The Ki-67 protein is associated with cellular proliferation, and the protein is present in the nucleus of all cells that are in the active phase of the cell cycle, but absent in resting cells, see [1]. The cell proliferation rate can be assessed by Ki-67-immunohistochemical (IHC) staining, and this can be correlated to the tumor grade and the clinical course. Ki-67 proliferative index is suggested to be an important prognostic variable and is used as a grading parameter for neuroendocrine neoplasms, see [2], including pancreatic neoplasms.
This APP can be used to assess tumors by determining the Ki-67 positivity. The protocol detects and classifies nuclei as positive or negative and returns an average proliferation index for the entire tumor region. Tumor regions must be identified and outlined manually within a region of interest (ROI).
The APP can also be used in a more advanced workflow, including automatic tumor detection and hotspot analysis (Figure 1-5). In this setup, tumor regions are identified automatically from cytokeratin stained slides (e.g. PCK) using the APP “20002 – PCK VDS, Tumor Detection”. The APP “10114 – Hot Spot” is used to generate a heatmap to identify a hot spot containing, e.g. 100 cells and the proliferative index is reported for both the entire tumor region and the hot spot.