Correlation of PD-L1 expression on tumour cells between diagnostic biopsies and surgical specimens of lung cancer in real life with respect to biopsy techniques and neoadjuvant treatment

Abstract

Purposes Programmed death-ligand 1 (PD-L1) testing is performed mainly on biopsy specimens in patients with advanced lung cancer. It is questionable whether the small amount of tissue analysed in biopsies may represent the true PD-L1 expression of a tumour. Methods In this retrospective study, PD-L1 expression on tumour cells derived from bronchoscopy brush cytology, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA), endobronchial biopsy, transbronchial biopsy (TBB) and computed tomography (CT)-guided transthoracic biopsy was compared to the PD-L1 expression of the corresponding surgical resection in lung cancer patients with regard to neoadjuvant treatment in-between. Results A quantitative comparison between the diagnostic biopsy of the primary tumour with corresponding resected surgical specimens in a total of 113 lung cancer patients (60% male, mean age 65 ± 9 years) revealed a statistically significant correlation of PD-L1 expression on tumour cells (r = 0.58, p< 0.001), for patients without neoadjuvant treatment in-between and for patients who underwent neoadjuvant treatment (both p < 0.001). Using a cut-off value of ≥ 50% PD-L1 TPS for comparing the biopsy samples and resected specimens, the concordance rate was 78% with a Cohen’s Kappa of 0.45. Conclusion A statistically significant concordance for PD-L1 expression on tumour cells between biopsies from primary lung tumour and resected specimen was found, but of uncertain clinical accuracy. The use of a cut-off value of ≥ 50% PD-L1 TPS resulted only in a moderate agreement. Therefore, the interpretation of the PD-L1 determined form biopsy specimens status should only be considered with caution for treatment decisionsQuery.

Artificial intelligence-based assessment of PD-L1 expression in diffuse large B cell lymphoma

“…Clinical findings [42][43][44][45][46] are well documented on the task of measuring PD-L1 related surgical specimens and fine-needle biopsies, yet there is a lack of quantitative research in the field of AI. Our investigation provides deeper insights into optimizing clinical practice of specimen assessment on PD-L1 expression.…”

PD‐L1 expression in patients with non‐small‐cell lung cancer is associated with sex and genetic alterations: A retrospective study within the Caucasian population

“…Several studies have described intra-tumoral heterogeneity and discrepancies between primary tumors, lymph node metastases, and distant metastases. 28,49,50 According to research conducted by Evans et al, PD-L1 expression in lung tumor samples was notably lower compared to samples from the pleura or lymph nodes. 10 One plausible reason for this difference could be the exposure to the leukocyte-rich environment of a lymph node or inflamed pleural fluid, which might influence PD-L1 expression in metastatic tumor cells.…”

“…Additionally, when analyzing PD‐L1 expression across different patient groups, it is essential to consider the inherent limitations associated with estimating PD‐L1 expression on tumor cells themselves. Several studies have described intra‐tumoral heterogeneity and discrepancies between primary tumors, lymph node metastases, and distant metastases 28,49,50 . According to research conducted by Evans et al, PD‐L1 expression in lung tumor samples was notably lower compared to samples from the pleura or lymph nodes 10 .…”

PD-L1 assessment in lung cancer biopsies—pitfalls and limitations

“…Another study, which compared the PD-L1 expression of tumor cells of biopsies and surgical specimens of patients who underwent chemotherapy and/or immunotherapy in-between, revealed contrary results. 7 The authors found a statistically significant correlation of the PD-L1 status prior to and following neoadjuvant treatments indicating that chemotherapy and/or immunotherapy did not have a relevant impact on the PD-L1 status. Isomoto et al 36 described the PD-L1 change after a targeted treatment in patients with epidermal growth factor receptor (EGFR)-mutated NSCLC.…”

“…However, when using a cut-off value of ≥50% PD-L1 TPS the concordance rate with 78% was only moderate. 7…”