Artificial intelligence-powered programmed death ligand 1 analyser reduces interobserver variation in tumour proportion score for non-small cell lung cancer with better prediction of immunotherapy response.

Background: Manual evaluation of programmed death ligand 1 (PD-L1) tumour proportion score (TPS) by pathologists is associated with interobserver bias.
Objective: This study explored the role of artificial intelligence (AI)-powered TPS analyser in minimisation of interobserver variation and enhancement of therapeutic response prediction.
Methods: A prototype model of an AI-powered TPS analyser was developed with a total of 802 non-small cell lung cancer (NSCLC) whole-slide images. Three independent board-certified pathologists labelled PD-L1 TPS in an external cohort of 479 NSCLC slides. For cases of disagreement between each pathologist and the AI model, the pathologists were asked to revise the TPS grade (<1%, 1%-49% and ≥50%) with AI assistance. The concordance rates among the pathologists with or without AI assistance and the effect of the AI-assisted revision on clinical outcome upon immune checkpoint inhibitor (ICI) treatment were evaluated.
Results: Without AI assistance, pathologists concordantly classified TPS in 81.4% of the cases. They revised their initial interpretation by using the AI model for the disagreement cases between the pathologist and the AI model (N = 91, 93 and 107 for each pathologist). The overall concordance rate among the pathologists was increased to 90.2% after the AI assistance (P < 0.001). A reduction in hazard ratio for overall survival and progression-free survival upon ICI treatment was identified in the TPS subgroups after the AI-assisted TPS revision.
Conclusion: The AI-powered TPS analyser assistance improves the pathologists' consensus of reading and prediction of the therapeutic response, raising a possibility of standardised approach for the accurate interpretation.
Competing Interests: Conflict of interest statement S.I.C., S.S., K.P., D.Y., W.J. and C.-Y.O. are employed by Lunit Inc. and has stock/stock options in Lunit Inc., and M.M., S.P., S.P. and B.J.A. are employed by Lunit Inc. No other disclosures were reported. The AI model in the study is a prototype model, and the model has developed for academic interest, not for commercialisation.
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