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PD-L1 Testing in Cytological Non-Small Cell Lung Cancer Specimens : A Comparison with Biopsies and Review of the Literature

Mansour, Mohammed S I LU orcid ; Lindquist, Kajsa Ericson LU ; Seidal, Tomas ; Mager, Ulrich ; Mohlin, Rikard ; Tran, Lena LU ; Hejny, Kim ; Holmgren, Benjamin ; Violidaki, Despoina LU orcid and Dobra, Katalin LU , et al. (2021) In Acta Cytologica 65(6). p.501-509
Abstract

INTRODUCTION: Programmed death-ligand 1 (PD-L1) expression is used for treatment prediction in non-small cell lung cancer (NSCLC). While cytology may be the only available material in the routine clinical setting, testing in clinical trials has mainly been based on biopsies.

METHODS: We included 2 retrospective cohorts of paired, concurrently sampled, cytological specimens and biopsies. Also, the literature on PD-L1 in paired cytological/histological samples was reviewed. Focus was on the cutoff levels ≥1 and ≥50% positive tumor cells.

RESULTS: Using a 3-tier scale, PD-L1 was concordant in 40/47 (85%) and 66/97 (68%) of the paired NSCLC cases in the 2 cohorts, with kappa 0.77 and 0.49, respectively. In the former cohort, all... (More)

INTRODUCTION: Programmed death-ligand 1 (PD-L1) expression is used for treatment prediction in non-small cell lung cancer (NSCLC). While cytology may be the only available material in the routine clinical setting, testing in clinical trials has mainly been based on biopsies.

METHODS: We included 2 retrospective cohorts of paired, concurrently sampled, cytological specimens and biopsies. Also, the literature on PD-L1 in paired cytological/histological samples was reviewed. Focus was on the cutoff levels ≥1 and ≥50% positive tumor cells.

RESULTS: Using a 3-tier scale, PD-L1 was concordant in 40/47 (85%) and 66/97 (68%) of the paired NSCLC cases in the 2 cohorts, with kappa 0.77 and 0.49, respectively. In the former cohort, all discordant cases had lower score in cytology. In both cohorts, concordance was lower in samples from different sites (e.g., biopsy from primary tumor and cytology from pleural effusion). Based on 25 published studies including about 1,700 paired cytology/histology cases, the median (range) concordance was 81-85% (62-100%) at cutoff 1% for a positive PD-L1 staining and 89% (67-100%) at cutoff 50%.

CONCLUSIONS: The overall concordance of PD-L1 between cytology and biopsies is rather good but with significant variation between laboratories, which calls for local quality assurance.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cytology, Histology, Lung Cancer, PD-L1, NSCLC, Cell Block, Immunohistochemistry (IHC), Onco-Pathology
in
Acta Cytologica
volume
65
issue
6
pages
501 - 509
publisher
Karger
external identifiers
  • pmid:34233336
  • scopus:85110239314
ISSN
0001-5547
DOI
10.1159/000517078
project
Biomarkers in mesothelioma and non-small cell lung cancer: Investigation of cytological specimens with correlation to histology
Improvement of diagnostic and prognostic cytopathology of lung cancer and malignant mesothelioma.
language
English
LU publication?
yes
id
2a3de999-d673-4b3e-8fce-bf7e873cf9ef
date added to LUP
2021-07-12 16:16:42
date last changed
2025-04-06 18:12:59
@article{2a3de999-d673-4b3e-8fce-bf7e873cf9ef,
  abstract     = {{<p>INTRODUCTION: Programmed death-ligand 1 (PD-L1) expression is used for treatment prediction in non-small cell lung cancer (NSCLC). While cytology may be the only available material in the routine clinical setting, testing in clinical trials has mainly been based on biopsies.</p><p>METHODS: We included 2 retrospective cohorts of paired, concurrently sampled, cytological specimens and biopsies. Also, the literature on PD-L1 in paired cytological/histological samples was reviewed. Focus was on the cutoff levels ≥1 and ≥50% positive tumor cells.</p><p>RESULTS: Using a 3-tier scale, PD-L1 was concordant in 40/47 (85%) and 66/97 (68%) of the paired NSCLC cases in the 2 cohorts, with kappa 0.77 and 0.49, respectively. In the former cohort, all discordant cases had lower score in cytology. In both cohorts, concordance was lower in samples from different sites (e.g., biopsy from primary tumor and cytology from pleural effusion). Based on 25 published studies including about 1,700 paired cytology/histology cases, the median (range) concordance was 81-85% (62-100%) at cutoff 1% for a positive PD-L1 staining and 89% (67-100%) at cutoff 50%.</p><p>CONCLUSIONS: The overall concordance of PD-L1 between cytology and biopsies is rather good but with significant variation between laboratories, which calls for local quality assurance.</p>}},
  author       = {{Mansour, Mohammed S I and Lindquist, Kajsa Ericson and Seidal, Tomas and Mager, Ulrich and Mohlin, Rikard and Tran, Lena and Hejny, Kim and Holmgren, Benjamin and Violidaki, Despoina and Dobra, Katalin and Dejmek, Annika and Planck, Maria and Brunnström, Hans}},
  issn         = {{0001-5547}},
  keywords     = {{Cytology; Histology; Lung Cancer; PD-L1; NSCLC; Cell Block; Immunohistochemistry (IHC); Onco-Pathology}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{6}},
  pages        = {{501--509}},
  publisher    = {{Karger}},
  series       = {{Acta Cytologica}},
  title        = {{PD-L1 Testing in Cytological Non-Small Cell Lung Cancer Specimens : A Comparison with Biopsies and Review of the Literature}},
  url          = {{http://dx.doi.org/10.1159/000517078}},
  doi          = {{10.1159/000517078}},
  volume       = {{65}},
  year         = {{2021}},
}