GALLBLADDER CARCINOMA - A VIDEO IMAGE-ANALYSIS OF AGNOR DISTRIBUTION AND ITS RELATION TO TUMOR STAGE AND GRADE

The amount and distribution of interphase argyrophilic nucleolar organ izer regions (AgNORs) was studied in 51 gallbladder surgical specimens including 32 primary carcinomas, 10 adenomas and 9 cases of chronic c holecystitis with calculi. The mean nuclear AgNOR area (NORA) and the AgNOR distribution score (NORDS), i.e. the percentage of cells cells c arrying nucleolar aggregates with move than 6 distinct silver dots, we re evaluated in 200 epithelial nuclei per specimen by means of automat ed image analysis and direct counting respectively. Statistical analys is (variance analysis and Student-Neuman-Keuls' test) performed on the pooled mean AgNOR values showed a significant difference (p < 0.001) between carcinomas and non-carcinomatous lesions. Both NORA and NORDS highly discriminated carcinomas with histopathological grade 4 versus cases with grade 1, 2 or 3 (p < 0.001); a less statistically significa tive p value (< 0.05) was encountered when NORDS values of well differ entiated grade 1 carcinomas and adenomas were compared. The NORA param eter permitted the discrimination of stage IV versus stage I carcinoma s (p < 0.001), while carcinomas in stage IV and those in stage II were distinguished with a p < 0.05; the NORDS parameter allowed also to di stinguish stage IV from both stage I or II tumours (p < 0.001). Our re sults indicate that the above-mentioned AgNOR parameters may be utiliz ed as additional, more objective quantitative criteria in the clinical -pathological assessment of the outcome of gallbladder carcinomas.