1. The impact of a pathologist's personality on the interobserver variability and diagnostic accuracy of predictive PD-L1 immunohistochemistry in lung cancer
- Author
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Rogier Butter, Liesbeth M. Hondelink, Lisette van Elswijk, Johannes L.G. Blaauwgeers, Elisabeth Bloemena, Rieneke Britstra, Nicole Bulkmans, Anna Lena van Gulik, Kim Monkhorst, Mathilda J. de Rooij, Ivana Slavujevic-Letic, Vincent T.H.B.M. Smit, Ernst-Jan M. Speel, Erik Thunnissen, Jan H. von der Thüsen, Wim Timens, Marc J. van de Vijver, David C.Y. Yick, Aeilko H. Zwinderman, Danielle Cohen, Nils A. 't Hart, Teodora Radonic, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Groningen Research Institute for Asthma and COPD (GRIAC), Pulmonary Medicine, Pathology, Amsterdam Gastroenterology Endocrinology Metabolism, AII - Cancer immunology, CCA - Imaging and biomarkers, Graduate School, Epidemiology and Data Science, APH - Methodology, MUMC+: DA Pat Pathologie (9), RS: GROW - R2 - Basic and Translational Cancer Biology, Pathologie, AII - Inflammatory diseases, Otolaryngology / Head & Neck Surgery, and CCA - Cancer biology and immunology
- Subjects
Observer Variation ,Pulmonary and Respiratory Medicine ,EXPRESSION ,Cancer Research ,Lung Neoplasms ,Non-small cell lung cancer (NSCLC) ,DECISION-MAKING ,programmed death-ligand 1 (PD-L1) ,Immunohistochemistry ,B7-H1 Antigen ,Pathologists ,Oncology ,SDG 3 - Good Health and Well-being ,Carcinoma, Non-Small-Cell Lung ,Biomarkers, Tumor ,Humans ,CELL ,Interobserver variability ,PEMBROLIZUMAB ,TRAITS ,Personality ,Diagnostic reliability - Abstract
OBJECTIVES: Programmed death-ligand 1 (PD-L1) is the only approved predictive biomarker for immunotherapy in non-small cell lung cancer (NSCLC). However, predictive PD-L1 immunohistochemistry is subject to interobserver variability. We hypothesized that a pathologist's personality influences the interobserver variability and diagnostic accuracy of PD-L1 immunoscoring.MATERIALS AND METHODS: Seventeen pathologists performed PD-L1 immunoscoring on 50 resected NSCLC tumors in three categories (RESULTS: The overall agreement among pathologists for a series of 47 tumors was substantial (kappa = 0.63). Of these, 23/47 (49%) tumors were entirely negative or largely positive, resulting in a kappa value of 0.93. The remaining 24/47 (51%) tumors had a PD-L1 score around the cutoff value, generating a kappa value of 0.32. Pathologists with high scores for conscientiousness (careful, diligent) had the least interobserver variability (r = 0.6, p = 0.009). Also, they showed a trend towards higher sensitivity (74% vs. 68%, p = 0.4), specificity (86% vs. 82%, p = 0.3) and percent agreement (83% vs. 79%, p = 0.3), although not significant. In contrast, pathologists with high scores for neuroticism (sensitive, anxious) had significantly lower specificity (80% vs. 87%, p = 0.03) and percent agreement (78% vs. 85%, p = 0.03). Also, a trend towards high interobserver variability (r = -0.3, p = 0.2) and lower sensitivity (68% vs. 74%, p = 0.3) was observed, although not significant. Pathologists with relatively high scores for conscientiousness scored fewer tumors PD-L1 positive at the ≥ 1% cut-off (r = -0.5, p = 0.03). In contrast, pathologists with relatively high scores for neuroticism score more tumors PD-L1 positive at ≥ 1% (r = 0.6, p = 0.017) and ≥ 50% cut-offs (r = 0.6, p = 0.009).CONCLUSIONS: This study is the first to demonstrate the impact of a pathologist's personality on the interobserver variability and diagnostic accuracy of immunostaining, in the context of PD-L1 in NSCLC. Larger studies are needed for validation of these findings.
- Published
- 2022