Digital analysis of distant and cancer-associated mammary adipocytes

Edoardo Isnaldi, François Richard, Maxim De Schepper, Delphine Vincent, Sophia Leduc, Marion Maetens, Tatjana Geukens, Giuseppe Floris, Ghizlane Rouas, Fatima Cardoso, Christos Sotiriou, Gabriele Zoppoli, Denis Larsimont, Elia Biganzoli, Christine Desmedt

Research output: Contribution to journalArticlepeer-review


Adipocytes and cancer-associated adipocytes (CAAs) are poorly investigated cells in the tumor microenvironment. Different image analysis software exist for identifying and measuring these cells using scanned hematoxylin and eosin (H&E)-stained slides. It is however unclear which one is the most appropriate for breast cancer (BC) samples. Here, we compared three software (AdipoCount, Adiposoft, and HALO®). HALO® outperformed the other methods with regard to adipocyte identification, (> 96% sensitivity and specificity). All software performed equally good with regard to area and diameter measurement (concordance correlation coefficients > 0.97 and > 0.96, respectively). We then analyzed a series of 10 BCE samples (n = 51 H&E slides) with HALO®. Distant adipocytes were defined >2 mm away from cancer cells or fibrotic region, whereas CAAs as the first three lines of adipocytes close to the invasive front. Intra-mammary heterogeneity was limited, implying that measuring a single region of ∼500 adipocytes provides a reliable estimation of the distribution of their size features. CAAs had smaller areas (median fold-change: 2.62) and diameters (median fold-change: 1.64) as compared to distant adipocytes in the same breast (both p = 0.002). The size of CAAs and distant adipocytes was associated with the body mass index (BMI) of the patient (area: rho = 0.89, p = 0.001; rho = 0.71, p = 0.027, diameter: rho = 0.87 p = 0.002; rho = 0.65 p = 0.049, respectively). To conclude, we demonstrate that quantifying adipocytes in BC sections is feasible by digital pathology using H&E sections, setting the basis for a standardized analysis of mammary adiposity in larger series of patients.

Original languageEnglish
Pages (from-to)179-186
Number of pages8
Publication statusPublished - Dec 2020


  • Adipocytes
  • Breast cancer
  • Cancer-associated adipocytes
  • Digital pathology
  • Obesity

ASJC Scopus subject areas

  • Surgery

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