Value of morphometry, texture analysis, densitometry, and histometry in the differential diagnosis and prognosis of malignant mesothelioma

Our plain-English summary of Value of morphometry, texture analysis, densitometry, and histometry in the differential diagnosis and prognosis of malignant mesothelioma, by B. Weyn, G. Van De Wouwer, M. Koprowski, et al (The Journal of Pathology, 1999).

The study

• Authors: B. Weyn, G. Van De Wouwer, M. Koprowski, A. Van Daele, K. Dhaene, P. Scheunders, W. Jacob, E. Van Marck
• Journal: The Journal of Pathology
• Published: 1999;189(4):581-9
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma is a tumour with increasing incidence due to widespread use of its causative agent, asbestos, in the past decades. The poor survival necessitates a correct differentiation from other lesions at the same site, such as hyperplastic mesothelium and carcinomas metastatic to pleura or peritoneum. Since genetic and immunohistochemical markers are not absolutely differentiating, the diagnosis is based on the histology complemented with (immuno)histochemistry. However, as the tumour presents itself in numerous heterogeneous histological forms, visual evaluation is extremely difficult. In order to evaluate the prognostic and diagnostic performance of syntactic structure analysis (SSA), chromatin texture analysis, densitometry, and morphometry, an automated KNN-classification system has been used to compare Feulgen-stained tissue sections of hyperplastic mesothelium, malignant mesothelioma, and pulmonary adenocarcinoma. In addition, we also studied most discriminative aspects in the differentiation, typing, and prediction of survival. The results indicate that for the diagnosis of malignant mesothelioma, chromatin texture parameters outperform SSA, densitometry, and morphometry (recognition score=96.8 per cent). Most discriminative parameters highlight spatial patterns of the chromatin distribution that are hard to appraise visually and directly show the benefits of a quantitative approach. Typing of the tumour is best described by SSA parameters, relating to the spatial arrangement of the cells in the tissue (recognition score=94.9 per cent). In survival time classifications, chromatin texture yields the highest recognition score (82.9 per cent), although accurate estimations are unreliable due to a large degree of misclassification.

Copyright 1999 John Wiley & Sons, Ltd.

In plain English

This laboratory study, from the University of Antwerp in Belgium, tested whether computer analysis of microscope images could tell malignant mesothelioma apart from two other conditions, identify its subtype, and predict survival. The authors used archived tissue from 39 malignant mesotheliomas (28 epithelial, three sarcomatous, eight mixed type), 20 pulmonary adenocarcinomas and seven cases of hyperplastic mesothelium (overgrown but non-cancerous lining tissue). They measured 82 features of cell nuclei and tissue layout and tested a computer classifier on each case in turn. In separating the three conditions, features describing the texture of nuclear chromatin classified 96.8 per cent of cases correctly, compared with 83.9 to 88.7 per cent for the other feature groups. Most errors were hyperplastic mesothelium classified as mesothelioma, and the authors cautioned that there were very few such cases. For mesothelioma subtype, tissue-layout features scored 94.9 per cent. For sorting patients into three survival groups, chromatin texture scored 82.9 per cent, but the authors said that accurate estimates were unreliable because many cases were misclassified. The article did not report the patients' asbestos exposure.

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 image-analysis study of archived tissue sections, using a computer classifier (K-nearest-neighbour) tested by the leave-one-out method
• Who was studied: Archived tissue from the Laboratory of Pathology, University Hospital Antwerp, Belgium: 39 cases of malignant mesothelioma (28 epithelial, 3 sarcomatous, 8 mixed type), 20 cases of pulmonary adenocarcinoma, and 7 cases of hyperplastic mesothelium. The dates of the cases are not given.
• Exposure: Asbestos exposure was not studied or reported. The study measured 82 image features (densitometry, nuclear morphometry, chromatin texture, and syntactic structure analysis of tissue architecture) in Feulgen-stained tissue sections.
• Main results:
  • Separating malignant mesothelioma, adenocarcinoma and hyperplastic mesothelium: chromatin texture parameters had a recognition score of 96.8 per cent, exceeding the other parameter groups.
  • Recognition scores (total correct) in this classification: densitometry 87.1%, morphometry 83.9%, texture 96.8%, SSA 88.7%, combination 96.8%.
  • Most misclassifications were hyperplastic mesothelium cases classified as malignant mesothelioma.
  • Typing of malignant mesothelioma (epithelial, sarcomatoid, mixed): syntactic structure analysis scored 94.9 per cent, compared with 79.5 per cent for densitometry, 82.1 per cent for morphometry and 92.3 per cent for chromatin texture.
  • Survival classification of mesothelioma patients into under 6 months, 6 to 12 months, and over 12 months: texture scored 82.9 per cent and SSA 80 per cent.
  • The authors found no strong discrimination between survival groups; misclassifications were spread over all three groups.
  • Median survival of the mesothelioma patients from diagnosis to death was 9.4 months (range 1 to 62 months).
• The authors' conclusion: The authors concluded that chromatin texture and tissue architecture can be regarded as important sources of quantitative information that may have considerable weight in the diagnosis and prognosis of malignant mesothelioma.
• Limitations the authors state:
  • The number of hyperplastic mesothelium cases was very low, so the misclassification results for that group should be interpreted with care.
  • Survival estimates were unreliable because of a large degree of misclassification.
  • Tissue sections do not allow measurement of cell dimensions or accurate measurement of ploidy.
  • The number of samples was small compared with the number of parameters, which made parameter selection necessary.

Topics

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

Medical terms in this study, explained in our Lexicon: Differential Diagnosis, Prognosis, Malignant Mesothelioma, Mesothelium, Carcinoma, Pleura, Peritoneum, Histology.

Related studies

• Computer-assisted differential diagnosis of malignant mesothelioma based on syntactic structure analysis — B. Weyn, G. van de Wouwer, et al. (1999)
• Value of Glut-1 and Koc markers in the differential diagnosis of reactive mesothelial hyperplasia, malignant mesothelioma and pulmonary adenocarcinoma — Ö. Üçer, A.F. Dağli, et al. (2013)
• The value of anti-calretinin antibody in the differential diagnosis of normal and reactive mesothelia versus metastatic tumors in effusion cytology — H. Nagel, B. Hemmerlein, et al. (1998)
• A morphometrically-based classification rule for the diagnosis of primary mesothelial lesions — F. Robutti, P.G. Betta, et al. (1990)
• Malignant pleural mesothelioma: some aspects of epidemiology, differential diagnosis and prognosis. Histological and immunohistochemical evaluation and follow-up of mesotheliomas diagnosed from 1964 to January 1985 — R. Walz, H.K. Koch (1990)
• Value of p63 and cytokeratin 5/6 as immunohistochemical markers for the differential diagnosis of poorly differentiated and undifferentiated carcinomas — O. Kaufmann, E. Fietze, et al. (2001)

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