title: Modified true-color computer-assisted image analysis versus subjective scoring of estrogen receptor expression in breast cancer: a comparison.
abstract: BACKGROUND
  Hormone receptor expression can be quantified by computerized image analysis in immunohistochemically stained specimens. When comparing semiquantitative scoring with computerized image analysis a review of the literature shows contradictory findings concerning the correlation of these two methods. Recent technical approaches have been developed with true-color computer-assisted image analysis facilitating new measurement designs. We performed a study with a new approach using the principle of semiquantitative assessment of hormone receptor content and measuring two different binary images (immunohistochemically stained nuclear area and total nuclear area).
  
  
  METHODS
  Eighty formalin-fixed, paraffin-embedded and immunohistochemically stained breast cancer specimens were assessed for estrogen receptor expression by true color computer-assisted image analysis and by conventional light microscopy scoring according to Remmele (immunoreactive score (IRS) = staining intensity (SI) x percentage of positive cells (PP)). The results of both methods were correlated.
  
  
  RESULTS
  Mean optical density (MOD) and subjective scoring of SI as well as stained nuclear area vs. total nuclear area and subjective scoring of stained cells (PP) showed a high correlation (Spearman correlation coefficient: 0.95, p-value: 0.0001 and 0.64, p-value: 0.0001, respectively).
  
  
  CONCLUSIONS
  On the basis of this new technical approach our results confirm the correlation of semiquantitative hormone receptor scoring and quantitative computer-assisted image analysis. We believe that by automating electronic analysis in the near future we will be able to establish reliable observer-independent evaluation of immunohistochemical variables ensuing comparability in multi-center trials and cost efficiency.
authors.affiliation: Department of Obstetrics and Gynecology 1, Freiburg University Medical Center, Germany. pkohlb@frk1.ukl.uni-freiburg.de
authors.forename: P D
authors.initials: PD
authors.lastname: Kohlberger
authors.forename: F
authors.initials: F
authors.lastname: Breitenecker
authors.forename: A
authors.initials: A
authors.lastname: Kaider
authors.forename: A
authors.initials: A
authors.lastname: Lösch
authors.forename: G
authors.initials: G
authors.lastname: Gitsch
authors.forename: G
authors.initials: G
authors.lastname: Breitenecker
authors.forename: D G
authors.initials: DG
authors.lastname: Kieback
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D002467:Cell Nucleus / Q000473:pathology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D015588:Observer Variation; D011960:Receptors, Estrogen / Q000032:analysis*
chemical_list: D011960:Receptors, Estrogen