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Probability of Malignancy Based on Numerification of Histological Atypicality and Linear Discriminant Function in Differentiating Adenocarcinoma from Intestinal Type Adenoma of the Stomach: Its Application to Biopsy Interpretation Tatsuya Ishido 1,2 , Kyoichi Nakamura 1 , Mamoru Nishizawa 3 1Division of Pathology, Tsuchiura Kyohdoh Hospital 2Department of Pathology, Faculty of Medicine, Tsukuba University 3Tokyo Metropolitan Cancer Detection Center Keyword: 胃の腸型上皮性腫瘍 , 異型度係数 , 悪性判別率 , 胃生検 , 組織診断基準 pp.971-981
Published Date 1990/8/25
DOI https://doi.org/10.11477/mf.1403111332
  • Abstract
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 In order to objectively differentiate adenocarcinoma from intestinal type adenoma of the stomach, a linear discriminant function was developed using four indices quantifying dgrees of histological atypicality. Based on that function a parameter was developed to indicate probability of malignancy. The indices employed here were defined as follows

 Index of Nucleus-Glandular Ratio (ING)

ING = (Area of nuclei / Area of cytoplasm) per glands in unit area×100 (%)

 Index of Tubular Density (ITD)

ITD = (Area of glands / Area of glands and stroma) per unit area×100 (%)

 Index of Dispersion of Tubular Size (IDS)

IDS = (Standard deviation / Mean value) of Maximum width of tubulus in unit area×100 (%)

 Degree of Complexity of Tubular Shape (DCT)

DCT= (Round factor of a tubulus / Round factor of an oval whose aspect ratio is the same as that of the tubulus) in unit area

 Frequency of Complicated Tubuli in Shape (FCT)

FCT = (Number of the tubulus whose DCT value is higher than 1.5 / Total number of tubuli) in unit area×100 (%)

 These indices were obtained by measuring and calculating intestinal type adenoma or adenocarcinoma surgically resected or surveyed for more than three years by biopsy using computed image analyser.

 A linear discriminant function and critical values for discriminating malignancy from benignancy were obtained as shown in Table 4. Eighty-three percent of adenomas were classified into benignancy and 80% of adenocarcinomas into malignancy. However, discriminant scores on adenomas and those on adenocarcinomas overlapped significantly as shown in Fig. 5. Therefore, discrimination based on the function had to be probabilistically expressed for each score. The probability of malignancy was defined as the ratio of the num-ber of lesions of adenocarcinomas to the total number of lesions of adenomas and those of adenocarcinomas for a given discriminant score. Histograms of the probability of malignancy were depicted for both groups of cases, i.e., surgically resected and biopsied (Figs. 8 and 11). About 80% of adenomas exhibited the probability of malignancy 0 to 20% and the scores in these cases were distributed within narrow range. On the other hand, about 60% of adenocarcinomas exhibited the probability of malignancy 80 to 100%, and about 35 of adenocarcinomas did 20 to 80% of the probability of malignancy. The scores in these cases were distributed in wider range than those of adenomas.

 Based on the probability of malignancy, biopsy specimen of intestinal type adenomas and adenocarcinomas of the stomach can be objectively diagnosed as follows: (1) If biopsy specimens in a given case exhibit the probability of malignancy 0 to 20%, then it may well be diagnosed as benign. (2) If biopsy specimens exhibit the probability of malignancy 20 to 80%, it is possible that it is malignant. (3) If biopsy specimens show the probability of malignancy over 80%, it can be diagnosed as malignant.


Copyright © 1990, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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