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MAI and the MPI Calculations |
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| MAI and MPI have been found
to give prognostic odds which might allow decisions in favor
of cytotoxic chemotherapy conservatism. Though the MAI ought
to correspond to the mitotic component of the 3-parameter scoring
assessment comprising the Elston grading of invasive ductal adenocarcinoma
of the breast, that mitotic component might well not have been
precisely determined according to the MAI criteria published
by the Amsterdam pathology group in Human Pathology 22:326-336,
1991 (and I first heard about it at an ASCP CME 4/1995). Patients/clinicians:
if the/your pathology report does not contain a specific measurement
of the MAI, you have every right to call the department and request
that your case be reviewed and the parameter expertly calculated.
It is quite time consuming to do so...especially on limited tumor
material (such as limited representation on cores). Results on
less than, say, a 50% representation of the imaged size of the
neoplasm run the risk of under-representation of cellular, more
proliferative tumor portions still in the patient. Your pathologist
may need the web site information on this page, below, in order
to produce the case MAI and MPI. As a last possible resort, your
slides could be forwarded to us; and, if we agree to do so, we
can calculate the MAI. |
MAI:
- Tumor area to assess (make it about a 5 x 5 mm. marked
area on the slide):
- chose the most cellular area of invasive cancer
- include tumor periphery
- reject areas with much inflammation
- reject areas with necrosis (if unavoidable, count where
as little as possible)
- start count at most mitotically active point by H&E
survey
- The counting:
- 40x objective & 10x eyepiece
- only fields with 50% or more invasive cells and less
than 50% stroma/CIS/benign stuff
- count only unequivocal, definite mitotic figures
- sum the total of mitotic figures in 10 "40x hpf" fields,
and this sum is the MAI.
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MPI:
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square root of MAI times
(+0.3341)=__________________
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tumor size_________cm. x (+0.2342)=__________________
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lymph node status*____ x (-0.7654)=__________________
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*node positive case, 1 point
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*node negative case, 2 points
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now sum (keep + and - signs correct) the 3: ______________
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Survival datafor [premenopausal]
[ in general] as it might impact chemotherapy
decisions
(posted November 2001; latest update 28 October
2002) |
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© Copyright
1999 - 2006, all rights reserved, Pathology Associates Of Lexington,
P.A. |
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