Although a full discussion of the research on automated digital image analysis of Ki-67 in breast cancer is beyond the scope of this review, the studies to date have generally shown that automated methods typically match the accuracy of manual estimates using rigorous standardized scoring methods (such as that proposed by the IKWG) and exceed the accuracy of visual estimates using less standardized methods [2,174,176,178]. This evidence concerns the gene MKI67 and breast cancer.