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Analytical Cellular Pathology
Volume 18 (1999), Issue 4, Pages 191-202

Primary Unit for Statistical Analysis in Morphometry: Patient or Cell?

Oleksiy Tsybrovskyy1 and Andrea Berghold2

1Department of Pathology, University of Graz, School of Medicine, Graz, Austria
2Department of Medical Informatics, Statistics and Documentation, University of Graz, School of Medicine, Graz, Austria

Received 3 December 1998; Accepted 2 July 1999

Copyright © 1999 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


In a series of 16 oxyphilic follicular neoplasms of the thyroid (8 adenomas and 8 carcinomas), three different approaches for the analysis of morphometric data were evaluated. It was shown that the statistical design of morphometric studies is by nature nested due to subsampling of cells within each patient. Therefore, the most appropriate analysis would be to account for this hierarchical structure. However, related statistical methods are not at present well established, especially as far as classification rules are concerned. Therefore, the nested design is converted into the simple factorial one by considering only one kind of statistical unit – either patients or cells. The results of the study presented indicate that ignoring the patient as unit of analysis leads to a substantial error in statistical output, regardless of the particular procedure applied. Moreover, the size of the error can be neither diminished nor controlled. Choosing patients as primary units assures accurate results and also has an advantage of gaining some additional information by calculating several distributional estimates in each patient. However, this approach often requires a reduction of dimensions and, furthermore, is not encouraged in certain fields of quantitative cytology. Advantages and disadvantages of all approaches have been summarized and practical recommendations for their use have been worked out.