title: Automated image analysis for high-throughput quantitative detection of ER and PR expression levels in large-scale clinical studies: the TEAM Trial Experience.
abstract: OBJECTIVE
  Routine immunohistochemistry is regarded as a semiquantitative method for the evaluation of in situ protein expression. Analysis of tissue biomarkers in large clinical trials is central to the development of novel targeted approaches to therapy, requires the analysis of tens of thousands of data points, and frequently makes use of high-throughput analysis of tissue microarrays (TMAs). The aim of this study was to investigate the potential of image analysis for accurate and reproducible quantitative evaluation of biomarkers.
  
  
  RESULTS
  We showed, in 397 cases of breast cancer from the Phase III TEAM clinical trial, excellent correlations between semiautomated image analysis of TMAs and manual scoring of oestrogen receptor (ER) and progesterone receptor (PR) levels (interclass correlation coefficients 0.93 and 0.96 respectively). Two or more TMA cores were excellently correlated with manual scores, and using more than three cores increased the number of cases available for analysis to >92%. TMAs are confirmed as representative of whole sections for immunohistochemical analysis of the tissue biomarkers ER and PR.
  
  
  CONCLUSIONS
  Semiautomated image analysis is appropriate for the analysis of tissue biomarkers within large clinical trials. These data provide support for the use of TMAs and image analysis in translational research.
authors.affiliation: Division of Pathology, Edinburgh Cancer Research Centre, Edinburgh, Scotland.
authors.forename: Dana
authors.initials: D
authors.lastname: Faratian
authors.forename: Charlene
authors.initials: C
authors.lastname: Kay
authors.forename: Tammy
authors.initials: T
authors.lastname: Robson
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Campbell
authors.forename: Margaret
authors.initials: M
authors.lastname: Grant
authors.forename: Dan
authors.initials: D
authors.lastname: Rea
authors.forename: John M S
authors.initials: JM
authors.lastname: Bartlett
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis*; D001943:Breast Neoplasms / Q000378:metabolism; D017326:Clinical Trials, Phase III as Topic; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007150:Immunohistochemistry; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D011960:Receptors, Estrogen / Q000032:analysis* / Q000096:biosynthesis; D011980:Receptors, Progesterone / Q000032:analysis* / Q000096:biosynthesis; D046888:Tissue Array Analysis / Q000379:methods*
chemical_list: D014408:Biomarkers, Tumor; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone