Image Analysis-Assisted Nuclear Morphometric Study of Benign and Malignant Breast Aspirates

BACKGROUND: Fineneedle aspiration cytology of the breast is well accepted and accurate for the diagnosis of benign and malignant lesions, however, it remains a subjective evaluation. AIMS AND OBJECTIVES: The present study was carried out to assess the utility of nuclear morphometry in differentiating benign and malignant breast aspirates. Importantly, we wanted to evaluate the utility of nuclear density parameters using Image J software. MATERIALS AND METHODS: Nuclear morphometry was carried out using image analysis software Image J 1.44 on 20 selected benign and malignant breast aspirates. Assessment was carried out on a total of 1000 cells in benign and 1000 cells in malignant aspirates counting 50 intact nuclei in nonoverlapping cells for each case. Six parameters including three size parameters, namely nuclear area, nuclear diameter, and nuclear perimeter; one shape parameter, i.e., axis ratio; and two nuclear chromasia parameters, namely density (integrated and raw), were measured. RESULTS: There were significant differences between nuclear area, perimeter, diameter, integrated density, and raw integrated density of benign and malignant lesions. No significant difference was found for axis ratio. Receiver operating characteristic curve analysis revealed that nuclear area, perimeter, diameter, integrated density, and raw integrated density are helpful in discriminating benign and malignant aspirates. CONCLUSIONS: Thus, Image J is helpful in the evaluation of nuclear size as well as chromasia. We conclude that nuclear size and density parameters can be used to derive cutoff values of various parameters to differentiate between benign and malignant cells in breast cytology.