ArticlePloS one2016
A Comparison of Visual Assessment and Automated Digital Image Analysis of Ki67 Labeling Index in Breast Cancer.
Article in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers.
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Who cites it
35 citing papers in PubMed, 64 citations in OpenAlex.
- Randomized phase II clinical trial and biomarker analysis of paclitaxel plus epirubicin versus vinorelbine plus epirubicin as neoadjuvant chemotherapy in locally advanced HER2-negative breast cancer with TEKT4 variations.Breast cancer research and treatment · 2021Trial
- MicroRNA-Directed Biomarkers and Breast Cancer Therapeutics-Potential to Advance Personalised Approaches in Clinical Trials.International journal of molecular sciences · 2026Review
- Advancing Ki67 hotspot detection in breast cancer: a comparative analysis of automated digital image analysis algorithms.Histopathology · 2025Article
- Random survival forest algorithm for risk stratification and survival prediction in gastric neuroendocrine neoplasms.Scientific reports · 2024Article
- Use of a Novel Deep Learning Open-Source Model for Quantification of Ki-67 in Breast Cancer Patients in Pakistan: A Comparative Study between the Manual and Automated Methods.Diagnostics (Basel, Switzerland) · 2023Article
- The Evolution of Ki-67 and Breast Carcinoma: Past Observations, Present Directions, and Future Considerations.Cancers · 2023Review
- Clinicopathologic characteristics of neuroendocrine tumors with assessment by digital image analysis for Ki-67 index with a focus on the gastroenteropancreatic tract: a single-center study.International journal of clinical and experimental pathology · 2023Article
- Validation of automated positive cell and region detection of immunohistochemically stained laryngeal tumor tissue using digital image analysis.Journal of pathology informatics · 2023Article
- Systematically higher Ki67 scores on core biopsy samples compared to corresponding resection specimen in breast cancer: a multi-operator and multi-institutional study.Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc · 2022Article
- Visual and digital assessment of Ki-67 in breast cancer tissue - a comparison of methods.Diagnostic pathology · 2022Article
- Artificial intelligence-assisted interpretation of Ki-67 expression and repeatability in breast cancer.Diagnostic pathology · 2022Article
- Reliability of CD44, CD24, and ALDH1A1 immunohistochemical staining: Pathologist assessment compared to quantitative image analysis.Frontiers in medicine · 2022Article
- Reliability of a computational platform as a surrogate for manually interpreted immunohistochemical markers in breast tumor tissue microarrays.Cancer epidemiology · 2021Article
- Review
- The tongue features associated with chronic kidney disease.Medicine · 2021Observational
- Association of the imaging characteristics of desmoplasia on digital breast tomosynthesis and the Ki-67 proliferation index in invasive breast cancer.Croatian medical journal · 2021Article
- Concomitant use ofGland surgery · 2021Article
- Quantitative and Semi-quantitative Methods for Assessing the Degree of Methylene Blue Staining in Sentinel Lymph Nodes in Dogs.Frontiers in veterinary science · 2021Article
- Sequential immunohistochemistry and virtual image reconstruction using a single slide for quantitative KI67 measurement in breast cancer.Breast (Edinburgh, Scotland) · 2020Article
- Overview of multiplex immunohistochemistry/immunofluorescence techniques in the era of cancer immunotherapy.Cancer communications (London, England) · 2020Review
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundKi67 labeling index (LI) is critical for treatment options and prognosis evaluation in breast cancer. Visual assessment (VA) is widely used to assess Ki67 LI, but has some limitations. In this study, we compared the consistency between VA and automated digital image analysis (DIA) of Ki67 LI in breast cancer, and to evaluate the application value of DIA in Ki67 LI assessment.
methodsKi67 immunostained slides of 155 cases of primary invasive breast cancer were eyeballing assessed by five breast pathologists and automated digital image analyzed by one breast pathologist respectively. Two score methods, hot-spot score and average score, were used to choose score areas. The intra-class correlation coefficient (ICC) was used to analyze the consistency between VA and DIA, and Wilcoxon signed-rank test was used to compare the median of paired-difference between VA and DIA values.
results(1) A perfect agreement was demonstrated between VA and DIA of Ki67 LI by ICC analysis (P<0.0001) in the whole cohort. A perfect agreement between VA and DIA of Ki67 LI was also showed in G2-G3, ER positive/HER2 negative cases. Average score and hot-spot score methods both demonstrated a perfect concordance between VA and DIA of Ki67 LI. (2) All cases were classified into three groups by VA values (≤10%, 11%-30% and >30% Ki67 LI). The concordance was relatively lower in intermediate Ki67 LI group (11%-30%) compared with high (>30%) Ki67 LI groups according to both methods. (3) All cases were classified into three groups by paired-difference (d) between VA values of hot-spot score and average score (d<5, 5≤d<10, d≥10) to evaluate the correlation between Ki67 staining distribution (heterogeneous or homogenous) and reproducibility of assessment. A perfect agreement was all demonstrated in three groups, and a slightly better Ki67 LI agreement between VA and DIA was indicated in homogenous staining slides than in heterogeneous staining ones. (4) VA values were relatively smaller than DIA values (average score: median of paired-difference -3.72; hot-spot score: median of paired-difference -9.12).
conclusionsAn excellent agreement between VA and DIA of Ki67 LI in breast cancer was demonstrated in the whole mixed cohort, suggesting that VA and DIA both could be used to assess Ki67 LI in clinical practice. Average score and hot-spot score methods both demonstrated a perfect concordance between VA and DIA of Ki67 LI. The almost perfect agreement between VA and DIA was observed in high Ki67 LI cases, displaying a homogenous staining pattern. The consistency between VA and DIA was relatively low in intermediate Ki67 LI group. The heterogeneity of tumors may slightly affect the concordance between VA and DIA of Ki67 LI. Assessment of VA provides lower Ki67 values than DIA, the biological importance of these values are not known at the moment.
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