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Cheung CC, Smith AC, Albadine R, Bigras G, Bojarski A, Couture C, Cutz JC, Huang WY, Ionescu D, Itani D, Izevbaye I, Karsan A, Kelly MM, Knoll J, Kwan K, Nasr MR, Qing G, Rashid-Kolvear F, Sekhon HS, Spatz A, Stockley T, Tran-Thanh D, Tucker T, Waghray R, Wang H, Xu Z, Yatabe Y, Torlakovic EE, Tsao MS. Canadian ROS proto-oncogene 1 study (CROS) for multi-institutional implementation of ROS1 testing in non-small cell lung cancer. Lung Cancer 2021; 160:127-135. [PMID: 34509095 DOI: 10.1016/j.lungcan.2021.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 04/23/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
Patients with non-small cell lung cancer (NSCLC) harboring ROS proto-oncogene 1 (ROS1) gene rearrangements show dramatic response to the tyrosine kinase inhibitor (TKI) crizotinib. Current best practice guidelines recommend that all advanced stage non-squamous NSCLC patients be also tested for ROS1 gene rearrangements. Several studies have suggested that ROS1 immunohistochemistry (IHC) using the D4D6 antibody may be used to screen for ROS1 fusion positive lung cancers, with assays showing high sensitivity but moderate to high specificity. A break apart fluorescence in situ hybridization (FISH) test is then used to confirm the presence of ROS1 gene rearrangement. The goal of Canadian ROS1 (CROS) study was to harmonize ROS1 laboratory developed testing (LDT) by using IHC and FISH assays to detect ROS1 rearranged lung cancers across Canadian pathology laboratories. Cell lines expressing different levels of ROS1 (high, low, none) were used to calibrate IHC protocols after which participating laboratories ran the calibrated protocols on a reference set of 24 NSCLC cases (9 ROS1 rearranged tumors and 15 ROS1 non-rearranged tumors as determined by FISH). Results were compared using a centralized readout. The stained slides were evaluated for the cellular localization of staining, intensity of staining, the presence of staining in non-tumor cells, the presence of non-specific staining (e.g. necrosis, extracellular mater, other) and the percent positive cells. H-score was also determined for each tumor. Analytical sensitivity and specificity harmonization was achieved by using low limit of detection (LOD) as either any positivity in the U118 cell line or H-score of 200 with the HCC78 cell line. An overall diagnostic sensitivity and specificity of up to 100% and 99% respectively was achieved for ROS1 IHC testing (relative to FISH) using an adjusted H-score readout on the reference cases. This study confirms that LDT ROS1 IHC assays can be highly sensitive and specific for detection of ROS1 rearrangements in NSCLC. As NSCLC can demonstrate ROS1 IHC positivity in FISH-negative cases, the degree of the specificity of the IHC assay, especially in highly sensitive protocols, is mostly dependent on the readout cut-off threshold. As ROS1 IHC is a screening assay for a rare rearrangements in NSCLC, we recommend adjustment of the readout threshold in order to balance specificity, rather than decreasing the overall analytical and diagnostic sensitivity of the protocols.
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Affiliation(s)
- Carol C Cheung
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Adam C Smith
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Roula Albadine
- Department of Pathology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gilbert Bigras
- Laboratory Medicine Department, University of Alberta, Edmonton, AB, Canada
| | - Anna Bojarski
- Department of Pathology and Laboratory Medicine, Health Sciences North, Sudbury, ON, Canada
| | - Christian Couture
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, QC, Canada
| | - Jean-Claude Cutz
- Department of Pathology and Molecular Medicine, McMaster University Health Sciences Centre and McMaster University, Hamilton, ON, Canada
| | - Weei-Yuan Huang
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Science Center, ON, Canada
| | - Diana Ionescu
- Department of Pathology and Laboratory Medicine, BC Cancer, Vancouver, BC, Canada
| | - Doha Itani
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Pathology, Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Iyare Izevbaye
- Laboratory Medicine Department, University of Alberta, Edmonton, AB, Canada
| | - Aly Karsan
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Margaret M Kelly
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joan Knoll
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Keith Kwan
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michel R Nasr
- Department of Pathology, Shared Health Manitoba, University of Manitoba, Winnipeg, MB, Canada; Department of Pathology SUNY Upstate Medical University, Syracuse, NY, USA
| | - Gefei Qing
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, AB, Canada, and Calgary Laboratory Services, Calgary, AB, Canada
| | - Fariboz Rashid-Kolvear
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, AB, Canada, and Calgary Laboratory Services, Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, Johns Hopkins Medicine, Johns Hopkins All Children's Hospital, Baltimore, MD, USA
| | - Harmanjatinder S Sekhon
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital and ORLA, University of Ottawa, Ottawa, ON, Canada
| | - Alan Spatz
- Divisions of Pathology and Molecular Genetics, McGill University Health Center and McGill University, Montreal, QC, Canada
| | - Tracy Stockley
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Danh Tran-Thanh
- Department of Pathology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Tracy Tucker
- Department of Pathology and Laboratory Medicine, BC Cancer, Vancouver, BC, Canada
| | - Ranjit Waghray
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hangjun Wang
- Divisions of Pathology and Molecular Genetics, McGill University Health Center and McGill University, Montreal, QC, Canada
| | - Zhaolin Xu
- Dept. of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center, Tokyo, Japan
| | - Emina E Torlakovic
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan and Saskatchewan Health Authority, Saskatoon, SK, Canada.
| | - Ming-Sound Tsao
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Torlakovic E, Albadine R, Bigras G, Boag A, Bojarski A, Cabanero M, Camilleri-Broët S, Cheung C, Couture C, Craddock KJ, Cutz JC, Dhamanaskar P, Fiset PO, Hossain M, Hwang DM, Ionescu D, Itani D, Kelly MM, Kwan K, Lim HJ, Nielsen S, Qing G, Sekhon H, Spatz A, Waghray R, Wang H, Xu Z, Tsao MS. Canadian Multicenter Project on Standardization of Programmed Death-Ligand 1 Immunohistochemistry 22C3 Laboratory-Developed Tests for Pembrolizumab Therapy in NSCLC. J Thorac Oncol 2020; 15:1328-1337. [PMID: 32304736 DOI: 10.1016/j.jtho.2020.03.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/20/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The programmed death-ligand 1 (PD-L1) immunohistochemistry (IHC) assay is used to select patients for first or second-line pembrolizumab monotherapy in NSCLC. The PD-L1 IHC 22C3 pharmDx assay requires an Autostainer Link 48 instrument. Laboratories without this stainer have the option to develop a highly accurate 22C3 IHC laboratory-developed test (LDT) on other instruments. The Canadian 22C3 IHC LDT validation project was initiated to harmonize the quality of PD-L1 22C3 IHC LDT protocols across 20 Canadian pathology laboratories. METHODS Centrally optimized 22C3 LDT protocols were distributed to participating laboratories. The LDT results were assessed against results using reference PD-L1 IHC 22C3 pharmDx. Analytical sensitivity and specificity were assessed using cell lines with varying PD-L1 expression levels (phase 1) and IHC critical assay performance controls (phase 2B). Diagnostic sensitivity and specificity were assessed using whole sections of 50 NSCLC cases (phase 2A) and tissue microarrays with an additional 50 NSCLC cases (phase 2C). RESULTS In phase 1, 80% of participants reached acceptance criteria for analytical performance in the first attempt with disseminated protocols. However, in phase 2A, only 40% of participants reached the desired diagnostic accuracy for both 1% and 50% tumor proportion score cutoff. In phase 2B, further protocol modifications were conducted, which increased the number of successful laboratories to 75% in phase 2C. CONCLUSIONS It is possible to harmonize highly accurate 22C3 LDTs for both 1% and 50% tumor proportion score in NSCLC across many laboratories with different platforms. However, despite a centralized approach, diagnostic validation of predictive IHC LDTs can be challenging and not always successful.
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Affiliation(s)
- Emina Torlakovic
- Department of Pathology and Laboratory Medicine, Royal University Hospital, Saskatchewan Health Authority, Saskatoon, Canada; College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Roula Albadine
- Montreal University Hospital Center (Centre hospitalier de l'Université de Montréal), Montreal, Quebec, Canada
| | - Gilbert Bigras
- Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander Boag
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Anna Bojarski
- Department of Pathology, Health Sciences North, Sudbury, Ontario, Canada
| | - Michael Cabanero
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Carol Cheung
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christian Couture
- University institute of Cardiology and Respirology of Quebec-Laval University (Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval), Quebec City, Quebec, Canada
| | | | - Jean-Claude Cutz
- St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Prashant Dhamanaskar
- Department of Pathology, Trillium Health Partners and Credit Valley Hospital, Mississauga, Ontario, Canada
| | - Pierre O Fiset
- McGill University Health Science Centre, McGill University, Montreal, Quebec, Canada
| | | | - David M Hwang
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Diana Ionescu
- British Columbia Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Doha Itani
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Margaret M Kelly
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keith Kwan
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Hyun J Lim
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Søren Nielsen
- Nordic immunohistochemical Quality Control, Aalborg, Denmark
| | - Gefei Qing
- Shared Health Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harman Sekhon
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Alan Spatz
- McGill University Health Science Centre, McGill University, Montreal, Quebec, Canada; Department of Pathology, Lady Davis Institute and McGill University, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ranjit Waghray
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hangjun Wang
- McGill University Health Science Centre, McGill University, Montreal, Quebec, Canada; Department of Pathology, Lady Davis Institute and McGill University, Jewish General Hospital, Montreal, Quebec, Canada
| | - Zhaolin Xu
- QEII Health Sciences Centre, Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ming Sound Tsao
- University Health Network, University of Toronto, Toronto, Ontario, Canada.
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