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Published on: December 6, 2014
Lymphoid-rich effusions. Diagnosis by morphometry using the CAS 200 System
A E Walts1, R Svidler, T Tolmachoff
1Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048.
Insights
A computerized system accurately classified benign lymphocytosis and malignant lymphoma in effusions. This image analysis tool shows promise for improving diagnostic accuracy in clinical cytology.
Area of Science:
- Cytopathology
- Computational Pathology
- Hematopathology
Background:
- Lymphoid-rich effusions pose diagnostic challenges in clinical cytology.
- Previous studies demonstrated the potential of computerized interactive morphometry for classifying these effusions.
Purpose of the Study:
- To evaluate the efficacy of the CAS 200 System and an expert system for classifying lymphoid-rich effusions.
- To assess the diagnostic accuracy for benign lymphocytosis, malignant lymphoma, and chronic lymphocytic leukemia.
Main Methods:
- Analysis of 134 lymphoid-rich effusions (pleural, peritoneal, pericardial) using the CAS 200 System.
- Application of criteria from a previously described rule-based expert system for classification.
- Measurement of lymphoid nuclear profile images in Papanicolaou-stained cytospin smears.
Main Results:
- The system achieved 98.9% accuracy for benign lymphocytoses and 88.9% for malignant lymphomas.
- Predictive values of correct diagnoses were 95.7% for benign and 97.3% for malignant cases.
- Chronic lymphocytic leukemias were not reliably distinguished from benign lymphocytoses based on nuclear profile areas.
Conclusions:
- The CAS 200 System demonstrates high diagnostic accuracy for distinguishing benign lymphocytosis from malignant lymphoma in effusions.
- Image analysis shows potential as a valuable tool in cytopathology for difficult effusion diagnoses.
- Further investigation is needed for differentiating chronic lymphocytic leukemia using this methodology.
Abstract:
Lymphoid-rich effusions frequently present diagnostic problems in clinical cytology. In the authors' previous studies, most lymphoid-rich effusions had been correctly classified as benign lymphocytosis or malignant lymphoma by an experimental computerized interactive morphometry system, in which randomly selected lymphoid nuclear profile images were measured in Papanicolaou fixed and stained cytospin smears. The present study used the CAS 200 System and criteria from the previously described rule-based expert system to classify similar preparations of 134 lymphoid rich pleural, peritoneal, and pericardial effusions (90 benign lymphocytoses, 36 malignant lymphomas, and 8 chronic lymphocytic leukemias). A total of 98.9% of the benign lymphocytoses and 88.9% of the malignant lymphomas were correctly classified (predictive values of correct diagnoses 95.7% and 97.3%, respectively). Chronic lymphocytic leukemias could not be distinguished from benign lymphocytoses by nuclear profile areas. Optical density histograms of benign, lymphomatous, and chronic lymphocytic leukemias effusions are described. Advantages and limitations of image analysis and immunocytochemistry are discussed.
