PD-L1 Immunoexpression on Cytology and its Paired Comparison with Histopathology in Lung Carcinoma
Abstract
Background Cell blocks are being increasingly used as a less invasive diagnostic procedure for various ancillary tests like immunohistochemistry. The assays programmed death ligand-1 (PD-L1) is one such companion diagnostic test playing a role in progression of lung cancer. The present study was carried out to examine efficacy of cell blocks for PD-L1 expression in lung cancer patients. Methods Over the course of a year, our pathology department conducted this prospective study and included newly diagnosed lung carcinoma cases on cytopathological examination. Tumor Proportion Score (TPS) was used for grading cell membrane PD-L1 positivity. Excel sheet was used for compiling and analysing the data using the IBM SPSS software version 28 (Statistical Package for Social Sciences) Chicago, USA. Result The study included 36 cases in which cell blocks and paired histopathological sections were studied, of which 1 cell block was inadequate for reporting. PD-L1 expression was negative in 57%, low grade in 40% and high grade in 3% cases. It was seen in 40% squamous cell carcinoma, 40% adenocarcinoma and 20% small cell carcinoma. Among them, 11 were true positive, 5 were false positive, 3 were false negative and 16 were true negative. With a 78.5% sensitivity, 76% specificity, 68.7% positive predictive value and 84.2% negative predictive value, PD-L1 on cell blocks correlated with paired histopathological sections in 77% of cases in our study. Conclusion: Cell blocks can be utilized for evaluating PD-L1 expression in lung carcinoma and act as an efficient and trustworthy substitute to routine histopathological techniques.References
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71(03):209–249
Inamura K. Lung cancer: understanding its molecular pathology and the 2015 WHO classification. Front Oncol 2017;7:193
Tejerina E, Garcia Tobar L, Echeveste JI, de Andrea CE, Vigliar E, Lozano MD. PD-L1 in cytological samples: A Review and A Practical Approach. Frontiers in Medicine. 2021;8:668612
Travis WD, Brambilla E, Nicholson AG, et al; WHO Panel. The 2015 World Health Organization Classification of Lung Tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol 2015;10(09):1243–1260
Pawelczyk K, Piotrowska A, Ciesielska U, et al. Role of PD-L1 expression in non-small cell lung cancer and their prognostic significance according to clinicopathological factors and diagnostic markers. Int J Mol Sci 2019; 20 (04):824
Shidham VB, Kampalath B, England J. Routine air drying of all smears prepared during fine needle aspiration and intraoperative cytology studies. An opportunity to practice a unified protocol offering the flexibility of choosing a variety of staining methods. Acta Cytol. 2001;45:60–8
Zuna RE. Diagnostic cytopathology of peritoneal washing. In: Shidham VB, Atkinson BF, editors. Cytopathologic Diagnosis of Serous Fluids. 1st ed. Ch. 7. Elsevier, W. B. Saunders Company; 2007. pp. 91–105
D'incecco A, Andreozzi M, Ludovini V, et al. PD-1 and PD-L1 expression in molecularly selected non-small-cell lung cancer patients. Br J Cancer. 2014;112:95-102
Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer 2012;12(04):252–264
Inamura K. Lung cancer: understanding its molecular pathology and the 2015 WHO classification. Front Oncol 2017;7:193
Garon EB, Rizvi NA, Hui R, et al. Pembrolizumab for the treatment of non-small-cell lung cancer. N Engl J Med.2015;372:2018–2028
Kakodkar UC, Vadala R, Mandrekar S. Utility of Cell-Block of Bronchial Washings in Diagnosis of Lung Cancer-A Comparative Analysis with Conventional Smear Cytology. Journal of clinical and diagnostic research: JCDR. 2016;10(4):OC25
Jain D, Sukumar S, Mohan A, Iyer VK. Programmed death‐ligand 1 immunoexpression in matched biopsy and liquid‐based cytology samples of advanced stage non‐small cell lung carcinomas. Cytopathology. 2018;29(6):550-7
Jug R, Giovacchini CX, Liu B, et al. EBUS-FNA cytologic-histologic correlation of PD-L1 immunohistochemistry in non–small cell lung cancer. Journal of the American Society of Cytopathology. 2020;9(6):485-93
Wang H, Agulnik J, Kasymjanova G, et al. Cytology cell blocks are suitable for immunohistochemical testing for PD-L1 in lung cancer. Annals of Oncology. 2018 ;29(6):1417-22
Thapar M, Mishra RK, Sharma A, et al. Critical analysis of cell block versus smear examination in effusions. Journal of cytology/Indian Academy of Cytologists. 2009;26(2):60
Heymann JJ, Bulman WA, Swinarski D, et al. PD‐L1 expression in non small cell lung carcinoma: comparison among cytology, small biopsy, and surgical resection specimens. Cancer cytopathology. 2017;125(12):896-907
Kuempers C, van der Linde LI, Reischl M, et al. Comparison of PD-L1 expression between paired cytologic and histologic specimens from non-small cell lung cancer patients. Virchows Archiv. 2020;476:261-71.
KulaÇ İ, Aydin A, Bulutay P, Firat P. Efficiency of cytology samples for PD-L1 evaluation and comparison with tissue samples. Turk Patoloji Derg. 2020;36(3):205-10.ss
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