Highlights
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Computational methods to assess immunohistochemistry are often used in epidemiology.
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We compared Definiens output to pathologist scores for 17 markers in breast cancer.
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Correlations ranged from weak (RXR, rho = -0.05) to strong (Ki67, rho = 0.79).
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Area under the curve > 0.70 was observed for all markers except RXR.
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Pilot studies are key; computational methods can aid high-throughput analyses.
Abstract
Background
Pathologist and computational assessments have been used to evaluate immunohistochemistry (IHC) in epidemiologic studies. We compared Definiens Tissue Studio® to pathologist scores for 17 markers measured in breast tumor tissue microarrays (TMAs) [AR, CD20, CD4, CD8, CD163, EPRS, ER, FASN, H3K27, IGF1R, IR, Ki67, phospho-mTOR, PR, PTEN, RXR, and VDR].
Methods
5 914 Nurses’ Health Study participants, diagnosed 1976–2006 (NHS) and 1989–2006 (NHS-II), were included. IHC was conducted by the Dana-Farber/Harvard Cancer Center Specialized Histopathology Laboratory. The percent of cells staining positive was assessed by breast pathologists. Definiens output was used to calculate a weighted average of percent of cells staining positive across TMA cores for each marker. Correlations between pathologist and computational scores were evaluated with Spearman correlation coefficients. Receiver-operator characteristic curves were constructed, using pathologist scores as comparison.
Results
Spearman correlations between pathologist and Definiens assessments ranged from weak (RXR, rho=-0.05; CD163, rho = 0.10) to strong (Ki67, rho = 0.79; pmTOR, rho = 0.77). The area under the curve was >0.70 for all markers except RXR.
Conclusion
Our data indicate that computational assessments exhibit variable correlations with interpretations made by an expert pathologist, depending on the marker evaluated. This study provides evidence supporting the use of computational platforms for IHC evaluation in large-scale epidemiologic studies, with the caveat that pilot studies are necessary to investigate agreement with expert assessments. In sum, computational platforms may provide greater efficiency and facilitate high-throughput epidemiologic analyses.
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Introduction
Immunohistochemistry (IHC) is frequently used to measure expression of putative biomarkers in tumor tissue microarrays (TMAs) constructed from formalin-fixed paraffin-embedded (FFPE) tissue samples. An expert pathologist’s interpretation of IHC assays has generally been considered the gold standard in large-scale epidemiologic investigations. Often these manually assigned scores are semi-quantitative, incorporating both intensity and extent of immunoreactivity [ ]. This approach is limited, however, in that it is expensive, time-consuming, reliant on subjective scoring parameters, and potentially prone to bias [ ].
An alternative strategy is to utilize computational platforms which, in theory, provide a more objective assessment of the extent and/or intensity of immunoreactivity [ ]. Previous studies have generally demonstrated good agreement between pathologist- and computationally-generated scores for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (HER2) [ ]. However, whether this agreement extends to other biomarkers, including those exhibiting cytoplasmic staining and reactivity in stromal cells, is not well understood. Understanding the extent to which automated platforms concur with pathologist assessments can help in determining the appropriate analytic method to evaluate immunoreactivity, particularly in analyses using archival FFPE tissues.
In this study, we evaluated the performance of the semi-automated Definiens TissueStudio® platform compared to pathologist assessment of 17 markers measured in breast tumors collected nationally over several decades [AR (androgen receptor), CD20, CD4, CD8, and CD163, EPRS (glutamyl-prolyl-tRNA synthetase), ER (estrogen receptor), FASN (fatty acid synthase), H3K27 (histone 3 lysine 27 trimethylation), IGF1R (insulin-like growth factor 1 receptor), IR (insulin receptor), Ki67 (marker of proliferation Ki-67), phospo-mTOR (phosphorylated mammalian target of rapamycin), PR (progesterone receptor), PTEN (phosphatase and tensin homolog), RXR (retinoic acid receptor), and VDR (vitamin D receptor)].
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