs:
    URI: http://medlib.mef.hr/id/eprint/777

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