A meeting among expert pathologists was held in 2019 in Rome to verify the results of the previous harmonization eﬀorts on the PD-L1 immunohistochemical testing by scoring a representative series of non-small cell lung cancer (NSCLC) digital slides. The current paper shows the results of this digital experimental meeting and the expertise achieved by the community of Italian pathologists. PD-L1 protein expression was determined using tumor proportion score (TPS),i.e.,thepercentageofviabletumorcellsshowingpartialorcompletemembranestainingatany intensity. The gold standard was deﬁned as the ﬁnal PD-L1 score formulated by a panel of seven lung committed pathologists. PD-L1 status was clustered in three categories, namely negative (TPS < 1), low (TPS 1–49%), and high (TPS≥50%). In 23 cases (71.9%) PD-L1 staining was performed using the companion diagnostic 22C3 pharmDx kit on Dako Autostainer, while in nine (28.1%) cases it was performed using the SP263 Ventana kit on BenchMark platform. A complete PD-L1 scoring agreement between the panel of experts and the participants was reached in 57.1% of cases, whereas a minor disagreement in 16.1% of cases was recorded. Italian pathologists performed best in strong positive cases (i.e., tumor proportion score TPS > 50%), whereas only 10.8% of disagreement with the gold standard was observed, and 55.6% regarded a single challenging case. The worst performance was achieved in the negative cases, with 32.0% disagreement. A signiﬁcant diﬀerence resulted from the analysis of the data separated by the diﬀerent clones used: 22.3% and 38.1% disagreement (p = 0.01) was found in the group of cases analyzed by 22C3 and SP263 antibody clones, respectively. In conclusion, this workshop record proposed the application of a digital pathology platform to share controversial cases in educational meetings as an alternative possibility for improving the interpretation and reporting of speciﬁc histological tools. Due to the crucial role of PD-L1 TPS for the selection of patients for immunotherapy, the identiﬁcation of unconventional approaches as virtual slides to focus experiences and give more detailed practical veriﬁcations of the standard quality reached may be a considerable option.
ASJC Scopus subject areas
- Cancer Research