Abstract
IntroductionIn epilepsy, the diagnosis of mild Malformation of Cortical Development type II (mMCD II) predominantly relies on the histopathological assessment of heterotopic neurons in the white matter. The exact diagnostic criteria for mMCD II are still ill-defined, mainly because findings from previous studies were contradictory due to small sample size, and the use of different stains and quantitative systems. Advance in technology leading to the development of whole slide imaging with high-throughput, automated quantitative analysis (WSA) may overcome these differences, and may provide objective, rapid, and reliable quantitation of white matter neurons in epilepsy. This study quantified the density of NeuN immunopositive neurons in the white matter of up to 142 epilepsy and control cases using WSA. Quantitative data from WSA was compared to two other systems, semi-automated quantitation, and the widely accepted method of stereology, to assess the reliability and quality of results from WSA.ResultsAll quantitative systems showed a higher density of white matter neurons in epilepsy cases compared to controls (P = 0.002). We found that, in particular, WSA with user-defined region of interest (manual) was superior in terms of larger sampled size, ease of use, time consumption, and accuracy in region selection and cell recognition compared to other methods. Using results from WSA manual, we proposed a threshold value for the classification of mMCD II, where 78% of patients now classified with mMCD II were seizure-free at the second post-operatively follow up.ConclusionThis study confirms the potential role of WSA in future quantitative diagnostic histology, especially for the histopathological diagnosis of mMCD.Electronic supplementary materialThe online version of this article (doi:10.1186/2051-5960-2-72) contains supplementary material, which is available to authorized users.
Highlights
In epilepsy, the diagnosis of mild Malformation of Cortical Development type II predominantly relies on the histopathological assessment of heterotopic neurons in the white matter
Using results from Whole slide imaging with automated analysis (WSA) manual, we proposed a threshold value for the classification of Malformation of Cortical Development (mMCD) II, where 78% of patients classified with Malformation of Cortical Development type II (mMCD II) were seizure-free at the second post-operatively follow up
This study confirms the potential role of WSA in future quantitative diagnostic histology, especially for the histopathological diagnosis of mMCD
Summary
The diagnosis of mild Malformation of Cortical Development type II (mMCD II) predominantly relies on the histopathological assessment of heterotopic neurons in the white matter. There is an increasing official acceptance of WSA: the United States Food and Drug Administration has approved the WSA of several major companies for the diagnostic evaluation/ screening of HER2, PR, ER, Ki67 and/or p53 immunolabelling (Additional file 2: Table S2), underlining the importance and relevance that quantitative histopathology has in personalised medicine Before such advanced system is used in routine clinical laboratory, it is important to carefully compare the cost and applicability, and validate the quality of results obtained against traditionally used methods such as semi-automated analysis, and established, gold standard approaches for quantifying the number of neurons in volume of tissue, such as stereology [27]
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