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Hempenius MA, Koomen BM, Deckers IAG, Oosting SF, Willems SM, van der Vegt B. Considerable interlaboratory variation in PD-L1 positivity for head and neck squamous cell carcinoma in the Netherlands- A nationwide evaluation study. Histopathology 2024; 85:133-142. [PMID: 38606992 DOI: 10.1111/his.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/13/2024]
Abstract
AIMS Patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) are eligible for first-line immune checkpoint inhibition if their tumour is positive for programmed death ligand 1 (PD-L1) determined by the combined positive score (CPS). This nationwide study, using real-world data, investigated the developing PD-L1 testing landscape in the first 3 years after introduction of the test in HNSCC and examined interlaboratory variation in PD-L1 positivity rates. METHODS Pathology reports of HNSCC patients mentioning PD-L1 were extracted from the Dutch Pathology Registry (Palga). Tumour and PD-L1 testing characteristics were analysed per year and interlaboratory variation in PD-L1 positivity rates was assessed using funnel plots with 95% confidence limits around the overall mean. RESULTS A total of 817 PD-L1 tests were reported in 702 patients among 19 laboratories; 85.2% of the tests on histological material were stated to be positive. The national PD-L1 positivity rate differed significantly per year during the study period (79.7-89.9%). The use of the recommended 22C3 antibody increased from 59.9 to 74.3%. A total of 673 PD-L1 tests on histological material from 12 laboratories were analysed to investigate interlaboratory variation. Four (33%) deviated significantly from the national mean of PD-L1-positive cases using CPS ≥ 1 cut-off, while two (17%) deviated significantly for CPS ≥ 20 cut-off. CONCLUSION In the first 3 years of PD-L1 assessment in HNSCC, the testing landscape became more uniform. However, interlaboratory variation in PD-L1 positivity rates between Dutch laboratories was substantial. This implies that there is a need for further test standardisation to reduce this variation.
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Affiliation(s)
- Maaike Anna Hempenius
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bregje M Koomen
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Sjoukje F Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan M Willems
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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2
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Aung TN, Bates KM, Rimm DL. High-Plex Assessment of Biomarkers in Tumors. Mod Pathol 2024; 37:100425. [PMID: 38219953 DOI: 10.1016/j.modpat.2024.100425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
The assessment of biomarkers plays a critical role in the diagnosis and treatment of many cancers. Biomarkers not only provide diagnostic, prognostic, or predictive information but also can act as effective targets for new pharmaceutical therapies. As the utility of biomarkers increases, it becomes more important to utilize accurate and efficient methods for biomarker discovery and, ultimately, clinical assessment. High-plex imaging studies, defined here as assessment of 8 or more biomarkers on a single slide, have become the method of choice for biomarker discovery and assessment of biomarker spatial context. In this review, we discuss methods of measuring biomarkers in slide-mounted tissue samples, detail the various high-plex methods that allow for the simultaneous assessment of multiple biomarkers in situ, and describe the impact of high-plex biomarker assessment on the future of anatomic pathology.
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Affiliation(s)
- Thazin N Aung
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Katherine M Bates
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut; Department of Internal Medicine (Medical Oncology), Yale University School of Medicine, New Haven, Connecticut.
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3
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Dunn C, Brettle D, Cockroft M, Keating E, Revie C, Treanor D. Quantitative assessment of H&E staining for pathology: development and clinical evaluation of a novel system. Diagn Pathol 2024; 19:42. [PMID: 38395890 PMCID: PMC10885446 DOI: 10.1186/s13000-024-01461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Staining tissue samples to visualise cellular detail and tissue structure is at the core of pathology diagnosis, but variations in staining can result in significantly different appearances of the tissue sample. While the human visual system is adept at compensating for stain variation, with the growth of digital imaging in pathology, the impact of this variation can be more profound. Despite the ubiquity of haematoxylin and eosin staining in clinical practice worldwide, objective quantification is not yet available. We propose a method for quantitative haematoxylin and eosin stain assessment to facilitate quality assurance of histopathology staining, enabling truly quantitative quality control and improved standardisation. METHODS The stain quantification method comprises conventional microscope slides with a stain-responsive biopolymer film affixed to one side, called stain assessment slides. The stain assessment slides were characterised with haematoxylin and eosin, and implemented in one clinical laboratory to quantify variation levels. RESULTS Stain assessment slide stain uptake increased linearly with duration of haematoxylin and eosin staining (r = 0.99), and demonstrated linearly comparable staining to samples of human liver tissue (r values 0.98-0.99). Laboratory implementation of this technique quantified intra- and inter-instrument variation of staining instruments at one point in time and across a five-day period. CONCLUSION The proposed method has been shown to reliably quantify stain uptake, providing an effective laboratory quality control method for stain variation. This is especially important for whole slide imaging and the future development of artificial intelligence in digital pathology.
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Affiliation(s)
- Catriona Dunn
- National Pathology Imaging Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
- Department of Pathology and Data Analytics, University of Leeds, Leeds, UK.
| | - David Brettle
- National Pathology Imaging Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Martin Cockroft
- New Technology Group, Futamura Chemical UK Limited, Wigton, UK
| | | | | | - Darren Treanor
- National Pathology Imaging Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Pathology and Data Analytics, University of Leeds, Leeds, UK
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Clinical Pathology and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualisation, Linköping University, Linköping, Sweden
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4
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Dabbs DJ, Chiriboga LA, Jasani B, Kinloch MA, Miller KD, Nielsen S, Szabolcs MJ, Torlakovic E, Bogen S, Parry S, 't Hart NA. In Support of Magnani and Taylor. Arch Pathol Lab Med 2024; 148:11. [PMID: 38157868 DOI: 10.5858/arpa.2023-0446-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 01/03/2024]
Affiliation(s)
- David J Dabbs
- Department of Pathology, PreludeDx, Laguna Hills, California
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Luis A Chiriboga
- Department of Pathology & Center for Biospecimen Research and Development, NYU Grossman School of Medicine, New York, New York
| | - Bharat Jasani
- Institute of Cancer & Genetics and Department of Cancer Pathology, Cardiff University, Cardiff, Wales, United Kingdom
| | - Mary A Kinloch
- Department of Pathology and Laboratory Medicine, University of Saskatchewan & Saskatoon Health Authority, Saskatoon, Saskatchewan, Canada
| | - Keith D Miller
- Department of Pathology, Institute of Biomedical Science, The Cancer Institute, University College, London Research, London, United Kingdom
| | - Søren Nielsen
- NordiQC, Aalborg, Denmark
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Matthias J Szabolcs
- Department of Pathology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Emina Torlakovic
- Department of Pathology, University of Saskatchewan & Saskatoon Health Authority, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Steve Bogen
- Department of Pathology, Boston Cell Standards & Tufts Medical Center, Boston, Massachusetts
| | - Suzanne Parry
- Department of Immunocytochemistry and In-Situ Hybridisation, UK NEQAS-ICC/ISH, London, United Kingdom
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Phipps WS, Kilgore MR, Kennedy JJ, Whiteaker JR, Hoofnagle AN, Paulovich AG. Clinical Proteomics for Solid Organ Tissues. Mol Cell Proteomics 2023; 22:100648. [PMID: 37730181 PMCID: PMC10692389 DOI: 10.1016/j.mcpro.2023.100648] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023] Open
Abstract
The evaluation of biopsied solid organ tissue has long relied on visual examination using a microscope. Immunohistochemistry is critical in this process, labeling and detecting cell lineage markers and therapeutic targets. However, while the practice of immunohistochemistry has reshaped diagnostic pathology and facilitated improvements in cancer treatment, it has also been subject to pervasive challenges with respect to standardization and reproducibility. Efforts are ongoing to improve immunohistochemistry, but for some applications, the benefit of such initiatives could be impeded by its reliance on monospecific antibody-protein reagents and limited multiplexing capacity. This perspective surveys the relevant challenges facing traditional immunohistochemistry and describes how mass spectrometry, particularly liquid chromatography-tandem mass spectrometry, could help alleviate problems. In particular, targeted mass spectrometry assays could facilitate measurements of individual proteins or analyte panels, using internal standards for more robust quantification and improved interlaboratory reproducibility. Meanwhile, untargeted mass spectrometry, showcased to date clinically in the form of amyloid typing, is inherently multiplexed, facilitating the detection and crude quantification of 100s to 1000s of proteins in a single analysis. Further, data-independent acquisition has yet to be applied in clinical practice, but offers particular strengths that could appeal to clinical users. Finally, we discuss the guidance that is needed to facilitate broader utilization in clinical environments and achieve standardization.
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Affiliation(s)
- William S Phipps
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mark R Kilgore
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jacob J Kennedy
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jeffrey R Whiteaker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA; Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Amanda G Paulovich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
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Caramelo A, Polónia A, Vale J, Curado M, Campelos S, Nascimento V, Barros M, Ferreira D, Pereira T, Neves B, Eloy C. Demonstrating the interference of tissue processing in the evaluation of tissue biomarkers: The case of PD-L1. Pathol Res Pract 2023; 248:154605. [PMID: 37320863 DOI: 10.1016/j.prp.2023.154605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
The immunohistochemical (IHC) expression of PD-L1 in cancer models is used as a predictive biomarker of response to immunotherapy. We aimed to evaluate the impact of the usage of 3 different tissue processors in the IHC expression of PD-L1 antibody clones: 22C3 and SP142. Three different topographies of samples (n = 73) were selected at the macroscopy room: 39 uterine leiomyomas, 17 placentas and 17 palatine tonsils. Three fragments were collected from each sample and were inked with a specific color that represented their separate processing in a different tissue processor (A, B or C). During embedding, the 3 fragments with distinct processing were ensemble in the same cassette for sectioning of 3 slides/each: hematoxylin-eosin, 22C3 PDL1 IHC staining and SP142 PD-L1 IHC staining, that were blindly observed by 2 pathologists under digital environment. All but one set of 3 fragments were considered adequate for observation even in the presence of artifacts associated with processing issues that were recorded as high as 50.7 % for processor C. The occurrence of background non-specific staining and the presence of false positive results appear to be unrelated with the PD-L1 clone or the type of tissue processing. 22C3 PD-L1 was more frequently considered adequate for evaluation than SP142 PD-L1 that, in 29.2 % of WSIs (after tissue processor C) were considered not adequate for observation due to lack of the typical pattern of expression. Similarly, the intensity of PD-L1 staining was significantly decreased in fragments processed by C (both PD-L1 clones) in tonsil and placenta specimens, and by A (both clones) in comparison with those processed by B. This study demonstrates the need to standardize the tissue processing in pathology to cope with the growing needs of precision medicine quantifications and the production of high-quality material necessary for computational pathology usage.
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Affiliation(s)
- Ana Caramelo
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (Ipatimup), Porto, Portugal
| | - António Polónia
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (Ipatimup), Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal
| | - João Vale
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (Ipatimup), Porto, Portugal
| | - Mónica Curado
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (Ipatimup), Porto, Portugal
| | - Sofia Campelos
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (Ipatimup), Porto, Portugal
| | - Vanessa Nascimento
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (Ipatimup), Porto, Portugal
| | - Mariana Barros
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (Ipatimup), Porto, Portugal
| | - Diana Ferreira
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (Ipatimup), Porto, Portugal
| | - Tânia Pereira
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (Ipatimup), Porto, Portugal
| | - Beatriz Neves
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (Ipatimup), Porto, Portugal
| | - Catarina Eloy
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (Ipatimup), Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal; Faculty of Medicine of University of Porto (FMUP), Porto, Portugal.
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7
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Sompuram SR, Torlakovic EE, 't Hart NA, Vani K, Bogen SA. In Reply: Programmed Death-Ligand 1 (PD-L1) Immunohistochemistry Calibration. Mod Pathol 2023; 36:100057. [PMID: 36853795 DOI: 10.1016/j.modpat.2022.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023]
Affiliation(s)
| | - Emina E Torlakovic
- Department of Pathology & Laboratory Medicine, University of Saskatchewan and Saskatoon Health Authority, Saskatoon, Saskatchewan, Canada; Canadian Biomarker Quality Assurance, Saskatoon, Saskatchewan, Canada
| | - Nils A 't Hart
- Department of Pathology, Isala Hospital, Zwolle, the Netherlands
| | - Kodela Vani
- Boston Cell Standards Inc, Boston, Massachusetts
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8
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Dabbs DJ, Huang RS, Ross JS. Novel markers in breast pathology. Histopathology 2023; 82:119-139. [PMID: 36468266 DOI: 10.1111/his.14770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 12/12/2022]
Abstract
Breast pathology is an ever-expanding database of information which includes markers, or biomarkers, that detect or help treat the disease as prognostic or predictive information. This review focuses on these aspects of biomarkers which are grounded in immunohistochemistry, liquid biopsies and next-generation sequencing.
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Affiliation(s)
- David J Dabbs
- PreludeDx, Laguna Hills, CA, USA.,Department of Pathology, University of Pittsburgh, Board Member, CASI (Consortium for Analytical Standardization in Immunohistochemistry), Pittsburgh, PA, USA
| | - Richard S Huang
- Clinical Development, Foundation Medicine, Cambridge, MA, USA
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9
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Calhoun BC, Dabbs DJ. Lack of Standardization in the Diagnosis of Invasive Lobular Carcinoma of the Breast. Mod Pathol 2023; 36:100041. [PMID: 36788075 DOI: 10.1016/j.modpat.2022.100041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/09/2022] [Accepted: 10/09/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Benjamin C Calhoun
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - David J Dabbs
- Pathology and Second Opinion Service, PreludeDX, Laguna Hills, California
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