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Noske A, Ammann JU, Wagner DC, Denkert C, Lebeau A, Sinn P, Kreipe HH, Sommer U, Baretton G, Steiger K, Kiechle M, Hieke-Schulz S, Flores M, Roth W, Weichert W. A multicentre analytical comparison study of inter-reader and inter-assay agreement of four programmed death-ligand 1 immunohistochemistry assays for scoring in triple-negative breast cancer. Histopathology 2020; 78:567-577. [PMID: 32936950 DOI: 10.1111/his.14254] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022]
Abstract
AIMS Studies in various cancer types have demonstrated discordance between results from different programmed death-ligand 1 (PD-L1) assays. Here, we compare the reproducibility and analytical concordance of four clinically developed assays for assessing PD-L1-positivity in tumour-infiltrating immune cells in the tumour area (PD-L1-IC-positivity) in triple-negative breast cancer (TNBC). METHODS AND RESULTS Primary TNBC resection specimens (n = 30) were selected based on their PD-L1-IC-positivity per VENTANA SP142 (<1%: 15 cases; 1-5%: seven cases; >5%: eight cases). Serial histological sections were stained for PD-L1 using VENTANA SP142, VENTANA SP263, DAKO 22C3 and DAKO 28-8. PD-L1-IC-positivity and tumour cell expression (≥1 versus <1%) were scored by trained readers from seven sites using online virtual microscopy. The adjusted mean of PD-L1-IC-positivity for SP263 (7.8%) was significantly higher than those for the other three assays (3.7-4.9%). Differences in adjusted means were statistically significant between SP263 and the other three assays (P < 0.0001) but not between the three remaining assays when excluding SP263 (P = 0.0961-0.6522). Intra-class correlation coefficients revealed moderate-to-strong inter-reader agreement for each assay (0.460-0.805) and poor-to-strong inter-assay agreement for each reader (0.298-0.678) on PD-L1-IC-positivity. CONCLUSIONS In this first multicentre study of different PD-L1 assays in TNBC, we show that PD-L1-IC-positivity for SP142, 22C3 and 28-8 was reproducible and analytically concordant, indicating that these three assays may be analytically interchangeable. The relevance of the higher PD-L1-IC-positivity for SP263 should be further investigated.
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Affiliation(s)
- Aurelia Noske
- Technical University of Munich, Institute of Pathology, Munich, Germany
| | | | - Daniel-Christoph Wagner
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Carsten Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital of Giessen and Marburg, Marburg, Germany
| | - Annette Lebeau
- Private Group Practice for Pathology Lübeck, Lübeck, Germany.,Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Sinn
- Division of Gynecopathology, University Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Ulrich Sommer
- Institute of Pathology, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Gustavo Baretton
- Institute of Pathology, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Katja Steiger
- Technical University of Munich, Institute of Pathology, Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Mike Flores
- Ventana Medical Systems, Inc., Tucson, AZ, USA
| | - Wilfried Roth
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Wilko Weichert
- Technical University of Munich, Institute of Pathology, Munich, Germany
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Schwamborn K, Ammann JU, Knüchel R, Hartmann A, Baretton G, Lasitschka F, Schirmacher P, Braunschweig T, Tauber R, Erlmeier F, Hieke-Schulz S, Weichert W. Multicentric analytical comparability study of programmed death-ligand 1 expression on tumor-infiltrating immune cells and tumor cells in urothelial bladder cancer using four clinically developed immunohistochemistry assays. Virchows Arch 2019; 475:599-608. [PMID: 31267201 PMCID: PMC6861354 DOI: 10.1007/s00428-019-02610-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023]
Abstract
Programmed death-ligand 1 (PD-L1) expression on tumor cells (TC) or tumor-infiltrating immune cells (IC) correlated in several studies with PD-L1/programmed death-1 (PD-1) checkpoint inhibitor efficacy. Since June 2018, a positive PD-L1 status is required for atezolizumab or pembrolizumab treatment of patients with advanced or metastasized urothelial bladder cancer, who are ineligible for cisplatin-containing therapy. We examined technical comparability and inter-reader agreement of four clinically developed PD-L1 assays in locally advanced disease. Archived, formalin-fixed, paraffin-embedded sections from 30 patients (73.3% cystectomies, 26.7% transurethral resections) were stained by PD-L1 immunohistochemistry using VENTANA SP142, VENTANA SP263, DAKO 22C3, and DAKO 28-8 at two sites per manufacturers’ protocols and scored blinded at five sites for PD-L1 expression on IC (% per tumor area) and TC (%). Small, non-significant inter-assay differences were observed for IC. For TC, SP142 showed significantly lower staining percentages. Pairwise comparisons revealed − 0.3 to 1.6% differences in adjusted means between assays for IC, and for TC, − 10.5 to − 7.8% (SP142 versus others) and − 1.9 to 2.7% (other comparisons). Inter-reader and inter-assay agreement was moderate to high for both IC and TC. Allocation to binary cutoffs (1%, 5%, 10%) showed substantial to high Kappa agreement scores (0.440–0.923) for IC and TC between assays for each reader. This first multicenter study, with five independent readers blinded with respect to the assay used, suggests that all four currently clinically relevant assays are analytically similar for evaluation of PD-L1-stained IC and three (SP263, 22C3, and 28-8) for PD-L1-stained TC. Inter-observer agreement for trained readers in scoring of both IC and TC positivity was generally high.
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Affiliation(s)
- Kristina Schwamborn
- Institute of Pathology, Technische Universität München, Trogerstr. 18, 81675, Munich, Germany.
| | | | - Ruth Knüchel
- Institute of Pathology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Gustavo Baretton
- Institute of Pathology, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Felix Lasitschka
- Institute of Pathology, Universitätsklinikum Heidelberg, Heidelberg, Germany
- Institut für Pathologie, Dres. med., Kaufmann und Wilke, Industriestr 11c, 67063, Ludwigshafen, Germany
| | - Peter Schirmacher
- Institute of Pathology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Robert Tauber
- Department of Urology, Technische Universität München, Munich, Germany
| | - Franziska Erlmeier
- Institute of Pathology, Technische Universität München, Trogerstr. 18, 81675, Munich, Germany
| | | | - Wilko Weichert
- Institute of Pathology, Technische Universität München and Member of the German Cancer Consortium (DKTK), Partner site München, Munich, Germany
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Rüschoff J, Lebeau A, Kreipe H, Gerharz CD, Sinn P, Schildhaus HU, Tennstedt-Schenk C, Ammann JU, Künzel C, Koch W, Untch M. Abstract P6-03-01: Variables influencing HER2-positivity in breast cancer: Assessment and validation of a statistical model based on two multicenter noninterventional studies in Germany. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-03-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
HER2 testing in breast cancer (BC), routine for >10 years, allows selection of patients (pts) for HER2-targeted therapy; however, testing quality remains a concern. While guidelines recommend assessment of HER2-positivity rates as a quality indicator, the influence of patient- or tumor-related factors on variability was unknown until we identified the effect (in order of influence) of histologic grade, hormone receptor (HR) status, histologic subtype, age, and nodal status in a large, multicenter, observational study in Germany (NIU HER2 study; Rüschoff et al., Mod Pathol 2017). Based on these variables and the statistical model developed, potential issues with HER2 testing quality in local practice may be identified. We now report interim analyses from a multicenter study in Germany (EPI HER2 BC study; NCT02666261), where data from the NIU and EPI studies were compared and the validity of the NIU study model assessed.
Methods:
Routine HER2 test results and patient- and tumor-related data were collected from eligible pts with BC. Factors influencing HER2-positivity rates in the EPI study were compared with those identified in the NIU study. The predictive power of the NIU study model, fitted to EPI data, was determined and assessments performed using the variable coefficients and cutoff resulting from the NIU study analysis. Attempts were also made to improve the model.
Results:
Analyses included 15281 (NIU) and 6019 (EPI) invasive BC samples. The distribution of relevant variables, including HER2-positivity rate (NIU: 14.4%; EPI: 13.5%), was comparable. When the NIU study model was fitted to EPI study data, all five covariates identified in the NIU analyses had a significant effect on HER2-positivity (p<0.001); the order of influence for covariates differed between studies (EPI [in order of influence]: histologic grading, histologic subtype, HR status, nodal status, and age). The relationship between HER2-positivity rate and the combined influence of covariates, visualized with the NIU study prediction profiler, was reproduced with EPI study data. The NIU study statistical model, with variable coefficients and cut-point determined in the NIU study, was used to predict the HER2-positivity of samples in EPI; if their NIU model-estimated probability of positivity was >0.1407, the resulting sensitivity, specificity, and receiver operating characteristic (ROC) area under the curve (AUC) were 0.7032, 0.6622, and 0.7259, respectively. Thus, initial validation of the NIU study model with EPI data was successful. Semiquantitative estrogen and progesterone receptor expression data were available from EPI only; their inclusion as independent continuous, rather than categorical, variables improved the model (ROC AUC = 0.7533).
Conclusions:
The statistical modeling approach used to analyze data from the NIU study showed that patient- or tumor-related characteristics should be considered when assessing HER2 testing quality. Our present analysis validates and improves upon this statistical model and further highlights the need to assess HER2 testing quality in BC. Comparison of calculated vs actual positivity rates may help identify centers with potential HER2 testing quality issues.
Citation Format: Rüschoff J, Lebeau A, Kreipe H, Gerharz CD, Sinn P, Schildhaus H-U, Tennstedt-Schenk C, Ammann JU, Künzel C, Koch W, Untch M. Variables influencing HER2-positivity in breast cancer: Assessment and validation of a statistical model based on two multicenter noninterventional studies in Germany [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-03-01.
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Affiliation(s)
- J Rüschoff
- Institut für Pathologie Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany; Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Gemeinschaftspraxis für Pathologie, Lübeck, Germany; Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Pathology, Bethesda Hospital, Duisburg, Germany; Sektion Gynäkopathologie, Pathologisches Institut der Universität, Heidelberg, Germany; Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany; Institut für Pathologie, Mühlhausen, Germany; Roche Pharma AG, Grenzach-Wyhlen, Germany; BDS Koch, Schwetzingen, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - A Lebeau
- Institut für Pathologie Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany; Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Gemeinschaftspraxis für Pathologie, Lübeck, Germany; Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Pathology, Bethesda Hospital, Duisburg, Germany; Sektion Gynäkopathologie, Pathologisches Institut der Universität, Heidelberg, Germany; Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany; Institut für Pathologie, Mühlhausen, Germany; Roche Pharma AG, Grenzach-Wyhlen, Germany; BDS Koch, Schwetzingen, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - H Kreipe
- Institut für Pathologie Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany; Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Gemeinschaftspraxis für Pathologie, Lübeck, Germany; Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Pathology, Bethesda Hospital, Duisburg, Germany; Sektion Gynäkopathologie, Pathologisches Institut der Universität, Heidelberg, Germany; Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany; Institut für Pathologie, Mühlhausen, Germany; Roche Pharma AG, Grenzach-Wyhlen, Germany; BDS Koch, Schwetzingen, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - CD Gerharz
- Institut für Pathologie Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany; Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Gemeinschaftspraxis für Pathologie, Lübeck, Germany; Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Pathology, Bethesda Hospital, Duisburg, Germany; Sektion Gynäkopathologie, Pathologisches Institut der Universität, Heidelberg, Germany; Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany; Institut für Pathologie, Mühlhausen, Germany; Roche Pharma AG, Grenzach-Wyhlen, Germany; BDS Koch, Schwetzingen, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - P Sinn
- Institut für Pathologie Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany; Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Gemeinschaftspraxis für Pathologie, Lübeck, Germany; Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Pathology, Bethesda Hospital, Duisburg, Germany; Sektion Gynäkopathologie, Pathologisches Institut der Universität, Heidelberg, Germany; Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany; Institut für Pathologie, Mühlhausen, Germany; Roche Pharma AG, Grenzach-Wyhlen, Germany; BDS Koch, Schwetzingen, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - H-U Schildhaus
- Institut für Pathologie Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany; Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Gemeinschaftspraxis für Pathologie, Lübeck, Germany; Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Pathology, Bethesda Hospital, Duisburg, Germany; Sektion Gynäkopathologie, Pathologisches Institut der Universität, Heidelberg, Germany; Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany; Institut für Pathologie, Mühlhausen, Germany; Roche Pharma AG, Grenzach-Wyhlen, Germany; BDS Koch, Schwetzingen, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - C Tennstedt-Schenk
- Institut für Pathologie Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany; Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Gemeinschaftspraxis für Pathologie, Lübeck, Germany; Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Pathology, Bethesda Hospital, Duisburg, Germany; Sektion Gynäkopathologie, Pathologisches Institut der Universität, Heidelberg, Germany; Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany; Institut für Pathologie, Mühlhausen, Germany; Roche Pharma AG, Grenzach-Wyhlen, Germany; BDS Koch, Schwetzingen, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - JU Ammann
- Institut für Pathologie Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany; Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Gemeinschaftspraxis für Pathologie, Lübeck, Germany; Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Pathology, Bethesda Hospital, Duisburg, Germany; Sektion Gynäkopathologie, Pathologisches Institut der Universität, Heidelberg, Germany; Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany; Institut für Pathologie, Mühlhausen, Germany; Roche Pharma AG, Grenzach-Wyhlen, Germany; BDS Koch, Schwetzingen, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - C Künzel
- Institut für Pathologie Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany; Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Gemeinschaftspraxis für Pathologie, Lübeck, Germany; Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Pathology, Bethesda Hospital, Duisburg, Germany; Sektion Gynäkopathologie, Pathologisches Institut der Universität, Heidelberg, Germany; Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany; Institut für Pathologie, Mühlhausen, Germany; Roche Pharma AG, Grenzach-Wyhlen, Germany; BDS Koch, Schwetzingen, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - W Koch
- Institut für Pathologie Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany; Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Gemeinschaftspraxis für Pathologie, Lübeck, Germany; Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Pathology, Bethesda Hospital, Duisburg, Germany; Sektion Gynäkopathologie, Pathologisches Institut der Universität, Heidelberg, Germany; Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany; Institut für Pathologie, Mühlhausen, Germany; Roche Pharma AG, Grenzach-Wyhlen, Germany; BDS Koch, Schwetzingen, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - M Untch
- Institut für Pathologie Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany; Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Gemeinschaftspraxis für Pathologie, Lübeck, Germany; Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Pathology, Bethesda Hospital, Duisburg, Germany; Sektion Gynäkopathologie, Pathologisches Institut der Universität, Heidelberg, Germany; Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany; Institut für Pathologie, Mühlhausen, Germany; Roche Pharma AG, Grenzach-Wyhlen, Germany; BDS Koch, Schwetzingen, Germany; HELIOS Klinikum Berlin-Buch, Berlin, Germany
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