Objective assessment of the malignant potential of intraocular melanomas with standard microslides stained with hematoxylin-eosin

A method for extracting prognostic information from the cytologic details of intraocular melanomas was developed. With computer assistance, a technician measures the nucleolar area of 200 tumor cells randomly selected from a standard paraffin-embedded microsection stained with hematoxylin-eosin, a procedure that requires approximately 40 minutes with an apparatus that costs less than $30,000. Standard deviation of nucleolar area (SDNA), computed from these measurements, provides an objective assessment of nucleolar pleomorphism. Previous studies showed that second measurements of the same microsection or of the same tumor at different levels yield SDNA values that closely approximate the original measurements. The application of this method to 540 cases from three independent laboratories yielded a correlation of SDNA with death from tumor that was high (P≪0.001) and consistent among cases from all three sources. Thus, SDNA provides a clinically useful cytologic measure of the malignancy of intraocular melanomas and may ultimately prove valuable in the assessment of other type of tumors.