Importance of nuclear morphology in breast cancer prognosis

The purpose of this study is to define prognostic relationships between com puter-derived nuclear morphological features, lymph node status, and tumor size in breast cancer. Computer-derived nuclear size, shape, and texture fe atures were determined in fine-needle aspirates obtained at the time of dia gnosis from 253 consecutive patients with invasive breast cancer. Tumor siz e and lymph node status were determined at the time of surgery, Median foll ow-up time was 61.5 months for patients without distant recurrence, In univ ariate analysis, tumor size, nuclear features, and the number of metastatic nodes were of decreasing significance for distant disease-free survival. N uclear features, tumor size, and the number of metastatic nodes were of dec reasing significance for overall survival. In multivariate analysis, the mo rphological size feature, largest perimeter, was more predictive of disease -free and overall survival than were either tumor size or the number of axi llary lymph node metastases. This morphological feature, when combined with tumor size, identified more patients at both the good and poor ends of the prognostic spectrum than did the combination of tumor size and axillary ly mph node status, Our data indicate that computer analysis of nuclear featur es has the potential to replace axillary lymph node status for staging of b reast cancer. If confirmed by others, axillary dissection for breast cancer staging, estimating prognosis, and selecting patients for adjunctive thera py could be eliminated.