@article{65471ecf590d4a9787535326d8e31f6a,
title = "Programmed death-ligand 1 (PD-L1)/thyroid transcription factor-1 double immunohistochemical staining facilitates scoring of tumor PD-L1 expression in cytopathology specimens from lung adenocarcinoma patients",
abstract = "Background: Immune checkpoint inhibitor therapy has revolutionized lung adenocarcinoma therapy. Treatment with antibodies against the immune checkpoint molecules programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) can induce a durable response in a subset of patients. Immunohistochemistry characterization of tumor PD-L1 expression using either a histopathology specimen or a cytopathology specimen has been shown to correlate with treatment response. However, the current practice relies on pathologists' visual estimation of tumor PD-L1 staining, which can be variable in certain conditions. Highlighting tumor cells via double immunostaining with PD-L1 and thyroid transcription factor-1 (TTF-1) may improve estimation accuracy. Methods: We performed PD-L1 single staining and PD-L1/TTF-1 double staining in 42 pairs of cytopathology and histopathology specimens from lung adenocarcinoma patients. An experienced pathologist visually estimated PD-L1 expression in each case and placed tumor PD-L1 expression into 1 of 3 categories: <1\%, 1\%-49\%, or ≥50\%. A medical technologist also performed estimations of the same cases based on a count of 200 tumor cells, and the results were compared. Results: PD-L1/TTF-1 double immunohistochemistry could better identify the PD-L1–positive tumor cells in cytopathology specimens compared with PD-L1 single staining. The concordance of PD-L1 expression categorization between the pathologist's visual estimation and the medical technologist's counting was increased by double staining in cytopathology specimens (Cohen's weighted kappa: single stain, 0.784; double stain, 0.880). Double staining reduced possible error in the pathologist's visual estimation of PD-L1 expression from 9.5\% to 4.8\%. The benefit was not observed in histopathology specimens. Conclusion: A simple PD-L1/TTF-1 double immunohistochemistry technique can be applied successfully to cytopathology specimens in better identifying patients who can potentially benefit from immune checkpoint blockade treatment.",
keywords = "cytology, immunohistochemistry, lung adenocarcinoma, programmed death-ligand 1, thyroid transcription factor-1",
author = "Lin, \{Yen Yu\} and Lin, \{Li Ya\} and Hang, \{Jen Fan\} and Lin, \{Chia Hung\} and Ho, \{Hsiang Ling\} and Chou, \{Teh Ying\}",
note = "Funding Information: This study was supported by the Cancer Progression Research Center, National Yang‐Ming University (from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education) and Taipei Veterans General Hospital, Taiwan (grants V109C‐002 and V108E‐008). Publisher Copyright: {\textcopyright} 2020 American Cancer Society",
year = "2021",
month = feb,
doi = "10.1002/cncy.22359",
language = "English",
volume = "129",
pages = "148--155",
journal = "Cancer cytopathology",
issn = "1934-662X",
publisher = "John Wiley and Sons Inc.",
number = "2",
}
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