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An important question in the effective use of quantitation in cytology is how to make the link between mathematical parameters and the cytologist. As an example, an investigation is discussed in which cell images from benign mesothelial proliferations were distinguished by quantitative characteristics from those of malignant mesotheliomas originating in the pleura and peritoneum. The significant differences between the three groups in nuclear size, cytoplasmic size and nuclear-cytoplasmic (N/C) ratio could partly be explained by the vacuolation patterns of the exfoliated mesothelial cells in each. Moreover, the primary site of the tumor could be predicted by the quantitative cell parameters. The characteristics of cytologic images, once known to be important, are easily incorporated into standard diagnosis. Thus it now seems possible for the cytologist to differentiate between the three groups by using the cytomorphologic features that relate to the computed parameters. This shows the value of translating computerized parameters into cytomorphologic criteria.

A quantitative analysis of the lipid vacuoles in benign hypertrophic and neoplastic mesothelial cells, using a size-independent distribution index, showed that computer-assisted image analysis for distribution patterns of cytoplasmic components can aid in distinguishing benign from malignant cells. Benign mesothelial cells had fewer lipid vacuoles, which were smaller and predominantly found around the nuclei. It is argued that, due to the high surface tension in the lipid vacuoles, the largest vacuoles are found in the center of the cells, which is the least flattened part of the air-dried mesothelial cells. It seems likely that the distribution pattern of rigid substructures, such as lipid vacuoles, varies between histologic and cytologic material as well as between cells processed by different cytologic methods with various cell-flattening artifacts. The study of the distribution of cytoplasmic components that differ in size was enhanced by using the defined size-independent distribution index, which incorporates the radius of the cell, the radius of the vacuoles and their respective centers of gravity.