Classification of bronchial epithelial atypias by the atypia status index

The atypia status index (ASI) is a categorization method of classifying digitized images of atypical bronchial epithelial cells in sputum. The ASI is defined as a linear composite of features linearly related to atypia stage. Over 200 features were examined for more than 3,000 cells that had been classified by atypia stage (squamous metaplasia, mild, moderate or severe atypia and malignant) and staining characteristic (orangeophilia and nonorangeophilia). We reduced the number of features by using a selection process to minimize redundancy. The feature weights were optimized via a least-squares procedure. The 14 features selected accounted for over 60% of the variation of atypia stage and produced ASI values that were within one atypia stage of the criterion classification for over 90% of the cells. The results are consistent with the hypothesis of a progressive pattern in bronchial epithelial atypia and indicate the feasibility of using image analysis for mass screening of premalignant atypias in sputum from subjects considered to be at high risk for lung cancer.