PD-L1 immunohistochemistry in non-small-cell lung cancer: unraveling differences in staining concordance and interpretat
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ORIGINAL ARTICLE
PD-L1 immunohistochemistry in non-small-cell lung cancer: unraveling differences in staining concordance and interpretation Cleo Keppens 1 & Elisabeth MC Dequeker 1 & Patrick Pauwels 2,3 Jan H von der Thüsen 7
&
Ales Ryska 4
&
Nils ‘t Hart 5,6 &
Received: 30 March 2020 / Revised: 3 November 2020 / Accepted: 22 November 2020 # The Author(s) 2020
Abstract Programmed death ligand 1 (PD-L1) immunohistochemistry (IHC) is accepted as a predictive biomarker for the selection of immune checkpoint inhibitors. We evaluated the staining quality and estimation of the tumor proportion score (TPS) in nonsmall-cell lung cancer during two external quality assessment (EQA) schemes by the European Society of Pathology. Participants received two tissue micro-arrays with three (2017) and four (2018) cases for PD-L1 IHC and a positive tonsil control, for staining by their routine protocol. After the participants returned stained slides to the EQA coordination center, three pathologists assessed each slide and awarded an expert staining score from 1 to 5 points based on the staining concordance. Expert scores significantly (p < 0.01) improved between EQA schemes from 3.8 (n = 67) to 4.3 (n = 74) on 5 points. Participants used 32 different protocols: the majority applied the 22C3 (56.7%) (Dako), SP263 (19.1%) (Ventana), and E1L3N (Cell Signaling) (7.1%) clones. Staining artifacts consisted mainly of very weak or weak antigen demonstration (63.0%) or excessive background staining (19.8%). Participants using CE-IVD kits reached a higher score compared with those using laboratory-developed tests (LDTs) (p < 0.05), mainly attributed to a better concordance of SP263. The TPS was under- and over-estimated in 20/423 (4.7%) and 24/423 (5.7%) cases, respectively, correlating to a lower expert score. Additional research is needed on the concordance of less common protocols, and on reasons for lower LDT concordance. Laboratories should carefully validate all test methods and regularly verify their performance. EQA participation should focus on both staining concordance and interpretation of PD-L1 IHC. Keywords PD-L1 . Immunohistochemistry . Tumor proportion score . External quality assessment
Abbreviations CI Confidence interval CDx Companion diagnostic
EQA ESS FDA
External quality assessment Expert staining score Food and Drug Administration
This article is part of the Topical Collection on Quality in Pathology * Jan H von der Thüsen [email protected] Cleo Keppens [email protected]
1
Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Leuven, Belgium
2
Center for Oncologic Research (CORE), University of Antwerp, Antwerp, Belgium
3
Department of Pathology, University Hospital Antwerp, Edegem, Belgium
Elisabeth MC Dequeker [email protected] 4
Patrick Pauwels [email protected]
Department of Pathology, Charles University Medical Faculty and University Hospital, Hradec Kralove, Czech Republic
5
Ales Ryska [email protected]
D
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