Fractal analysis: an objective method for identifying atypical nuclei in dysplastic lesions of the cervix uteri.

OBJECTIVES Fractal geometry is a tool used to characterize irregularly shaped and complex figures. It can be used not only to generate biological structures (e.g., the human renal artery tree), but also to derive parameters such as the fractal dimension in order to quantify the shapes of structures. As such, it allows user-independent evaluation and does not rely on the experience level of the examiner. METHODS We applied a box-counting algorithm to determine the fractal dimension of atypical nuclei in dysplastic cervical epithelium. An automatic algorithm was used to determine the fractal dimension of nuclei in order to prevent errors from manual segmentation. Four groups of patients (CIN 1-3 and control) with 10 subjects each were examined. In total, the fractal dimensions of 1200 nuclei were calculated. RESULTS We found that the fractal dimensions of the nuclei increased as the degree of dysplasia increased. There were significant differences between control and atypical nuclei found by an analysis of variance. Atypical nuclei associated with CIN 1, CIN 2, and CIN 3 also differed significantly among these groups. CONCLUSION We conclude that the fractal dimension is a valuable tool for detecting irregularities in atypical nuclei of the cervix uteri and thus allows objective nuclear grading.