J Gynecol Oncol.  2023 Jul;34(4):e47. 10.3802/jgo.2023.34.e47.

Histopathological subtyping of high-grade serous ovarian cancer using whole slide imaging

• Miyagawa C
• Nakai H
• Otani T
• Murakami R
• Takamura S
• Takaya H
• Murakami K
• Mandai M
• Matsumura N

• KMID: 2552630
• DOI: http://doi.org/10.3802/jgo.2023.34.e47

Abstract

Objective
We have established 4 histopathologic subtyping of high-grade serous ovarian cancer (HGSOC) and reported that the mesenchymal transition (MT) type has a worse prognosis than the other subtypes. In this study, we modified the histopathologic subtyping algorithm to achieve high interobserver agreement in whole slide imaging (WSI) and to characterize the tumor biology of MT type for treatment individualization.
Methods
Four observers performed histopathological subtyping using WSI of HGSOC in The Cancer Genome Atlas data. As a validation set, cases from Kindai and Kyoto Universities were independently evaluated by the 4 observers to determine concordance rates. In addition, genes highly expressed in MT type were examined by gene ontology term analysis. Immunohistochemistry was also performed to validate the pathway analysis.
Results
After algorithm modification, the kappa coefficient, which indicates interobserver agreement, was greater than 0.5 (moderate agreement) for the 4 classifications and greater than 0.7 (substantial agreement) for the 2 classifications (MT vs. non-MT). Gene expression analysis showed that gene ontology terms related to angiogenesis and immune response were enriched in the genes highly expressed in the MT type. CD31 positive microvessel density was higher in the MT type compared to the non-MT type, and tumor groups with high infiltration of CD8/CD103 positive immune cells were observed in the MT type.
Conclusion
We developed an algorithm for reproducible histopathologic subtyping classification of HGSOC using WSI. The results of this study may be useful for treatment individualization of HGSOC, including angiogenesis inhibitors and immunotherapy.

Keyword

Carcinoma; Ovarian Epithelial Cancer; Biomarkers; Histopathology