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Torben Steiniche

Melanocytic tumours - update on image analysis

Handout (pdf 48p) 
Handout (pdf 12p)

Abstract:
The distinction between malignant and benign melanocytic lesions is, in some cases, difficult, even for highly skilled pathologists. At the same time, melanocytic lesions account for a large proportion of the tissue samples sent to an average pathology department. In this context, it is hardly surprising that the most frequent reason for a malpractice lawsuit in surgical pathology is failure to diagnose melanoma on a skin biopsy.

The immunohistochemical proliferation marker Ki-67 may aid the pathologists in their distinction. In general, Ki-67-positive melanocytic cells are located in the superficial dermal compartment in nevi but scattered throughout dermis in melanomas. To accurately distinguish Ki-67-positive melanocytic cells from other proliferating cells, for example, lymphocytes, stromal cells, and endothelial cells, novel research favors Ki-67/MART1 double stains. These double stains also facilitate fast and repeatable index quantification by automated image analysis (AIA), which may limit the intraobserver and interobserver variability usually associated with manual estimation.

The dermal Ki-67 index obtained by AIA may help to distinguish between melanomas and nevi, but the index is far from conclusive. By including epidermal proliferation in the index, the diagnostic performance increased noticeably, and our high melanoma detection rate indicates that a lesion with high certainty is a benign nevus if low Ki-67/MART1 positivity is detected in both dermis and epidermis.

Excluding lesions with only few melanocytic cells a simultaneous analysis by AIA of epidermis and dermis yielded an ROC area of 0.94 (95% CI, 0.91-0.96) for lesions with a dermal component and 0.98 (95% CI, 0.97-1.0) for lesions with a considerable dermal component.

Conclusion:

Ki67/MART1 double stains combined with AIA may be an important tool in selection melanocytic lesions, where the general pathologist should consider consulting an expert pathologist, before a final diagnosis is signed out.

References:

Nielsen PS, Spaun E, Riber-Hansen R, Steiniche T. Automated quantification of MART1-verified Ki-67 indices: useful diagnostic aid in melanocytic lesions. Hum Pathol. 2014 Jun;45(6):1153-61. doi: 10.1016/j.humpath.2014.01.009. Epub 2014 Jan 31. PubMed PMID: 24704158.

CV
 
Employments
2013 - : Head of Department, Institute of Pathology, Aarhus University Hospital.
2010 - : Professor, Institute of Pathology, Aarhus University Hospital.
2006 - 2010: Head of Department, Institute of Pathology, Vejle Hospital.
2006 - 2010: Clin. Assoc. Prof., University of Southern Denmark.
1998 - 2006: Clin. Assoc. Prof. and Senior consultant, Institute of Pathology, Aarhus UniversityHospital.

Academic achievements
1995 : Doctoral degree (D.M.Sc.), Aarhus University.
Bone histomorphometry in the pathophysiological evaluation of primary and secondary osteoporosis and various treatment modalities.
1987 : Gold medal, Aarhus University.

Pregraduate teaching
2010 - : Professor in Clinical Pathology.
1996 - 2006 : Clinical Assistant Professor Health Sciences.

Postgraduate teaching
2001 - : Specialist training in Dermatopathology for residents in Clinical Pathology.
1999 - : PhD courses in bone biology at Aarhus University.

Administrative qualifications
2013 - : Head of Department, Institute of Pathology, Aarhus University Hospital
2009 - : Board member, The National Danish Cancer Biobank.
2007 - : Scientific board member, “Dansk Kræftforsknings Fond”.
2004 - 2009 : Chairman of the Danish Society for Pathological Anatomy and Clinical Cytology.

Research supervision
11 Ph.D. projects.

Publications
81 peer reviewed articles
~10 books/chapters.
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