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Role of fractal dimension in distinguishing benign from malignant endometrial clusters in liquid‐based cervical samples
Author(s) -
Gupta Parikshaa,
Gupta Nalini,
Rajwanshi Arvind,
Dey Pranab
Publication year - 2020
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/cyt.12826
Subject(s) - medicine , predictive value , histopathology , endometrium , gynecology , radiology , pathology , obstetrics
Abstract Introduction Exfoliated endometrial cells are often seen as hyperchromatic crowded groups ( HCG s) in cervical samples. It is challenging for the cytopathologists to discriminate between HCG s of benign and malignant endometrial cells. Fractal dimension ( FD ) analysis has proved to be a useful tool in discriminating between different types of cell groups in previous studies. Aims This study was conducted to evaluate the utility of FD for differentiating between benign and malignant endometrial HCG s, in liquid‐based cervical samples. Methods Two groups of cervical samples, with subsequent histopathology, were selected: Group A: 30 cases with benign endometrial HCG s; and Group B: 39 cases with malignant endometrial HCG s. Image J, NIH and FracLac software were used for selecting and measuring the FD of the HCG s. Student t ‐test was used for statistical analysis. Results The mean FD for benign endometrial HCG s (1.066943 ± 0.0699) was significantly lower than that of the malignant endometrial HCG s (1.086271 ± 0.05121; P = .001). Using receiver operator characteristic curve analysis, we determined that an FD cut‐off value of 1.01 would yield sensitivity of 90.3%, specificity of 26.1%, positive predictive value of 47.3% and negative predictive value of 78.6%. Conclusion The measurement of FD of HCG s in cervical samples can serve as a useful screening adjunct to differentiate malignant from benign HCG s, owing to its high sensitivity. However, in view of its low specificity and positive predictive value, we recommend that cases labelled as malignant by the FD value be confirmed for malignancy by other methods.