The impact of a pathologist's personality on the interobserver variability and diagnostic accuracy of predictive PD-L1 immunohistochemistry in lung cancer. (April 2022)

• Record Type: Journal Article
• Authors: Butter, Rogier; Hondelink, Liesbeth M.; van Elswijk, Lisette; Blaauwgeers, Johannes L.G.; Bloemena, Elisabeth; Britstra, Rieneke; Bulkmans, Nicole; van Gulik, Anna Lena; Monkhorst, Kim; de Rooij, Mathilda J.; Slavujevic-Letic, Ivana; Smit, Vincent T.H.B.M.; Speel, Ernst-Jan M.; Thunnissen, Erik; von der Thüsen, Jan H.; Timens, Wim; van de Vijver, Marc J.; Yick, David C.Y.; Zwinderman, Aeilko H.; Cohen, Danielle; 't Hart, Nils A.; Radonic, Teodora
• Is Part Of: Lung cancer. Volume 166(2022)
• Page Start: 143
• Page End: 149
• Publication Date: 2022-04
• Subjects: Non-small cell lung cancer (NSCLC) -- programmed death-ligand 1 (PD-L1) -- Immunohistochemistry -- Interobserver variability -- Diagnostic reliability; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2022.03.002
• Languages: English
• ISSNs: 0169-5002

Abstract

Abstract: Objectives: Programmed death-ligand 1 (PD-L1) is the only approved predictive biomarker for immunotherapy in non-small cell lung cancer (NSCLC). However, predictive PD-L1 immunohistochemistry is subject to interobserver variability. We hypothesized that a pathologist's personality influences the interobserver variability and diagnostic accuracy of PD-L1 immunoscoring. Materials and Methods: Seventeen pathologists performed PD-L1 immunoscoring on 50 resected NSCLC tumors in three categories (<1%;1–49%;≥50%). Also, the pathologists completed a certified personality test (NEO-PI-r), assessing five personality traits: neuroticism, extraversion, openness, altruism and conscientiousness. Results: The overall agreement among pathologists for a series of 47 tumors was substantial (kappa = 0.63). Of these, 23/47 (49%) tumors were entirely negative or largely positive, resulting in a kappa value of 0.93. The remaining 24/47 (51%) tumors had a PD-L1 score around the cutoff value, generating a kappa value of 0.32. Pathologists with high scores for conscientiousness (careful, diligent) had the least interobserver variability (r = 0.6, p = 0.009). Also, they showed a trend towards higher sensitivity (74% vs. 68%, p = 0.4), specificity (86% vs. 82%, p = 0.3) and percent agreement (83% vs. 79%, p = 0.3), although not significant. In contrast, pathologists with high scores for neuroticism (sensitive, anxious) had significantly lower specificity (80% vs. 87%, p = 0.03) and percent agreement (78% vs. 85%, p = 0.03). Also, a trend towards high interobserver variability (r = -0.3, p = 0.2) and lower sensitivity (68% vs. 74%, p = 0.3) was observed, although not significant. Pathologists with relatively high scores for conscientiousness scored fewer tumors PD-L1 positive at the ≥ 1% cut-off (r = −0.5, p = 0.03). In contrast, pathologists with relatively high scores for neuroticism score more tumors PD-L1 positive at ≥ 1% (r = 0.6, p = 0.017) and ≥ 50% cut-offs (r = 0.6, p = 0.009). Conclusions: This study is the first to demonstrate the impact of a pathologist's personality on the interobserver variability and diagnostic accuracy of immunostaining, in the context of PD-L1 in NSCLC. Larger studies are needed for validation of these findings.