Abstract
Purpose
The determination of the programmed death ligand-1 (PD-L1) expression is part of the diagnostic algorithm for advanced non-small cell lung cancer (NSCLC) patients. We aimed to analyze the diagnostic performance of EBUS-TBNA performed as first-choice nodal staging procedure for the determination of PD-L1 expression in NSCLC patients.
Methods
Longitudinal-prospective study including NSCLC patients diagnosed between January 2018 and October 2019, for whom a primary tumor biopsy sample and an EBUS-TBNA cytological malignant sample were available. Samples with fewer than 100 malignant cells were considered inadequate. PDL-1 IHC 22C3 pharmDx antibody was used. The percentage of tumor cells expressing PD-L1, setting 1% and 50% as cutoff points, was collected. The weighted kappa coefficient was used to assess the concordance of PD-L1 expression. The PD-L1 expression was compared in precision terms.
Results
From a total of 43 patients, 53 pairs of samples were obtained, of which 23 (43.4%) were adequate and included for analysis. The weighted kappa coefficient for PD-L1 expression was 0.41 (95% CI 0.15–0.68) and 0.56 (95% CI 0.23–0.9) for cutoff values ≥ 1% and ≥ 50%, respectively. In advanced stages, the weighted kappa coefficient was 0.6 (95% CI 0.3–0.9) and 1 (95% CI 1–1) for PD-L1 expression cutoff values ≥ 1% and ≥ 50%, respectively. EBUS-TBNA showed a sensitivity, specificity, positive predictive value, and negative predictive value of 1 to detect PDL-1 expression ≥ 50% in advanced stages.
Conclusion
EBUS-TBNA performed as first nodal staging procedure in advanced NSCLC patients provides reliable specimens for the detection of PD-L1 expression ≥ 50% and could guide immunotherapy.
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The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- ALK:
-
Anaplastic lymphoma kinase
- CI:
-
Confidence interval
- CNS:
-
Coagulation necrosis sign
- CT:
-
Computed tomography
- EBUS-TBNA:
-
Endobronchial ultrasound transbronchial needle aspiration
- EBUS:
-
Endobronchial ultrasound
- EGFR:
-
Epidermal growth factor receptor
- FDT:
-
Fast diagnostic track
- FNA:
-
Fine needle aspiration
- H&E:
-
Hematoxylin and eosin
- IASLC:
-
International association for the study of lung cancer
- IHC:
-
Immunohistochemistry
- NPV:
-
Negative predictive value
- NSCLC:
-
Non-small cell lung cancer
- PD-1:
-
Programmed death protein-1
- PD-L1:
-
Programmed death protein-1 ligand
- PPV:
-
Positive predictive value
- TBNA:
-
Transbronchial needle aspiration
- TNM:
-
Tumor node metastases system
- TPS:
-
Tumor proportion score
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Acknowledgements
LP is the recipient of a predoctoral fellowship from the Ministry of Universities of Spain (FPU19/01555).
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All the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by DP, LP, EG-L, SG, MZ, MP, SG and FB. The first draft of the manuscript was written by DP, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.
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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the University Hospital Arnau de Vilanova and Santa María (Date September 17th,2018/No.1959).
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Polanco, D., Pinilla, L., Gracia-Lavedan, E. et al. Performance of endobronchial ultrasound transbronchial needle aspiration as the first nodal staging procedure for the determination of programmed death ligand-1 expression in non-small cell lung cancer patients. J Cancer Res Clin Oncol 149, 12459–12468 (2023). https://doi.org/10.1007/s00432-023-05039-9
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DOI: https://doi.org/10.1007/s00432-023-05039-9