Interobserver reproducibility of tumor-infiltrating lymphocyte evaluations in breast cancer

Study of Tumor-Infiltrating Lymphocytes in Breast Carcinoma and Their Association With Pathological and Prognostic Factors and Pathological Tumor-Node-Metastasis (pTNM) Staging

OBJECTIVES

Breast carcinoma is the second most frequent type of cancer globally, with an estimated 2.08 million new carcinoma cases identified in 2018. Breast cancer prognosis is influenced by a number of variables, including the patient's age, morphological variant, stromal inflammatory reaction, elastotic, fibrotic focus, lymphovascular emboli, recurrence of tumor, etc. Recently, the morphological evaluation and extent of tumor-infiltrating lymphocytes (TIL) have also been studied in breast cancer. An attempt is being made to understand the role of TIL in determining the prognostication of carcinoma breast. Thus, the goal of the current academic study is to assess TIL in breast carcinoma.

MATERIALS AND METHOD

The study was performed at a medical institution's pathology department, which covered newly diagnosed cases of infiltrating ductal carcinoma of the breast on histopathology during the January to December 2019 time frame. The gross and hematoxyline-eosin-stained paraffin sections were studied for histopathological examination.

RESULTS

The study included 50 cases of infiltrating ductal carcinoma of the breast with a female-to-male ratio of 24:1. Stromal TIL was negative (0-10%) in 12 cases, while was positive (11-100 %) in 38 cases. The results of the receiver operating characteristic (ROC) curve study indicated that the specificity was 70.7% and the sensitivity was 85.3% when the cutoff of stromal TIL <11% was used to predict the live status of patients.

CONCLUSION

Stromal TIL is an important parameter that must be reported in breast carcinoma cases. Positive stromal TIL shows a statistically significant difference with pathological tumor-node-metastasis (pTNM) staging, tumor laterality, size of the tumor, and involvement of nipple and areola.

ONEST (Observers Needed to Evaluate Subjective Tests) Analysis of Stromal Tumour-Infiltrating Lymphocytes (sTILs) in Breast Cancer and Its Limitations

Tumour-infiltrating lymphocytes (TILs) reflect antitumour immunity. Their evaluation of histopathology specimens is influenced by several factors and is subject to issues of reproducibility. ONEST (Observers Needed to Evaluate Subjective Tests) helps in determining the number of observers that would be sufficient for the reliable estimation of inter-observer agreement of TIL categorisation. This has not been explored previously in relation to TILs. ONEST analyses, using an open-source software developed by the first author, were performed on TIL quantification in breast cancers taken from two previous studies. These were one reproducibility study involving 49 breast cancers, 23 in the first circulation and 14 pathologists in the second circulation, and one study involving 100 cases and 9 pathologists. In addition to the estimates of the number of observers required, other factors influencing the results of ONEST were examined. The analyses reveal that between six and nine observers (range 2-11) are most commonly needed to give a robust estimate of reproducibility. In addition, the number and experience of observers, the distribution of values around or away from the extremes, and outliers in the classification also influence the results. Due to the simplicity and the potentially relevant information it may give, we propose ONEST to be a part of new reproducibility analyses.

Comparison of tumor microenvironment in primary and paired metastatic ER+/HER2- breast cancers: results of a pilot study

Background

Tumor microenvironment (TME) is a dynamic setting and changes in TILs and their subpopulations are potential candidates to influence the metastatic process. Aim of this pilot study is to describe the changes occurring between primary breast cancers and their paired metastases in terms of TILs composition. To assess if these changes influence the process of metastasis development, we used a control group of patients.

Methods

We retrospectively identified 18 Luminal patients, for whom primary and metastatic tissue were available (cases) and 18 paired-matched patients (controls), not relapsed after at least 9 years of follow-up, and we quantified TILs and their composition (i.e. T CD8+ and CD4+/FOXP3+). The presence of TILs was defined as ≥10%.

Results

Our results showed that the microenvironment composition of relapsed patients was poor of TILs (median = 5%, I-III quartiles = 0.6–5%), CD8+ (2.5%, 0–5%) and CD4+/FOXP3 + (0%, 0–0.6%) in the primary tumor. Comparable results were observed in their related metastases (TILs 3.8%, 0.6–5%; CD8+ 0%, 0–1.3%; CD4+/FOXP3+ 0%,0–1.9%). On the contrary, the microenvironment in the control group was richer of TILs (5%, 5–17.5%) in comparison to cases, both in primary tumor (p = 0.035) and related metastases (p = 0.018). Although CD8+ in controls were similar to cases at primary tumor (p = 0.6498), but not at metastasis (p = 0.0223), they expressed only one part on the TILs subpopulations (p = 0.0060), while TILs in the cases at primary tumor were almost completely CD8+ (p = 0.5034).

Conclusions

These findings suggest that the lack of activation of immune system in the primary tumor might influence the multifactor process of cancer progression.

A novel Adiponectin receptor (AdipoR) involved in regulating cytokines production and apoptosis of haemocytes in oyster Crassostrea gigas

Adiponectin receptors (AdipoRs) comprise a seven-transmembrane domain-containing protein family, which specifically recognize adiponectin (APN) and play critical roles in the immunological and physiological processes in vertebrates. In the present study, a novel AdipoR is identified from oyster Crassostrea gigas (designated as CgAdipoR). The full-length cDNA of CgAdipoR is of 1209 bp encoding a polypeptide of 343 amino acids. There is an N-terminal domain, a Hly III domain, and a C-terminal domain in CgAdipoR. After the transfection of CgAdipoR, the level of intracellular Ca²⁺ into HEK293T cells increases significantly (1.36-fold, p < 0.05) after APN incubation. The mRNA transcripts of CgAdipoR are widely distributed in all the tested tissues, with the highest expression level in haemocytes (3.20-fold of that in hepatopancreas, p < 0.05). After lipopolysaccharide (LPS), Vibrio splendidus and polyinosinic-polycytidylic acid (poly (I:C)) stimulations, the mRNA expression of CgAdipoR in haemocytes is significantly up-regulated and reached the highest level at 24 h (15.07-fold, p < 0.01), 6 h (4.39-fold, p < 0.01) and 24 h (5.62-fold, p < 0.01) compared to control group, respectively. After CgAdipoR is interfered by specific CgAdipoR-dsRNA, the expression level of interleukins (CgIL17-1, CgIL17-2, CgIL17-3 and CgIL17-5) in haemocytes decreases significantly (p < 0.01) at 24 h post LPS stimulation, while the expression level of CgTNF-1 increases significantly (1.68-fold, p < 0.01), compared to that in the dsEGFP group. In CgAdipoR dsRNA-injected oysters, the mRNA expressions of anti-apoptotic B-cell lymphoma-2 (Bcl-2) in haemocytes significantly decreases at 24 h after LPS challenge, which is (0.58-fold, p < 0.05) of that in dsEGFP-injected oysters, while the apoptotic rate of haemocytes is significantly up-regulated (1.93-fold of that in dsEGFP group, p < 0.05). These results collectively suggest that CgAdipoR plays an important role in the immune response of oysters by regulating the expressions of inflammatory cytokines and haemocyte apoptosis.

[Standardized determination of tumor-infiltrating lymphocytes in breast cancer : A prognostic marker for histological diagnosis]

BACKGROUND

Tumor-infiltrating lymphocytes (TILs) have been identified as prognostic parameter in breast cancer.

OBJECTIVES

The aim of this review article is to provide an overview on the clinical and analytical validation of TILs in breast cancer.

MATERIALS AND METHODS

Summary of international guidelines of the TIL working group as well as clinical and translational studies.

RESULTS, CONCLUSIONS

Breast carcinomas with a high TIL level have an improved response to neoadjuvant chemotherapy. Triple-negative and HER2-positive carcinomas with increased TIL levels have improved survival. TILs are a new prognostic biomarker for routine histopathological diagnosis.

Correlation between apparent diffusion coefficient of magnetic resonance imaging and tumor-infiltrating lymphocytes in breast cancer

PURPOSE

To evaluate a possible correlation between apparent diffusion coefficient (ADC) value and tumor-infiltrating lymphocytes (TILs) level in breast cancer (BC). A second objective was to assess whether there were other histopathologic features that could affect mean ADC value.

METHODS

In this 4-year retrospective study were included 125 patients who underwent radical or modified mastectomy for monofocal BC. All subjects had performed preoperative MRI with the same 1.5-T machine and protocol, which consisted of STIR, DWI and DCE sequences. Based on TIL score, BCs were stratified into two groups: absent-low TIL (≤ 10%) and medium-high TIL (> 10%). The t test was used to correlate mean ADC value with TIL groups. Receiver operating characteristic curve and Youden index were used in order to identify ADC value threshold to distinguish the two TIL groups.

RESULTS

BC patients with absent-low TIL level and medium-high TIL one were, respectively, 66 (52.8%) and 59 (47.2%). Mean ADC value was 1.05 ± 0.19 * 10-3 mm2 s-1. Absent-low TIL group showed a lower mean ADC value than medium-high TIL one (0.96 ± 0.18 * 10-3 mm2 s-1 vs 1.14 ± 0.16 * 10-3 mm2 s-1; p < 0.0001). ADC value threshold in order to distinguish the two TIL groups with maximum sensitivity (67.8%) and specificity (80.3%) was 1.03 * 10-3 mm2 s-1. ADC value was shown to be significantly related to TILs level (p < 0.0001) and cancer histotype (p = 0.0006), with a lower mean ADC value correlated to absent-low TIL level and ductal histotype.

CONCLUSION

BCs with absent-low TIL showed a statistically significant lower mean ADC value than those with medium-high TIL. ADC value threshold in order to distinguish these two groups was 1.03 * 10-3 mm2 s-1.