title: Fractal analysis of cervical intraepithelial neoplasia.
abstract: BACKGROUND
  Cervical intraepithelial neoplasias (CIN) represent precursor lesions of cervical cancer. These neoplastic lesions are traditionally subdivided into three categories CIN 1, CIN 2, and CIN 3, using microscopical criteria. The relation between grades of cervical intraepithelial neoplasia (CIN) and its fractal dimension was investigated to establish a basis for an objective diagnosis using the method proposed.
  
  
  METHODS
  Classical evaluation of the tissue samples was performed by an experienced gynecologic pathologist. Tissue samples were scanned and saved as digital images using Aperio scanner and software. After image segmentation the box counting method as well as multifractal methods were applied to determine the relation between fractal dimension and grades of CIN. A total of 46 images were used to compare the pathologist's neoplasia grades with the predicted groups obtained by fractal methods.
  
  
  RESULTS
  Significant or highly significant differences between all grades of CIN could be found. The confusion matrix, comparing between pathologist's grading and predicted group by fractal methods showed a match of 87.1%. Multifractal spectra were able to differentiate between normal epithelium and low grade as well as high grade neoplasia.
  
  
  CONCLUSIONS
  Fractal dimension can be considered to be an objective parameter to grade cervical intraepithelial neoplasia.
authors.affiliation: Institute of Biophysics, Centre for Physiological Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Fabrizii
authors.affiliation: Unit of Breast and Gynaecologic Pathology, Institute of Pathology, Medical University of Graz, Graz, Austria; Department of Pathology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Farid
authors.initials: F
authors.lastname: Moinfar
authors.affiliation: Centre for Research in Complex Systems, Charles Sturt University, Albury, Australia; School of Community Health, Charles Sturt University, Albury, Australia.
authors.forename: Herbert F
authors.initials: HF
authors.lastname: Jelinek
authors.affiliation: School of Community Health, Charles Sturt University, Albury, Australia.
authors.forename: Audrey
authors.initials: A
authors.lastname: Karperien
authors.affiliation: Institute of Biophysics, Centre for Physiological Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Helmut
authors.initials: H
authors.lastname: Ahammer
mesh_terms: D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D017709:Fractals; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*