17. Pathology Division
The Pathology Division of the Research Institute East is in its second year of existence. Its research activities are centered on the morphological study of cancer tissue. Major projects include quality control of pathological diagnosis, clinico-pathological study of cancers(193-197) and pathology of precancerous lesions and early cancers.
Morphological Diagnosis by Image Analysis and Artificial Intelligence
For the development of a computer-assisted image diagnosis system, image analysis data on intraductal lesions of the breast are analyzed by artificial intelligence. Numerical image data are extracted by a computer-assisted image analysis system and are fed to the artificial intelligence. The differentiation ability of the artificial intelligence was tested and the results indicate that it can separate definite cancer cells and non-neoplastic ductal cells with 80 to 90% accuracy. In a preliminary study, this system was able to differentiate cells of benign papilloma from papillary carcinoma with about 75% accuracy. Further study will be conducted on a larger scale, and the diagnostic ability of the system will be tested.
Quality Control of Pathological Diagnosis
Pathological diagnosis is dependent on the knowledge and experience of the pathologist. Therefore, certain discrepancies in diagnostic criteria are inevitable among pathologists. In this project, the discrepancies in diagnostic criteria have been analyzed for future standardization of diagnostic criteria. This year, pathological material from 85 cases of HodgkinÕs disease treated by radiation therapy at different hospitals was reviewed by three experienced hematopathologists. Lesions from 15 of the 85 cases were diagnosed as other than HodgkinÕs disease. This strongly indicates that establishment and promotion of diagnostic criteria are urgently required.
When results of cancer treatment are compared among nations, it also becomes important to standardize diagnostic criteria among countries. It is known that diagnostic criteria are different between Japan and the United States or Europe. In order to test whether there is a difference in diagnostic criteria of Hodgkin's disease, 20 cases registered in a protocol study for Hodkgin's disease were sent to an American hematopathologist. His diagnoses and the consensus diagnoses made by three Japanese hematopathologists are in good agreement, indicating that data of this protocol study can be compared with those of the US.
Fibrotic Focus in Invasive Ductal Carcinoma of the Breast
When the primary tumor of recurrent breast cancer is examined, a fibrotic focus is often detected. Therefore, the clinicopathological significance of the presence of a fibrotic focus in breast cancer was studied. It became apparent that invasive ductal carcinomas with a fibrotic focus or foci have more axillary lymph node metastases and a higher histological grade, both indicators of high aggressiveness of breast cancer, than those without a fibrotic focus. In addition, patients with invasive ductal carcinomas with a fibrotic focus or foci had a significantly lower survival rate than those without a fibrotic focus. These data indicate that the presence of a fibrotic focus is a marker of high aggressiveness in invasive ductal carcinoma of the breast.
Pathology of Precancerous Lesions of Lung Adenocarcinoma
Adenomatous hyperplasia and atypical adenomatous hyperplasia are sometimes difficult to differentiate from well-differentiated adenocarcinoma of the lung. To determine whether these lesions represent a precancerous condition of adenocarcinoma, DNA ploidy patterns and nuclear areas of adenomatous hyperplasia, atypical adenomatous hyperplasia and well-differentiated adenocarcinoma of the lung were studied by the image analysis system. Aneuploid DNA patterns were found in 22 of 26 cases of adenocarcinoma, seven of 21 cases of atypical adenomatous hyperplasia, and none of seven cases of adenomatous hyperplasia. The mean nuclear area increased from adenomatous hyperplasia to atypical adenomatous hyperplasia and adenocarcinoma. These data indicate that atypical adenomatous hyperplasia is an abnormality intermediate between benign adenomatous hyperplasia and adenocarcinoma. Atypical adenomatous hyperplasia with an aneuploid DNA pattern is probably a precancerous lesion of adenocarcinoma of the lung.
Three-dimensional Reconstruction of Cancer and Precancerous Lesions
Three dimensional (3D) images of adenomatous hyperplasia and well-differentiated adenocarcinoma of the lung are being reconstructed. It is still in a primitive stage, but some measurements, such as distance between nuclei and nuclear volume, can be obtained from the 3D images. This technique may provide us with a useful parameter which can be applied in cases in which differential diagnoses is difficult.
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