Discriminant analysis of malignant mesothelioma and reactive mesothelium using three-dimensional nuclear estimation

Our plain-English summary of Discriminant analysis of malignant mesothelioma and reactive mesothelium using three-dimensional nuclear estimation, by K. Washiya, K. Narumi, T. Noro, et al (Acta Cytologica, 2012).

The study

• Authors: K. Washiya, K. Narumi, T. Noro, S. Hamakawa, N. Furuta, H. Yoshioka, J. Watanabe
• Journal: Acta Cytologica
• Published: 2012;56(2):189-95
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The cytological diagnosis of coelomic fluid is essential for examining malignant mesothelioma (MM). However, reactive mesothelium (RM), caused by various factors, is morphologically similar to MM and thus often complicates the differential diagnosis. Here, nuclear luminance and steric alterations were assessed for the discriminant analysis of MM and RM.

Study Design: Thirteen epithelial MM and 11 RM cases were included. One hundred alterations in the numbers of nuclear pixels and focus layers and the coefficient of variation of nuclear luminance among layers were determined for each case to conduct discriminant analysis using the Mahalanobis distance.

Results: A cutoff value of 0.072 allowed highly accurate discrimination of MM (89.5%) and RM (89.6%). Fifteen cells appeared in 6 agglomerates of indiscriminable MM cases. The 6 agglomerates were individually examined. Malignant cells were dominant in 3 agglomerates (50%), allowing the discrimination of malignant cases.

Conclusion: Discrimination using nuclear luminance and steric alterations is useful for morphologically indiscriminable MM cases. Three-dimensional analysis of agglomerates will be further investigated to improve the diagnostic accuracy.

Copyright © 2012 S. Karger AG, Basel.

In plain English

This Japanese laboratory study tested whether a three-dimensional computer measurement of cell nuclei could help tell epithelial malignant mesothelioma from reactive mesothelium, a non-cancerous condition whose cells can look similar, in body-fluid samples. It used 13 mesothelioma and 11 reactive mesothelium cases, from pleural fluid (20 cases) and ascites (4 cases). The article does not discuss asbestos. From stacked microscope images, the authors measured nuclear size, number of focus layers, and variation in nuclear brightness between layers. Compared with reactive mesothelium, mesothelioma nuclei were 1.7 times larger (1,393 vs 841 pixels), spanned more focus layers (5.4 vs 4.4), and showed less brightness variation (4.9 vs 10.7, in units of 10 to the minus 3). All of these differences had p less than 0.01. Using a cutoff of 0.072, 89.5% of mesothelioma cells (85/95) and 89.6% of reactive cells (86/96) were classified correctly, after 5 and 4 "gray zone" cells were set aside. The authors concluded that the method is useful for mesothelioma cases that cannot be told apart by appearance.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Laboratory diagnostic-technique study: image analysis of cells from fluid samples, with discriminant analysis using the Mahalanobis distance
• Who was studied: Fluid samples from 13 epithelial malignant mesothelioma cases (9 pleural effusion, 4 ascites) and 11 reactive mesothelium cases (all pleural effusion), Japan; diagnoses made histologically with immunohistochemical staining
• Exposure: Not an exposure study; no asbestos or other exposure was assessed
• Main results:
  • Mean nuclear size was 1,393 pixels for mesothelioma cells and 841 pixels for reactive mesothelium cells (1.7 times larger)
  • Mean number of focus layers was 4.4 for reactive mesothelium and 5.4 for mesothelioma
  • Variation in nuclear brightness between layers (3D-CV, times 10 to the minus 3) was lower for mesothelioma (4.9, SD 3.6) than for reactive mesothelium (10.7, SD 7.5)
  • Differences between the groups in all three measures had p less than 0.01
  • With a cutoff of 0.072, 89.5% of mesothelioma cells (85/95, 5 gray zone cells excluded) and 89.6% of reactive mesothelium cells (86/96, 4 gray zone cells excluded) were classified correctly
  • In mesothelioma cases, 15 cells classed as benign (10) or gray zone (5) were found in 6 cell clusters; malignant-classed cells were dominant in 3 of these clusters
  • In reactive mesothelium cases, 14 cells classed as malignant (10) or gray zone (4) appeared in 6 clusters; in 4 of these, benign-classed cells were dominant (90.0, 80.0, 87.5 and 80.0%)
  • Of 29 gray zone or misclassified cells, 11 (38%) could be excluded by examining clusters
• The authors' conclusion: The authors concluded that discrimination using nuclear luminance and steric (three-dimensional) alterations is useful for mesothelioma cases that cannot be distinguished by appearance, and that three-dimensional analysis of cell clusters will be investigated further to improve accuracy
• Limitations the authors state:
  • One reactive mesothelium cluster may have been affected by drying of the sample; the authors state that samples with slight artifacts should have been excluded

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelium, Differential Diagnosis.

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