{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T14:53:25Z","timestamp":1779375205527,"version":"3.53.1"},"update-to":[{"DOI":"10.12688\/f1000research.146907.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000}},{"DOI":"10.12688\/f1000research.146907.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000}}],"reference-count":32,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"None"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Introduction Pancreatic carcinoma (PC) is a highly malignant and lethal tumor characterized by a dismal prognosis which raised the need to identify other prognostic factors for better patient risk stratification. Tumor budding (TB), defined as isolated single cancer cells or small clusters of up to four cells at the invasive front, is an emerging histoprognostic factor associated with aggressiveness in various malignancies. This study investigated the prognostic significance of tumor budding (TB) in pancreatic carcinoma using artificial intelligence. Methods In this retrospective multicenter study, we collected all cases of PC diagnosed (2008-2022). TB was assed using 2 methods: manual on hematoxylin-eosin (HE) slides and semi-automated using QUPATH software. The selected slide for each case was digitalized using NIS software version 4.00 connected to the microscope NIKON (Eclipse Ni-U). The pathological images were then incorporated into QUPATH. The budds were counted using cell count functionality based on the nucleus size and pixel variability, and TB scores were categorized as BUDD1(0-4), BUDD2(5-9) and BUDD3(\u226510). We analyzed the association between the TB score and prognostic clinicopathological factors and overall survival. Results 25 patients were included (mean age:62.3years;male-to-female ratio:2.57). TB was found in 100%of cases and a high TB score (BUDD2-3) was observed in 56%of cases (using QUPATH versus 48% using HE slides); statistical analysis showed no significant difference between the two methods (p=0.589). A high TB score was associated with older age (&gt;72 years), ductal histological subtype and advanced stage (pT&gt;2).53.8% of patients with lymph node metastasis or advanced stage had high TB score. Multivariate analysis revealed that TB score was strongly and independently associated with overall survival (OS), with a hazard ratio of 2.35. Conclusion TB is an additional prognostic factor in PC, and using artificial intelligence via QUPATH software offers a promising and accessible tool for pathologists to evaluate TB and to improve risk stratification in patients with PC.<\/ns3:p>","DOI":"10.12688\/f1000research.146907.3","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T17:20:07Z","timestamp":1756833607000},"page":"282","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic significance of tumor budding in pancreatic carcinoma: Digitalized image approach evaluation using artificial intelligence."],"prefix":"10.12688","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9150-3444","authenticated-orcid":false,"given":"Sarra","family":"Ben Rejeb","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasser","family":"Yaacoubi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"3634","DOI":"10.3390\/cancers15143634","article-title":"Overview of Pancreatic Cancer Epidemiology in Europe and Recommendations for Screening in High-Risk Populations.","volume":"15","author":"O Partyka","year":"15 juill 2023","journal-title":"Cancers."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"292-302","DOI":"10.1007\/s10350-004-0773-y","article-title":"Tumor Budding as an Indicator of Isolated Tumor Cells in Lymph Nodes From Patients With Node-Negative Colorectal Cancer.","volume":"48","author":"S Park","year":"f\u00e9vr 2005","journal-title":"Dis. 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Study report and literature review.","volume":"18","author":"E Chouat","year":"janv 2018","journal-title":"Pancreatology."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1299-1311","DOI":"10.1038\/modpathol.2017.46","article-title":"Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference (ITBCC) 2016.","volume":"30","author":"A Lugli","year":"sept 2017","journal-title":"Mod. Pathol."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"16878","DOI":"10.1038\/s41598-017-17204-5","article-title":"QuPath: Open source software for digital pathology image analysis.","volume":"7","author":"P Bankhead","year":"4 d\u00e9c 2017","journal-title":"Sci. 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Microbiol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"113","DOI":"10.3390\/cancers11010113","article-title":"Prognostic Role of High-Grade Tumor Budding in Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis with a Focus on Epithelial to Mesenchymal Transition.","volume":"11","author":"R Lawlor","year":"19 janv 2019","journal-title":"Cancers."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e340-e348","DOI":"10.1097\/MPA.0000000000002440","article-title":"Tumor Budding Is an Independent Adverse Prognostic Factor of Pancreatic Ductal Adenocarcinoma Patients Treated by Resection After Preoperative Chemoradiotherapy.","volume":"54","author":"A Hayasaki","year":"avr 2025","journal-title":"Pancreas."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.3390\/biomedicines10071761","article-title":"Tumor Budding Is an Independent Prognostic Factor in Pancreatic Adenocarcinoma and It Positively Correlates with PD-L1 Expression on Tumor Cells.","volume":"10","author":"R P\u0119ksa","year":"21 juill 2022","journal-title":"Biomedicines."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.3390\/cancers13051090","article-title":"Pancreatic Cancers with High Grade Tumor Budding Exhibit Hallmarks of Diminished Anti-Tumor Immunity.","volume":"13","author":"H Sadozai","year":"4 mars 2021","journal-title":"Cancers."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1485-1491","DOI":"10.1038\/s41416-018-0093-y","article-title":"Tumour buds determine prognosis in resected pancreatic ductal adenocarcinoma.","volume":"118","author":"P Lohneis","year":"mai 2018","journal-title":"Br. 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