Mitotic counting in surgical pathology: sampling bias, heterogeneity and statistical uncertainty

• Published in: Histopathology Vol. 39; no. 1; pp. 1 - 8
• Main Authors: Thunnissen, F B J M, Ambergen, A W, Koss, M, Travis, W D, O'Leary, T J, Ellis, I O
• Format: Journal Article
• Language: English
• Published: Oxford UK Blackwell Science Ltd 01-07-2001; Blackwell
• Subjects: Biological and medical sciences; count; Data Interpretation, Statistical; definition; Genetic Heterogeneity; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; methodology; Miscellaneous. Technology; Mitosis; Mitotic Index - methods; Mitotic Index - standards; Mitotic Index - statistics & numerical data; Neoplasms - genetics; Neoplasms - pathology; Pathology, Surgical; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; review; Selection Bias; Human; Pathology; Heterogeneity; Mitotic index; Methodology; Bias; Variability; Definition; Review; Technique; Sampling; Quantitative analysis
• ISSN: 0309-0167; 1365-2559
• DOI: 10.1046/j.1365-2559.2001.01187.x

Mitotic counting in surgical pathology: sampling bias, heterogeneity and statistical uncertainty
Although several articles on the methodological aspects of mitotic counting have been published, the effects of macroscopic sampling and tumour heterogeneity have not been discussed in any detail. In this review the essential elements for a standardized mitotic counting protocol are described, including microscopic calibration, specific morphological criteria, macroscopic selection, counting procedure, effect of biological variation, threshold, and the setting of an area of uncertainty (‘grey area’). We propose that the use of a standard area for mitotic quantification and of a grey area in mitotic counting protocols will facilitate the application of mitotic counting in diagnostic and prognostic pathology.