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Mitosis-Karyorrhexis Index evaluation by digital image visual analysis for application of International Neuroblastoma
Neha Bhardwaj1, Manish Rohilla1, Amita Trehan2
1Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Background:
The Mitosis-Karyorrhexis Index (MKI) score is important in neuroblastoma evaluation and in the application of the International Neuroblastoma Pathology Classification (INPC). Currently, it is not standardized for smears. Hence, the aim of this study was to devise and validate methods for MKI evaluation in fine-needle aspiration biopsy (FNAB) of neuroblastoma.
Methods:
A total of 50 cases of neuroblastoma diagnosed by FNAB from January 2017 to December 2019 were retrieved, and detailed cytomorphological evaluations were performed. The MKI was evaluated, and the eyeball visual assessment score (EVAS) was compared with the digital image visual analysis score (DIVAS) on cytology smears and corresponding histology sections of cell blocks. The interobserver reproducibility and concordance were calculated. INPC subtyping into favorable and unfavorable groups was performed by the collation of age, MKI, and cytomorphology and was correlated to clinical outcomes.
Results:
Neuroblastoma was categorized as undifferentiated (22 of 50) or poorly differentiated (28 of 50) on cytomorphology. The overall concordance for the MKI by 3 observers was 86% (κ = 0.85), and this increased to 98% in the high MKI category. MKI evaluations on smears showed 96% concordance with cell block histology, and the EVAS was concordant with the DIVAS in 86% of the cases. Overall, the MKI was high in 39 cases, intermediate in 4 cases, and low in 7 cases. The INPC category was unfavorable in 90% (n = 45) and favorable in 10% (n = 5) and had significant correlations with outcomes (P = .029).
Conclusions:
An MKI assessment on smears by digital image visual analysis is accurate, reproducible, and objective and should be incorporated into the routine reporting of neuroblastoma FNAB for diagnostic schemas as per the INPC.
Insights
Digital image analysis of the Mitosis-Karyorrhexis Index (MKI) on neuroblastoma fine-needle aspiration biopsies (FNAB) is accurate and reproducible. This method should be integrated into routine diagnostics for improved neuroblastoma classification.
Area of Science:
- Oncology
- Pathology
- Cytopathology
Background:
- The Mitosis-Karyorrhexis Index (MKI) is crucial for neuroblastoma evaluation and the International Neuroblastoma Pathology Classification (INPC).
- Standardized methods for MKI assessment on cytology smears are currently lacking.
- This study aimed to develop and validate MKI evaluation techniques for neuroblastoma fine-needle aspiration biopsies (FNAB).
Purpose of the Study:
- To devise and validate methods for Mitosis-Karyorrhexis Index (MKI) evaluation in neuroblastoma fine-needle aspiration biopsies (FNAB).
- To compare visual assessment scores (eyeball vs. digital image analysis) for MKI on cytology smears and cell block histology.
- To assess interobserver reproducibility and concordance for MKI evaluation.
Main Methods:
- Retrospective analysis of 50 neuroblastoma FNAB cases diagnosed between January 2017 and December 2019.
- Cytomorphological evaluations and MKI assessment on smears and cell block histology.
- Comparison of eyeball visual assessment score (EVAS) with digital image visual analysis score (DIVAS) and calculation of interobserver reproducibility and concordance.
Main Results:
- High concordance (86%, κ = 0.85) for MKI assessment among three observers, increasing to 98% in the high MKI category.
- 96% concordance between MKI on smears and cell block histology; 86% concordance between EVAS and DIVAS.
- Neuroblastoma cases were predominantly unfavorable (90%) according to INPC subtyping, correlating significantly with clinical outcomes (P = .029).
Conclusions:
- Digital image visual analysis for MKI assessment on neuroblastoma FNAB smears is accurate, reproducible, and objective.
- This digital method should be incorporated into routine reporting for neuroblastoma FNAB.
- Standardized MKI evaluation via digital analysis supports accurate INPC subtyping and clinical outcome correlation.
