Nuclear size, shape and summed optical density in endometrial cancer

Abstract

Endometrial carcinoma is the most common gynecologic malignancy in developed countries affecting an estimated 140 000 women worldwide. Image analysis involves the integration of an optical microscope with a computer to describe cellular and nuclear features which may not otherwise be quantifiable. The authors, using image analysis, prospectively investigated three optical nuclear parameters to determine their relevance as prognostic indicators in endometrial cancer. Seventy-four consecutive patients with endometrial cancer, and who were being surgically treated, were evaluated for their DNA index (DI), time to recurrence, peritoneal cytology, depth of invasion, lymphovascular space invasion, FIGO stage, grade, histology, as well as nuclear size (NUSZ), shape (NUSH), and summed optical density (NUSD). DNA index, nuclear size, shape and density were quantified using image analysis. Fifteen patients had a recurrence of disease and 12 patients died from disease during the observation period of the study. Median follow-up was 31 months with a range from 1–44 months. Fifty patients had stage I cancers, five had stage II, 16 had stage III, and three had stage IV. Nuclear summed optical density correlated well with traditional prognostic indicators: depth of myometrial invasion (P = 0.003), histologic grade (P = 0.01), DNA index (P<0.001) and FIGO stage (P = 0.004). Nuclear size also correlated well with traditional prognostic indicators: depth of myometrial invasion (P = 0.002), histologic grade (P<0.001), progesterone receptor level (P = 0.005), DNA index (P<0.001), and FIGO stage (P = 0.001). Nuclear shape showed significant correlation only with FIGO stage (P = 0.002). The mean NUSD in patients with a recurrence of disease was 151.53 while the mean NUSD in patients without recurrence was 103.48 (P = 0.002). The mean NUSZ in patients with a recurrence of disease was 156.62 μm2 (P = 0.043). Multivariate analysis showed both NUSZ (P<0.0001) and NUSD (P<0.0001) to be independent prognostic variables. Image analysis is able to quantify cellular and nuclear parameters not otherwise quantifiable. Nuclear summed optical density and NUSZ correlated well with traditional prognostic indicators and were demonstrated to be significantly different in patients with recurrence of disease vs patients without recurrence.