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Cytology for PD-L1 testing: A systematic review.

John R Gosney1, A-M Boothman2, Marianne Ratcliffe2

  • 1Department of Cellular Pathology, Royal Liverpool University Hospital, Duncan Building, Prescot Street, Liverpool L8 7XP, United Kingdom.

Lung Cancer (Amsterdam, Netherlands)
|February 3, 2020
PubMed
Summary

Cytology specimens are reliable for assessing programmed cell death ligand-1 (PD-L1) expression in advanced non-small-cell lung cancer (NSCLC). This systematic review found high concordance between cytology and histology, supporting its use in clinical practice.

Keywords:
CytologyFine needle aspirateImmunohistochemistryNSCLCPD-L1Systematic review

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Area of Science:

  • Oncology
  • Pathology
  • Biomarker Analysis

Background:

  • Tumoral programmed cell death ligand-1 (PD-L1) evaluation is crucial for advanced non-small-cell lung cancer (NSCLC) patients considered for PD-1/PD-L1 pathway inhibitors.
  • Histology specimens are currently the standard for PD-L1 testing, but cytology specimens are often the only option for 30-40% of advanced NSCLC patients.

Purpose of the Study:

  • To systematically review the success rate, concordance, and clinical utility of assessing PD-L1 expression in cytology specimens compared to histology specimens in advanced NSCLC.
  • To determine if cytology specimens are adequate for PD-L1 biomarker analysis in NSCLC.

Main Methods:

  • A systematic review of EMBASE and PubMed databases was conducted, identifying 142 unique publications and including 15 that met the criteria.
  • Analyzed data from 709 specimens across seven publications for PD-L1 test evaluability.
  • Performed concordance analysis between cytology and histology specimens using PD-L1 tumor cell expression cutoffs of ≥50% and ≥1%.

Main Results:

  • Cytology specimens were evaluable for PD-L1 testing in 92.0% of cases (n=709).
  • High overall agreement (89.7%) was observed between cytology and histology for PD-L1 expression ≥50%.
  • Similar concordance rates were found using a ≥1% cutoff, suggesting feasibility and reliability.

Conclusions:

  • Cytology specimens are a feasible and reliable alternative to histology specimens for assessing PD-L1 expression in advanced NSCLC.
  • The study found no convincing evidence that cytology is inferior to histology for PD-L1 assessment in NSCLC patients.
  • These findings support the use of cytology specimens for PD-L1 biomarker analysis, expanding treatment options for NSCLC patients.