Intratumoral distribution of anisokaryosis in canine cutaneous mast cell tumors

Automated measurements of anisokaryosis in canine cutaneous mast cell tumors (ccMCTs) have been shown to be predictive of survival, but questions remain regarding the intratumoral distribution of anisokaryosis. Whole-slide images of 96 ccMCTs were analyzed with a deep learning-based segmentation algorithm to quantify anisokaryosis using the standard deviation (SD) of the nuclear area. In 35/96 cases, \textgreater5\% of the non-overlapping 256 × 256 µm 2 regions were hotspots (SD ≥11.5 µm 2 ). Regions selected by 7 pathologists within these 35 cases matched hotspots in 32\% of the instances. Outcome analysis (tumor-related death) based on single tumor regions yielded an area under the curve (AUC) of 0.901 for pathologist-selected hotspots, falling between random region selection (AUC: 0.862) and 90th-percentile targeted selection (AUC: 0.956). Whole-slide analysis of the hotspot proportion predicted survival with an AUC of 0.956, with 20\% of hotspots as a prognostically meaningful threshold. Whereas pathologists-selected tumor regions are prognostically meaningful for nuclear morphometry, whole-slide analysis may provide additional prognostic information.