Histopathologist-level quantification of Ki-67 immunoexpression in gastroenteropancreatic neuroendocrine tumors using semiautomated method

Heba Saadeh; Niveen Abdullah; Madiha Erashdi; Maher Sughayer; Omar Al-Kadi

doi:10.1117/1.JMI.7.1.012704

Histopathologist-level quantification of Ki-67 immunoexpression in gastroenteropancreatic neuroendocrine tumors using semiautomated method

J Med Imaging (Bellingham). 2020 Jan;7(1):012704. doi: 10.1117/1.JMI.7.1.012704. Epub 2019 Dec 9.

Authors

Heba Saadeh¹, Niveen Abdullah², Madiha Erashdi², Maher Sughayer², Omar Al-Kadi³

Affiliations

¹ The University of Jordan, King Abdullah II School for IT, Computer Science Department, Amman, Jordan.
² King Hussein Cancer Center, Department of Pathology and Laboratory Medicine, Al-Jubeiha, Amman, Jordan.
³ The University of Jordan, King Abdullah II School for IT, Information Technology Department, Amman, Jordan.

Abstract

The role of Ki-67 index in determining the prognosis and management of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) has become more important yet presents a challenging assessment dilemma. Although the precise method of Ki-67 index evaluation has not been standardized, several methods have been proposed, and each has its pros and cons. Our study proposes an imaging semiautomated informatics framework [semiautomated counting (SAC)] using the popular biomedical imaging tool "ImageJ" to quantify Ki-67 index of the GEP-NETs using camera-captured images of tumor hotspots. It aims to assist pathologists in achieving an accurate and rapid interpretation of Ki-67 index and better reproducibility of the results with minimal human interaction and calibration. Twenty cases of resected GEP-NETs with Ki-67 staining that had been done for diagnostic purposes have been randomly selected from the pathology archive. All of these cases were reviewed in a multidisciplinary cancer center between 2012 and 2019. For each case, the Ki-67 immunostained slide was evaluated and five camera-captured images at $40 \times$ magnification were taken. Prints of images were used by three pathologists to manually count the tumor cells. The digital versions of the images were used for the semiautomated cell counting using ImageJ. Statistical analysis of the Ki-67 index correlation between the proposed method and the MC revealed strong agreement on all the cases evaluates ( $n = 20$ ), with an intraclass correlation coefficient of 0.993, "95% CI: 0.984 to 0.997." The results obtained from the SAC are promising and demonstrate the capability of this methodology for the development of reproducible and accurate semiautomated quantitative pathological assessments. ImageJ features are investigated carefully and accurately fine-tuned to obtain the optimal sequence of steps that will accurately calculate Ki-67 index. SAC is able to accurately grade all the cases evaluated perfectly mating histopathologists' manual grading, providing reliable and efficient solution for Ki-67 index assessment.

Keywords: ImageJ; Ki-67 index; gastroenteropancreatic neuroendocrine tumors; histopathology; manual counting; semiautomated method.