Computer-assisted Grading and Risk Stratification of Follicular Lymphoma

描述（由申请人提供）：滤泡性淋巴瘤（FL）是第二常见的非霍奇金淋巴瘤。目前有几种治疗方案，但这些方案都很昂贵，而且毒性很大。在临床实践中没有生物学或遗传学标记可用于滤泡性淋巴瘤的可靠风险分层，并且适当治疗的选择在很大程度上取决于基于形态学的组织学分级。在世界卫生组织（WHO）采用的系统中，滤泡性淋巴瘤根据10个随机选择的标准高倍视野（HPF）中中心母细胞的平均计数分为三级。低组织学分级的滤泡性淋巴瘤表现出无痛的临床过程，平均生存期长，但被认为是不可治愈的与目前可用的治疗。相比之下，高级别滤泡性淋巴瘤具有侵袭性的临床过程，如果不进行侵袭性化疗，则会迅速致命。然而，与低级别滤泡性淋巴瘤相反，高级别FL可以通过积极的化疗治愈。目前，病理学家对FL分级的阅片者间一致性极低。在一项多中心研究中，专家之间的协议为滤泡性淋巴瘤的各种等级之间变化61%和73%.由于实际原因，病理学家仅使用10个HPF，因此在切片的各个区域显示出显著差异的情况下，该系统可能倾向于选择偏倚。这个项目的主要目标是开发一个有效的计算机辅助系统，以协助病理学家在滤泡性淋巴瘤的组织学分级的诊断决策。值得注意的是，该项目旨在为病理学家提供补充信息，因为他或她进行分类过程;这不是一个自动化的分类过程的尝试。为了实现这一目标，十个委员会认证的血液病理学家（在分级滤泡性淋巴瘤的经验）从俄亥俄州州立大学，克利夫兰诊所，范德比尔特大学，和私人执业将参与创建的数据库，其中将包含数字化滤泡性淋巴瘤幻灯片图像，以及相关的真理的发展和评价的计算机辅助滤泡性淋巴瘤分级系统.在使用收集的数据集和结果数据以及癌症和白血病组B（CALGB）试验的数据集对系统进行广泛评估后，开发的系统将安装在参与的病理学家机构，开发的软件将作为可共享资源提供给研究界。公共卫生相关性：滤泡性淋巴瘤（FL）是第二常见的非霍奇金淋巴瘤。该项目旨在利用计算机图像分析技术为病理学家提供肿瘤分级的补充信息。这些补充信息将有助于更好地诊断、预后和治疗。

DESCRIPTION (provided by applicant): Follicular lymphoma (FL) is the second most common non-Hodgkin's lymphoma. Several treatment options exist today, but these are costly and include significant toxicities. No biological or genetic markers are available in clinical practice for reliable risk stratification of follicular lymphomas and the choice of appropriate treatment depends heavily on morphology-based histological grading. In a system adopted by the World Health Organization (WHO), follicular lymphomas are stratified into three grades depending on the average count of centroblasts in ten randomly selected, standard high-power fields (HPFs). Follicular lymphomas with low histological grades show an indolent clinical course with long average survival, but are considered incurable with currently available therapies. In contrast, high-grade follicular lymphomas have an aggressive clinical course and are rapidly fatal if not treated with aggressive chemotherapy. However, in contrast to low-grade follicular lymphoma, high-grade FL may be cured with aggressive chemotherapy. Currently, the inter-reader agreement between pathologists in grading FL is extremely low. In a multi-site study, the agreement among experts for the various grades of follicular lymphoma varied between 61% and 73%. Since only ten HPFs are used by the pathologist for practical reasons, this system may be prone to selection bias in cases that show significant differences in various areas of a section. The primary goal of this project is to develop an effective computer-aided system to assist pathologists in making diagnostic decisions about histological grading of follicular lymphoma. It is important to note that this project aims to provide supplementary information to the pathologist as he or she carries out the classification process; this is not an attempt to automate the classification process. To achieve this objective, ten board-certified hematopathologists (with experience in grading follicular lymphoma) from The Ohio State University, Cleveland Clinic, Vanderbilt University, and private practice will participate in the creation of the database that will contain digitized follicular lymphoma slide images, as well as the associated truth for the development and evaluation of the computer-aided follicular lymphoma grading system. After extensive evaluation of the system with the collected datasets and outcome data, as well as datasets from the Cancer and Leukemia Group B (CALGB) trials, the developed system will be installed at participating pathologists' institutions, and the developed software will be made available to the research community as a shareable resource. PUBLIC HEALTH RELEVANCE: Follicular lymphoma (FL) is the second most common non-Hodgkin's lymphoma. This project aims to provide supplementary information to the pathologist for the grading of the tumor using computerized image analysis techniques. The supplementary information will be useful for better diagnosis, prognosis and treatment of this disease.