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Counting mitoses: SI(ze) matters!

Ian A Cree1, Puay Hoon Tan2, William D Travis3

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Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc
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Pathologists assess cancer malignancy by counting mitoses per high power field (HPF). Standardizing mitotic counts per square millimeter (mm²) using SI units will improve accuracy and patient care.

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Area of Science:

  • Pathology
  • Oncology
  • Histopathology

Background:

  • Mitotic counts are crucial for cancer diagnosis, malignancy grading, and prognosis.
  • Traditional methods using high power fields (HPFs) lack standardization due to variable field sizes.
  • Digital pathology exacerbates inconsistencies in area measurement for mitotic counts.

Purpose of the Study:

  • To address the inaccuracies in mitotic counting caused by non-standardized high power fields (HPFs).
  • To propose a standardized method for mitotic counting to improve diagnostic accuracy and patient care.
  • To advocate for the adoption of metric units for mitotic index reporting.

Main Methods:

  • Review of current practices in mitotic counting in histopathology.
  • Analysis of the variability in high power field (HPF) areas across different microscopes and digital systems.
  • Proposal for a standardized counting method using square millimeters (mm²).

Main Results:

  • High power fields (HPFs) vary significantly in actual area, leading to inconsistent mitotic counts.
  • Current methods of reporting mitoses per HPF are prone to considerable error.
  • The use of standardized international (SI) units, specifically mm², offers a solution.

Conclusions:

  • Standardizing mitotic counts per square millimeter (mm²) is essential for accurate cancer diagnosis and grading.
  • Adoption of SI units will enhance consistency and reliability in histopathological assessments.
  • Implementing standardized reporting, including area and method (hotspot/average), will improve patient care.