Quantification of estrogen receptor-alpha expression in human breast carcinomas with a miniaturized, low-cost digital microscope: A comparison with a high-end whole slide- scanner

Abstract

Introduction A significant barrier to medical diagnostics in low-resource environments is the lack of medical care and equipment. Here we present a low-cost, cloud-connected digital microscope for applications at the point-of-care. We evaluate the performance of the device in the digital assessment of estrogen receptor-alpha (ER) expression in breast cancer samples. Studies suggest computer-assisted analysis of tumor samples digitized with whole slide-scanners may be comparable to manual scoring, here we study whether similar results can be obtained with the device presented. Materials and Methods A total of 170 samples of human breast carcinoma, immunostained for ER expression, were digitized with a high-end slide-scanner and the point-of-care microscope. Corresponding regions from the samples were extracted, and ER status was determined visually and digitally. Samples were classified as ER negative (1% ER positivity) or positive, and further into weakly (1â€"10% positivity) and strongly positive. Interobserver agreement (Cohen’s kappa) was measured and correlation coefficients (Pearson’s product-momentum) were calculated for comparison of the methods. Results Correlation and interobserver agreement (r = 0.98, p 0.001, kappa = 0.84, CI95% = 0.75â€" 0.94) were strong in the results from both devices. Concordance of the point-of-care microscope and the manual scoring was good (r = 0.94, p 0.001, kappa = 0.71, CI95% =0.61â€"0.80), and comparable to the concordance between the slide scanner and manual scoring (r = 0.93, p 0.001, kappa = 0.69, CI95% = 0.60â€"0.78). Fourteen (8%) discrepant cases between manual and device-based scoring were present with the slide scanner, and 16 (9%) with the point-of-care microscope, all representing samples of low ER expression. Conclusions Tumor ER status can be accurately quantified with a low-cost imaging device and digital image-analysis, with results comparable to conventional computer-assisted or manual scoring. This technology could potentially be expanded for other histopathological applications at the point-of-care.