Summary
Invasive lobular carcinoma (ILC) is almost always classified as Nottingham histological
grade 2. Despite this, prognosis is markedly varied, with some ILCs behaving more
akin to grade 3 invasive ductal carcinoma (IDC). Methods to separate these aggressive
ILCs are needed. Digital image analysis (DIA) of the Ki-67 biomarker has potential
in this regard; thus, we sought to determine the feasibility of its use for automated
evaluation of ILC. An initial pilot study demonstrated no ILC specific changes were
required to our Ki-67 DIA algorithm for reproducible results. Subsequently, 42 consecutive
cases of ILC were evaluated by visual mitosis counting in H&E stained sections and
by DIA on Ki-67 stained sections. Ki-67 proliferative index (PI) DIA showed significant
correlation with visual mitosis counting on H&E stained sections (rs=0.63; p<0.05), significant strong correlation (rs=0.78; p<0.05) and substantial agreement (κ=0.62) with manual/visual Ki-67 assessment and
significant positive associations with grade, nodal status and ‘pleomorphic’ ILC subtype,
and a wide stratification of values in classical/grade 2 ILC. In conclusion, DIA of
Ki-67 PI in ILC is feasible, correlates with mitotic index, manual/visual Ki-67 PI
and clinico-pathological variables. The broad stratification of Ki-67 PI in classical/grade
2 ILC supports its practicability as a biomarker with prognostic and predictive potential,
although large studies with outcome data are required for validation.
Key words
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Article info
Publication history
Published online: October 17, 2019
Accepted:
August 19,
2019
Received in revised form:
August 9,
2019
Received:
May 29,
2019
Identification
Copyright
Crown Copyright © 2019 Published by Elsevier B.V. on behalf of Royal College of Pathologists of Australasia. All rights reserved.
