title: Use of image cytometry to classify biliary and ampullary adenocarcinomas.
abstract: OBJECTIVE
  To create an objective classification system to perform TNM classification of ampullary adenocarcinoma and cholangiocarcinoma using image cytometric data derived from Feulgen-stained tumor nuclei.
  
  
  METHODS
  Surgically resected cases of ampullary adenocarcinoma and cholangiocarcinoma with established TNM classifications were selected on the basis of available formalin-fixed, paraffin-embedded tissue. Fifteen numerical variables related to morphometric, densitometric and textural features of each tumor nucleus were recorded. We employed a methodology based on multivariate statistical tools to characterize the association of morphonuclear variables with TNM classification. The first step consisted of identifying and selecting representative nuclei of each T class. From this "purified" data set an objective classification system was created. The classification system was assessed using internal and external validation.
  
  
  RESULTS
  Employing ANOVA, all 15 variables were significantly associated with T classification, 11 of 15 with N and 4 with M. Multivariate analysis was employed to distinguish between T1, T2 and T3 lesions. Our methodology correctly classified 76% of T1 nuclei, 47% of T2 nuclei and 84% of T3 nuclei. Heterogeneity within an individual tumor was defined in 61% of cases included in the training set. Complete concordance between pathologic classification and the classification system was observed in 71% of an independent validation.
authors.affiliation: Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville, USA.
authors.forename: P
authors.initials: P
authors.lastname: Yeaton
authors.forename: H F
authors.initials: HF
authors.lastname: Frierson
authors.forename: A
authors.initials: A
authors.lastname: Hittelet
authors.forename: C
authors.initials: C
authors.lastname: Duckworth
authors.forename: C
authors.initials: C
authors.lastname: DePrez
authors.forename: N
authors.initials: N
authors.lastname: Bourgeois
authors.forename: I
authors.initials: I
authors.lastname: Salmon
authors.forename: R S
authors.initials: RS
authors.lastname: Jones
authors.forename: R
authors.initials: R
authors.lastname: Kiss
authors.forename: C
authors.initials: C
authors.lastname: Decaestecker
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000175:diagnosis*; D014670:Ampulla of Vater; D000704:Analysis of Variance; D001650:Bile Duct Neoplasms / Q000145:classification* / Q000473:pathology; D018281:Cholangiocarcinoma / Q000145:classification* / Q000473:pathology; D003138:Common Bile Duct Neoplasms / Q000145:classification* / Q000473:pathology; D006801:Humans; D019044:Image Cytometry / Q000379:methods*; D007091:Image Processing, Computer-Assisted; D015999:Multivariate Analysis; D009367:Neoplasm Staging