Neoplasm |
Mean NS5 |
Median NS |
Pleomorphism6 |
Cellularity |
ISK1 |
117 |
110 |
57 |
398 |
VV2 |
216 |
201 |
92 |
127 |
HAK3 |
223 |
210 |
111 |
83 |
SCC4 |
231 |
218 |
126 |
66 |
1: Irritated seborrheic keratosis 2: Verruca vulgaris 3: Hypertrophic actinic keratosis 4: Squamous cell carcinoma 5: Nuclear Size 6: Pleomorphism measured via the standard deviation of the nuclear size
Table 1: Image Analysis Characteristics of the Known Neoplasms
Neoplasm |
NS5 Range6 |
Pleomorphism Range7 |
Cellularity Range8 |
ISK1 |
61-173 |
49-65 |
200-596 |
VV2 |
124-307 |
74-110 |
52-202 |
HAK3 |
112-334 |
89-133 |
50-116 |
SCC4 |
105-357 |
95-157 |
32-100 |
1: Irritated seborrheic keratosis 2: Verruca vulgaris 3: Hypertrophic actinic keratosis 4: Squamous cell carcinoma 5: Nuclear Size 6: Created by taking the NS +/- 1 standard deviation 7: Created by taking the NS standard deviation +/- 1 standard deviation 8: Created by taking the Cellularity +/- 1 standard deviation
Table 2: Diagnostic Ranges
Case |
Mean NS1 |
Possibilities |
IA Diagnosis |
Clinical Correlation |
Case 1 |
115 |
ISK2 |
Benign |
Benign |
Case 2 |
297 |
VV3, HAK4, SCC5 |
Indeterminate * |
Benign |
Case 3 |
536 |
SCC |
Malignant |
Malignant |
Case 4 |
209 |
VV, HAK, SCC |
Indeterminate |
Benign |
Case5 |
300 |
VV, HAK, SCC |
Indeterminate |
Benign |
Case 6 |
267 |
VV, HAK, SCC |
Indeterminate |
Malignant |
Case 7 |
342 |
SCC |
Malignant |
Malignant |
Case 8 |
355 |
SCC |
Malignant |
Benign |
Case 9 |
197 |
VV, HAK, SCC |
Indeterminate |
Benign |
Case 10 |
412 |
SCC^ |
Malignant |
Malignant |
1: Nuclear Size 2: Irritated seborrheic keratosis 3: Verruca vulgaris 4: Hypertrophic actinic keratosis 5: Squamous cell carcinoma *: When cases could not be reliably classified as Benign or Pre-malignant/Malignant, they were classified as Indeterminate. ^: In instances where the NS exceeded the highest value of the NS diagnostic ranges, the IA diagnosis rendered was that of SCC. Blue: Designates an IA diagnosis that correctly correlates with the clinical course. Red: Designates an IA diagnosis that incorrectly correlates with the clinical course.
Table 3a: Diagnosing Transected Neoplasms using the Nuclear Size Diagnostic Range
Case |
Pleomorpism |
Possibilities |
Plemorphism Diagnosis |
Clinical Correlation |
Case 1 |
42 |
ISK1* |
Benign |
Benign |
Case 2 |
83 |
VV2 |
Benign |
Benign |
Case 3 |
191 |
SCC3 |
Malignant |
Malignant |
Case 4 |
50 |
ISK4 |
Benign |
Benign |
Case5 |
94 |
VV, HAK |
Indeterminate |
Benign |
Case 6 |
108 |
VV, HAK, SCC |
Indeterminate |
Malignant |
Case 7 |
125 |
HAK, SCC |
Malignant |
Malignant |
Case 8 |
65 |
ISK |
Benign |
Benign |
Case 9 |
82 |
VV |
Benign |
Benign |
Case 10 |
144 |
SCC |
Malignant |
Malignant |
1: Irritated seborrheic keratosis 2: Verruca vulgaris 3: Hypertrophic actinic keratosis 4: Squamous cell carcinoma *: In instances where the pleomorphism fell below the lowest value of the Pleomorphism diagnostic ranges, the IA diagnosis rendered was that of ISK.
Table 3b: Diagnostic Ranges
Case |
Cellularity |
Possibilities |
Cellularity Diagnosis |
Clinical |
Case 1 |
215 |
ISK1 |
Benign |
Benign |
Case 2 |
42 |
SCC |
Malignant |
Benign |
Case 3 |
36 |
SCC |
Malignant |
Malignant |
Case 4 |
93 |
VV2, HAK3, SCC4 |
Indeterminate |
Benign |
Case5 |
86 |
VV, HAK, SCC |
Indeterminate |
Benign |
Case 6 |
108 |
VV |
Benign |
Malignant |
Case 7 |
71 |
VV, HAK, SCC |
Indeterminate |
Malignant |
Case 8 |
69 |
VV, HAK, SCC |
Indeterminate |
Benign |
Case 9 |
216 |
ISK |
Benign |
Benign |
Case 10 |
63 |
VV, HAK, SCC |
Indeterminate |
Malignant |
1: Irritated seborrheic keratosis 2: Verruca vulgaris 3: Hypertrophic actinic keratosis 4: Squamous cell carcinoma
Table 3c: Diagnosing Transected Neoplasms using the Cellularity Diagnostic Range
Figure 1: Example of Image Anaysis performed on a Known Neoplasm 1a: H&E image of a known hypertrophic actinic keratosis neoplasm (original magnification x 20). 1b: A representative area of stratum spinosum is selected comprising 210,000 pixels. 1c: Nuclei are selected out. 1d: Image analysis carried out using Image J software.