Research ArticlesCancer

Quantitative Image Analysis of Cellular Heterogeneity in Breast Tumors Complements Genomic Profiling

Science Translational Medicine  24 Oct 2012:
Vol. 4, Issue 157, pp. 157ra143
DOI: 10.1126/scitranslmed.3004330

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Digitizing Pathology for Genomics

The tumor microenvironment is a complex milieu that includes not only the cancer cells but also the stromal cells, immune cells, and even normal, healthy cells. Molecular analysis of tumor tissue is therefore a challenging task because all this “extra” genomic information can muddle the results. Conversely, biopsy tissue staining can provide a spatial and cellular readout (architecture and content), but it is mostly qualitative information. In response, Yuan and colleagues have developed a quantitative, computational approach to pathology. When combined with molecular analyses, the authors were able to uncover new knowledge about breast tumor biology and, in turn, predict patient survival.

Yuan et al. first collected histopathology images, gene expression data, and DNA copy number variation data for 564 breast cancer patients. Using a portion of the images (the “discovery set”), they developed an image processing approach that automatically classified cells as cancer, lymphocyte, or stroma on the basis of their size and shape. This approach was validated on the remaining samples, and any errors in this analysis were digitally corrected before obtaining a plot of tumor cellular heterogeneity. With exact knowledge of the tumor’s cellular composition, the authors were able to correct copy number data to more accurately reflect HER2 status compared with uncorrected data.

Yuan and colleagues combined their digital pathology with genomic information to devise an integrated predictor of survival for estrogen receptor (ER)–negative patients. Higher number of infiltrating lymphocytes (immune cells) as quantified by their image analysis platform were found in a subset of patients with better clinical outcome than the rest of ER-negative patients, and this outcome difference was significantly enhanced with the addition of gene expression. The quantitative and objective nature of this integrated predictor could benefit diagnosis and prognosis in many areas of cancer by using the rich combination of tumor cellular content and genomic data.