title: A pilot study on the role of fractal analysis in the microscopic evaluation of colorectal cancers.
abstract: BACKGROUND
  Colorectal cancer (CRC) represents one of the most common cancers worldwide; its growing incidence and prevalence quickly transforming it into a major health burden. Globally, survival varies from one country to another and constantly remains significantly low, despite increasing diagnostic efforts and tools. Fractal geometry and, specifically, fractal dimension (FD) are interesting tools to quantify cellular elements. In this paper, we aimed to identify and quantify by fractal analysis the elements obtained from medical images from pathological and immunohistochemical investigations of colonic biopsy fragments.
  
  
  METHODS
  We prospectively selected the study group between September 2014 and January 2015, from patients who underwent surgery for previously diagnosed CRC at the Emergency County Hospital, Craiova, Romania. We performed the histological and immunohistochemical studies by following standardized protocols. Anti-Ki67, anti-p53 and anti-VEGF-C antibodies were used for immunostaining. We performed the fractal analysis with an in-house tool and we performed statistical tests on the results.
  
  
  RESULTS
  We have included 41 (29 males) consecutive patients with different characteristics; after analyzing the FDs we found significant differences between adenocarcinomas and the other types of colonic cancers (p<0.001). However, we found no significant differences between most types of CRCs. We found significant statistical differences when compared well-differentiated tumors with all other stages (p<0.001).
  
  
  CONCLUSIONS
  Fractal analysis with the calculation of FDs is a novel, interesting tool, for determining the pathologic diagnosis of CRCs and may further improve diagnostic and prognostic rates, thus improving patient care.
authors.affiliation: Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania; costinstreba@gmail.com.
authors.forename: Liliana
authors.initials: L
authors.lastname: Streba
authors.forename: Mircea Cătălin
authors.initials: MC
authors.lastname: ForŢofoiu
authors.forename: Carmen
authors.initials: C
authors.lastname: Popa
authors.forename: Daniela
authors.initials: D
authors.lastname: Ciobanu
authors.forename: Corina Lavinia
authors.initials: CL
authors.lastname: Gruia
authors.forename: Stelian ŞtefăniŢă
authors.initials: SŞ
authors.lastname: Mogoantă
authors.forename: Costin Teodor
authors.initials: CT
authors.lastname: Streba
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003106:Colon / Q000473:pathology; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000503:physiopathology*; D003936:Diagnosis, Computer-Assisted; D005260:Female; D017709:Fractals; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012307:Risk Factors; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism; D042582:Vascular Endothelial Growth Factor C / Q000378:metabolism
chemical_list: D019394:Ki-67 Antigen; C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53; C467486:VEGFC protein, human; D042582:Vascular Endothelial Growth Factor C