title: Fine-needle aspiration of follicular adenoma versus parathyroid adenoma: the utility of multispectral imaging in differentiating lesions with subtle cytomorphologic differences.
abstract: BACKGROUND
  Multispectral image analysis is an emerging tool that utilizes both spatial and spectral image information to classify images that can be used for the differentiation between benign versus malignant cells. The aim of the current study was to analyze the ability of this tool in differentiating subtle cytologic differences that cannot be appreciated by the human eye. Herein, the authors used fine-needle aspirations (FNAs) of follicular adenoma (FA) and parathyroid adenoma (PA) as a test case.
  
  
  METHODS
  The Nuance platform was used to collect image stacks that were subsequently analyzed with CRI-MLS software, a neural network-based artificial intelligence system that can classify images using automatically "learned" spatial-spectral features. CRI-MLS was trained on random, well-preserved FA cells and PA cells from the training set (n = 45 cells each). An algorithmic solution was developed and then validated on an independent series comprised of 1904 FA cells from 5 FA cases and 690 PA cells from 5 PA cases.
  
  
  RESULTS
  The solution from the CRI-MLS classifier showed 1876 FA cells (98.5%) as true FA and 28 FA cells (1.5%) as false PA, whereas 663 PA cells (96%) were true PA and 27 PA cells (4%) were false FA. The summary result of this solution was a sensitivity of 98.5%, a specificity of 96.1%, and a positive predictive value of 98.6%.
  
  
  CONCLUSIONS
  The best spatial-spectral imaging solution was able to correctly classify 2534 of 2594 cells (98%) and misclassified only 55 of 2594 cells (2%). These data suggest that this technology may be valuable in a clinical setting to help differentiate and classify morphologically similar lesions.
authors: Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520-8023, USA.
authors: Ibrahim
authors: I
authors: Mansoor
authors: Carola
authors: C
authors: Zalles
authors: Farhan
authors: F
authors: Zahid
authors: Kirk
authors: K
authors: Gossage
authors: Richard M
authors: RM
authors: Levenson
authors: David L
authors: DL
authors: Rimm
mesh_terms: D000236:Adenoma / Q000473:pathology*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D010282:Parathyroid Neoplasms / Q000473:pathology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013057:Spectrum Analysis; D013964:Thyroid Neoplasms / Q000473:pathology*