A semi-automated microscopic image analysis method for scoring Ki-67 nuclear immunostaining

Nuclear proliferation marker MIB-1 (Ki-67) immunohistochemistry (IHC) is used to examine tumor cell proliferation. However, the diagnostic or prognostic value of the Ki-67 nuclear staining intensity and location, defined as nuclear gradient (NG), has not been assessed. This study examined the potential association between Ki-67 NG and cell cycle phases and its effect on the prognosis of pulmonary typical carcinoid (PTC) tumors. We propose a method for classifying the NG of Ki-67 during the cell cycle and compare the results between PTC, pulmonary adenocarcinoma (PAD), and breast ductal carcinoma (BDC). A literature review and objective analysis of IHC-stained paraffin sections were used to determine the Ki-67 labeling index and composed a stratification of the NG into NG1, NG2, and NG3/4 categories. A semi-automated image analysis protocol was established to determine the Ki-67 NG in PTC, PAD, and BDC. High intraobserver consistency and moderate interobserver agreement were achieved in the determination of Ki-67 NG in tumor specimens. NG1 and NG2 were lower in PTC than in PAD and BDC. Cox multivariate analysis of PTC after adjusting for age and number of metastatic lymph nodes showed that Ki-67 NG1 and NG2 significantly predicted clinical outcomes. The semi-automated method for quantification of Ki-67 nuclear immunostaining proposed in this study could become a valuable diagnostic and prognostic tool in PTC.

Observation of Short-term and Long-term Efficacy of Bronchoscopic Interventional Therapy in the Treatment of Typical Carcinoid / 中国肺癌杂志

BACKGROUND@#The curative potential of various bronchoscopic treatments such as electric snare, carbon dioxide freezing, argon plasma coagulation (APC), Neudymium-dopted Yttrium Aluminium Garnet (Nd:YAG) laser and photodynamic therapy (PDT) for the treatment of intraluminal tumor has been administered previously, but this regimen is not common in the treatment of typical carcinoid. The aim of this study is to investigate the curative effects both in short-term and long-term of interventional bronchoscopy in the treatment of typical carcinoid.@*METHODS@#We retrospectively reviewed the clinical data of typical carcinoid patients who were treated with interventional bronchoscopy for tumor suppression and they were hospitalized in the Emergency General Hospital from December 2010 to December 2020, and Wilcoxon rank sum test and chi-square test were used for analysis.@*RESULTS@#A total of 32 patients were included, including 18 cases of preoperative bronchial artery embolization (embolization rate 56%, 95%CI: 31%-79%). The grade score of dyspnea decreased from before treatment to after treatment, and the difference was statistically significant [(1.44±1.03) score vs (0.25±0.58) score, P=0.003]; The degree of bronchial stenosis decreased from pre-treatment to post-treatment, and the difference was statistically significant [(87.50%±13.90%) vs (17.50%±6.83%), P<0.001]; There was significant difference in bronchial diameter before and after treatment [(0.14±0.18) cm vs (0.84±0.29) cm, P<0.001].@*CONCLUSIONS@#Bronchoscopic interventional therapy has significant short-term and long-term effects in the treatment of typical carcinoid.

Hallazgos por imagen de tumor carcinoide bronquial en hospital de la habana / Imaging findings of bronchial carcinoid tumor in haban-hospital

Se presenta un caso de adolescente sin comorbilidades, quien cursó durante tres meses con infecciones respiratorias a repetición sin mejoría a pesar de manejo médico apropiado. En imagen de control posterior a la hospitalización, se documenta en estudios de imagen lesión del lóbulo inferior derecho con crecimiento endoluminal y mediante broncoscopía se confirma la presencia de una masa tumoral en la luz del bronquio para dicho lóbulo. Se realiza biopsia y el estudio anatomopatológico reporta tumor carcinoide variedad típica. A pesar que es una entidad poco frecuente, el tumor carcinoide es una neoplasia neuroendócrina que se puede presentar en el sistema respiratorio en este grupo poblacional y se debe considerar en el contexto de infecciones respiratorias a repetición. Los estudios de imagen deberían ser parte de la evaluación de todo paciente que cursa con complicaciones de infecciones respiratorias y en el diagnóstico diferencial de otras entidades respiratorias.

It is present a case of teenager without comorbidities, who had recurrent respiratory infections during three months without improving besides proper medical treatment. Imaging post-hospitalization control documented in imaging studies a right lower lobe lesion with endobronchial grow and bronchoscopy confirmed a growing into the lumen tumoral mass of such lobular bronchi. A biopsy was performed and an pathological study reported carcinoid tumor typical type. Even though it is a rare entity, carcinoids tumors are neuroendocrine neoplasms that can be found in the respiratory system among this population group and it should be considered in a repetitive respiratory infections scene. Imaging studies should be part of every patient evaluation that course with complications as well as a tool for other entities differential diagnosis.

Morphologic Analysis of Pulmonary Neuroendocrine Tumors

BACKGROUND: Few studies on how to diagnose pulmonary neuroendocrine tumors through morphometric analysis have been reported. In this study, we measured and analyzed the characteristic parameters of pulmonary neuroendocrine tumors using an image analyzer to aid in diagnosis. METHODS: Sixteen cases of typical carcinoid tumor, 5 cases of atypical carcinoid tumor, 15 cases of small cell carcinoma, and 51 cases of large cell neuroendocrine carcinoma were analyzed. Using an image analyzer, we measured the nuclear area, perimeter, and the major and minor axes. RESULTS: The mean nuclear area was 0.318+/-0.101 microm2 in typical carcinoid tumors, 0.326+/-0.119 microm2 in atypical carcinoid tumors, 0.314+/-0.107 microm2 in small cell carcinomas, and 0.446+/-0.145 microm2 in large cell neuroendocrine carcinomas. The mean nuclear circumference was 2.268+/-0.600 microm in typical carcinoid tumors, 2.408+/-0.680 microm in atypical carcinoid tumors, 2.158+/-0.438 microm in small cell carcinomas, and 3.247+/-1.276 microm in large cell neuroendocrine carcinomas. All parameters were useful in distinguishing large cell neuroendocrine carcinoma from other tumors (p=0.001) and in particular, nuclear circumference was the most effective (p=0.001). CONCLUSIONS: Pulmonary neuroendocrine tumors showed nuclear morphology differences by subtype. Therefore, evaluation of quantitative nuclear parameters improves the accuracy and reliability of diagnosis.