Accuracy of Cytologic vs Histologic Specimens for Assessment of Programmed Cell Death Ligand-1 Expression in Non-Small Cell Lung Cancer

Abstract

BackgroundProgrammed death ligand 1 (PD-L1) expression on tumor cells, evaluated by immunohistochemistry, guides the use of immunotherapy in advanced non-small cell lung cancer (NSCLC).Research QuestionWhat is the sensitivity and specificity of PD-L1 testing performed in cytologic vs paired histologic specimens in patients with NSCLC?Study Design and MethodsThe MEDLINE, Embase, Web of Science, and Cochrane Registry databases were searched through June 1, 2021. The primary outcome was pooled sensitivity and specificity of PD-L1 testing performed on cytologic specimens compared with the reference standard of histologic specimens, analyzed at the PD-L1 expression cutoffs (tumor proportion score) ≥ 1% and ≥ 50%. Pooled sensitivity and specificity, and associated 95% CIs, were estimated using bivariate generalized linear mixed models.ResultsTwenty-six articles were included, encompassing a total of 1,064 pairs of histology specimens and cytology cell blocks, and 267 pairs of histology specimens and direct smears. Among these, 946 paired specimens were acquired without interval treatment between the collection of histology and cytology samples. The pooled sensitivity and specificity of cytology specimens compared with paired histology specimens at the PD-L1 expression cutoff ≥ 1% were 0.84 (95% CI, 0.77-0.89) and 0.88 (95% CI, 0.82-0.93), respectively, whereas the pooled sensitivity and specificity at cutoff ≥ 50% were 0.78 (95% CI, 0.69-0.86) and 0.94 (95% CI, 0.91-0.96), respectively. When only paired specimens acquired without interval treatment were considered, the pooled sensitivity and specificity of cytology specimens at PD-L1 expression cutoff ≥ 1% were 0.84 (95% CI, 0.76-0.90) and 0.89 (95% CI, 0.82-0.94), respectively, whereas the pooled sensitivity and specificity at cutoff ≥ 50% were 0.80 (95% CI, 0.71-0.89) and 0.94 (95% CI, 0.91-0.96), respectively.InterpretationCytologic specimens provide an accurate assessment of PD-L1 expression in most patients with NSCLC, at both ≥ 1% and ≥ 50% cutoffs, when compared with histologic specimens.Trial RegistrationPROSPERO; No.: CRD42020153279; URL: https://www.crd.york.ac.uk/prospero/ Programmed death ligand 1 (PD-L1) expression on tumor cells, evaluated by immunohistochemistry, guides the use of immunotherapy in advanced non-small cell lung cancer (NSCLC). What is the sensitivity and specificity of PD-L1 testing performed in cytologic vs paired histologic specimens in patients with NSCLC? The MEDLINE, Embase, Web of Science, and Cochrane Registry databases were searched through June 1, 2021. The primary outcome was pooled sensitivity and specificity of PD-L1 testing performed on cytologic specimens compared with the reference standard of histologic specimens, analyzed at the PD-L1 expression cutoffs (tumor proportion score) ≥ 1% and ≥ 50%. Pooled sensitivity and specificity, and associated 95% CIs, were estimated using bivariate generalized linear mixed models. Twenty-six articles were included, encompassing a total of 1,064 pairs of histology specimens and cytology cell blocks, and 267 pairs of histology specimens and direct smears. Among these, 946 paired specimens were acquired without interval treatment between the collection of histology and cytology samples. The pooled sensitivity and specificity of cytology specimens compared with paired histology specimens at the PD-L1 expression cutoff ≥ 1% were 0.84 (95% CI, 0.77-0.89) and 0.88 (95% CI, 0.82-0.93), respectively, whereas the pooled sensitivity and specificity at cutoff ≥ 50% were 0.78 (95% CI, 0.69-0.86) and 0.94 (95% CI, 0.91-0.96), respectively. When only paired specimens acquired without interval treatment were considered, the pooled sensitivity and specificity of cytology specimens at PD-L1 expression cutoff ≥ 1% were 0.84 (95% CI, 0.76-0.90) and 0.89 (95% CI, 0.82-0.94), respectively, whereas the pooled sensitivity and specificity at cutoff ≥ 50% were 0.80 (95% CI, 0.71-0.89) and 0.94 (95% CI, 0.91-0.96), respectively. Cytologic specimens provide an accurate assessment of PD-L1 expression in most patients with NSCLC, at both ≥ 1% and ≥ 50% cutoffs, when compared with histologic specimens. PROSPERO; No.: CRD42020153279; URL: https://www.crd.york.ac.uk/prospero/ Take-home PointsStudy Question: What is the diagnostic accuracy of cytologic vs paired histologic specimens for assessment of programmed cell death ligand-1 (PD-L1) expression in patients with non-small cell lung cancer?Results: The pooled sensitivity values of cytologic specimens at the clinically relevant PD-L1 expression cutoffs of ≥ 1% and ≥ 50% were 84% and 78%, respectively, whereas specificity values of cytologic specimens at these same cutoffs were 88% and 94%, respectively. When only paired specimens acquired in the absence of interval treatment were considered, the pooled sensitivity of cytologic specimens compared with paired histologic specimens at the ≥ 50% PD-L1 expression cutoff was 80%, with similar specificity.Interpretation: Cytologic specimens provide an accurate assessment of PD-L1 expression in most patients with non-small cell lung cancer, at both ≥ 1% and ≥ 50% cutoffs, when compared with histologic specimens. Study Question: What is the diagnostic accuracy of cytologic vs paired histologic specimens for assessment of programmed cell death ligand-1 (PD-L1) expression in patients with non-small cell lung cancer? Results: The pooled sensitivity values of cytologic specimens at the clinically relevant PD-L1 expression cutoffs of ≥ 1% and ≥ 50% were 84% and 78%, respectively, whereas specificity values of cytologic specimens at these same cutoffs were 88% and 94%, respectively. When only paired specimens acquired in the absence of interval treatment were considered, the pooled sensitivity of cytologic specimens compared with paired histologic specimens at the ≥ 50% PD-L1 expression cutoff was 80%, with similar specificity. Interpretation: Cytologic specimens provide an accurate assessment of PD-L1 expression in most patients with non-small cell lung cancer, at both ≥ 1% and ≥ 50% cutoffs, when compared with histologic specimens. The introduction of immune checkpoint inhibitors (ICIs) into clinical practice has transformed the care of patients with non-small cell lung cancer (NSCLC). Programmed cell death protein-1 (PD-1) is a transmembrane receptor expressed on T cells. Interaction with programmed death ligand-1 (PD-L1), a transmembrane protein on tumor cells, inhibits the immune system’s ability to destroy cancer cells. ICIs, whether targeting the PD-1 receptor or its ligand PD-L1, break this inhibitory system and allow T cells to attack cancer cells.1Ohaegbulam K.C. Assal A. Lazar-Molnar E. Yao Y. Zang X. Human cancer immunotherapy with antibodies to the PD-1 and PD-L1 pathway.Trends Mol Med. 2015; 21: 24-33Abstract Full Text Full Text PDF PubMed Scopus (563) Google Scholar,2Ichikawa M. Chen L. Role of B7-H1 and B7-H4 molecules in down-regulating effector phase of T-cell immunity: novel cancer escaping mechanisms.Front Biosci. 2005; 10: 2856-2860Crossref PubMed Scopus (56) Google Scholar Patients whose tumors demonstrate higher levels of PD-L1 expression derive greater clinical benefit from immunotherapy.3Brody R. Zhang Y. Ballas M. et al.PD-L1 expression in advanced NSCLC: insights into risk stratification and treatment selection from a systematic literature review.Lung Cancer. 2017; 112: 200-215Abstract Full Text Full Text PDF PubMed Scopus (198) Google Scholar, 4Reck M. Rodriguez-Abreu D. Robinson A.G. et al.Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer.N Engl J Med. 2016; 375: 1823-1833Crossref PubMed Scopus (7040) Google Scholar, 5Reck M. Rodriguez-Abreu D. Robinson A.G. et al.Updated analysis of KEYNOTE-024: pembrolizumab versus platinum-based chemotherapy for advanced non-small-cell lung cancer with PD-L1 tumor proportion score of 50% or greater.J Clin Oncol. 2019; 37: 537-546Crossref PubMed Scopus (1014) Google Scholar PD-L1 expression on tumor cells, assessed by immunohistochemistry (IHC), guides the use of immunotherapy in patients with advanced NSCLC. Currently, pembrolizumab (anti-PD-1) can be administered as a first-line single agent or combined with chemotherapy in patients with PD-L1 expression on at least 50% of tumor cells in a biopsy sample, what is known as tumor proportion score (TPS) ≥ 50%. Pembrolizumab combined with chemotherapy is approved for the frontline treatment of with PD-L1 expression M. Rodriguez-Abreu D. Robinson A.G. et al.Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer.N Engl J Med. 2016; 375: 1823-1833Crossref PubMed Scopus (7040) Google L. Rodriguez-Abreu D. et al.Pembrolizumab chemotherapy in non-small-cell lung cancer.N Engl J Med. PubMed Scopus Google cell lung cancer Scholar The clinical of PD-L1 expression using histologic samples. the to of patients with advanced with cytologic specimens Y. of PD-L1 in Cancer. for the Study of Scholar a in the of patients with NSCLC, and and and in the of patients with lung and of lung cancer, of clinical practice Full Text Full Text PDF PubMed Scopus Google et for non-small cell lung and of lung cancer, of clinical practice Full Text Full Text PDF PubMed Scopus Google Scholar The of PD-L1 expression has in specimens, in cytologic Y. of PD-L1 in Cancer. for the Study of L. M. et immune of non-small-cell lung of cytologic and histologic through J Med. PubMed Scopus Google Scholar has in the of using cytologic cell for of PD-L1 by the for the Study of M. et for the Study of on Programmed 1 for Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar in cell and were for PD-L1 testing by and of respectively. PD-L1 testing is in cytologic M. et for PD-L1 testing in non-small cell lung Full Text Full Text PDF PubMed Scopus Google A. A. et 1 testing of acquired for the and of non-small cell lung PubMed Scopus Google Scholar the of PD-L1 expression in paired cytologic and histologic specimens from patients with of PD-L1 expression on cytologic and histologic specimens from in the lung assessed with PD-L1 and PD-L1 Mol 2017; PubMed Scopus Google Scholar, et of Programmed between and lung cancer Full Text Full Text PDF PubMed Scopus Google Scholar, D. M. PD-L1 testing using the for selection of patients with non-small cell lung cancer to immune checkpoint cytology cell a PubMed Scopus Google Scholar The by et et of Programmed between and lung cancer Full Text Full Text PDF PubMed Scopus Google Scholar in the risk of when PD-L1 expression was assessed in vs specimens. systematic M. for PD-L1 a systematic review.Lung Cancer. Full Text Full Text PDF PubMed Scopus Google E. A. L. death ligand-1 in lung cancer a systematic PubMed Scopus Google Scholar the of PD-L1 expression in cytologic vs histologic specimens, has the diagnostic accuracy of cytologic vs paired histologic specimens for assessment of PD-L1 to and the sensitivity and specificity of PD-L1 testing performed in cytologic vs paired histologic specimens in patients with NSCLC. systematic and was in with the for and et an for systematic PubMed Scopus Google Scholar and for D. et for a and of the PubMed Scopus Google Scholar and was in The literature was in with a using to NSCLC, PD-L1, and cytology The MEDLINE, Embase, Web of Science, and Cochrane Registry databases were searched on were performed on and June 1, 2021. was on or of only were and A. or A. and and evaluated articles for The reference of systematic were were through with a were to the patients with for cytologic and histologic specimens were evaluated for PD-L1 PD-L1 assessment by with specimens with ≥ tumor cells, and in the and the of PD-L1 testing in paired histologic and cytologic specimens were cutoffs of PD-L1 ≥ 50% and ≥ 1% were for of paired specimens. specimens specimens, and L. M. et immune of non-small-cell lung of cytologic and histologic through J Med. PubMed Scopus Google Scholar Cytologic specimens and or samples. specimens were as cytologic and histologic specimens acquired from the same with or without interval treatment between of the specimens. were on the PD-L1 testing in NSCLC, specimens the cytologic specimens by of the primary specimens with tumor cells for assessment of PD-L1 for assessment of PD-L1 expression and to sensitivity specificity using histologic specimens as the reference with literature was or A. evaluated the of using the of for diagnostic accuracy et a for the assessment of diagnostic accuracy Med. PubMed Scopus Google Scholar The assessment both risk of and of is in reference and and evaluated in and reference were through the from using and or for PD-L1 of for PD-L1 testing vs of cytologic cytologic vs direct agent for cytologic of histologic of paired interval between of paired of and using histologic specimens as the reference standard with the PD-L1 expression cutoffs ≥ 50% and ≥ and interval treatment between of paired specimens, The of interval treatment was from the or through with for the of interval treatment be were from the interval treatment were and were by were in a from for pooled to The on the most the of paired samples. were by to to to pairs between and were to provide for of sensitivity and specificity using histologic specimens as the reference The primary were pooled sensitivity and specificity of PD-L1 testing performed on cytologic specimens, compared with the reference standard of histologic specimens, analyzed at the PD-L1 expression cutoffs (TPS) ≥ 1% and ≥ 50%. Pooled sensitivity and specificity, and associated 95% CIs, were estimated using bivariate generalized linear mixed of sensitivity and specificity with a generalized linear mixed Clin Full Text Full Text PDF PubMed Scopus Google Scholar at the of the for sensitivity and specificity, and these to be Pooled and were estimated using bivariate generalized linear mixed models. The were diagnostic accuracy of cytologic vs histologic specimens in the absence of interval treatment between collection of paired diagnostic accuracy of vs paired histologic specimens for assessment of PD-L1 of cell and direct cytologic specimens vs paired histologic specimens for assessment of PD-L1 and diagnostic accuracy of cytologic vs histologic specimens to PD-L1 Pooled sensitivity and specificity for of cell vs direct and to were estimated using bivariate generalized linear of was assessed using of were using the in of diagnostic accuracy with Scholar systematic was total of articles were from the with articles for articles were for from total of articles were in the encompassing 1,064 pairs of histologic specimens and cytologic cell blocks, and 267 pairs of histologic specimens and direct smears. Among these, 946 paired specimens from were acquired in the absence of interval treatment cell and 267 direct were whereas the were The most was of PD-L1 expression on cytologic and histologic specimens from in the lung assessed with PD-L1 and PD-L1 Mol 2017; PubMed Scopus Google Y. et as a for Programmed 1 testing in patients of non-small cell lung Cancer. PubMed Scopus Google Scholar, of PD-L1 using cell in patients with non-small-cell lung PubMed Scopus Google Scholar, A. M. D. D. assessment of PD-L1 immunohistochemistry on paired and cytology specimens from non-small cell lung Cancer. Full Text Full Text PDF PubMed Scopus Google Scholar of PD-L1 testing using the for pooled is E. The of cytologic for PD-L1 in non-small cell lung PubMed Scopus Google Scholar, E. et of the expression of programmed death ligand 1 (PD-L1) on in advanced cell lung Cancer. Full Text Full Text PDF PubMed Scopus Google Scholar, A. et al.PD-L1 in histology specimens and cell of patients with 2019; PubMed Scopus Google Scholar, A. A. of Programmed 1 (PD-L1) expression on cytology specimens in non-small cell lung J Clin 2019; PubMed Google Scholar, D. et al.PD-L1 expression in non-small cell lung and 2017; PubMed Scopus Google Scholar, M. L. of the 1 to programmed 1 expression in cytology from non-small cell lung cancer PubMed Scopus Google Scholar, Y. et death ligand 1 testing in non-small cell lung cytology cell and PubMed Scopus Google Scholar, for programmed cell death ligand-1 of and specimens in lung 2019; PubMed Scopus Google Scholar, et cell for testing for PD-L1 in lung Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar, et al.PD-L1 testing on the cytology specimens of non-small cell lung Cancer. 2019; Full Text Full Text PDF PubMed Scopus Google Scholar, Y. M. et analysis of PD-L1 expression and in biopsy specimens of non-small cell lung assessment of primary and Cancer. 2019; Full Text Full Text PDF PubMed Scopus Google Scholar, M. et is for accurate PD-L1 immunohistochemistry assessment on cytology PubMed Scopus Google Scholar, Zhang Y. PD-L1 expression in and its with in non-small cell lung PubMed Scopus Google Scholar, Y. L. et cell from for PD-L1 in advanced compared with histology Cancer. PubMed Scopus Google Scholar, A. A. A. PD-L1 expression in NSCLC: of cell and between PubMed Scopus Google Scholar, M. et analysis of programmed death ligand 1 expression in paired cytologic and histologic specimens of non-small cell lung PubMed Scopus Google Scholar, R. et of PD-L1 immunohistochemistry in non-small cell lung PubMed Scopus Google Scholar, et of PD-L1 in cell of lung with and of PubMed Scopus Google Scholar, R. et for testing in non-small cell lung PubMed Scopus Google Scholar, E. et of programmed death ligand 1 (PD-L1) tumor proportion score (TPS) on in advanced non-small cell lung a Oncol. PubMed Scopus Google of et E. The of cytologic for PD-L1 in non-small cell lung PubMed Scopus Google et E. et of the expression of programmed death ligand 1 (PD-L1) on in advanced cell lung Cancer. Full Text Full Text PDF PubMed Scopus Google tumors or et A. et al.PD-L1 in histology specimens and cell of patients with 2019; PubMed Scopus Google et A. A. of Programmed 1 (PD-L1) expression on cytology specimens in non-small cell lung J Clin 2019; PubMed Google et D. et al.PD-L1 expression in non-small cell lung and 2017; PubMed Scopus Google to et M. L. of the 1 to programmed 1 expression in cytology from non-small cell lung cancer PubMed Scopus Google et Y. et death ligand 1 testing in non-small cell lung cytology cell and PubMed Scopus Google and for programmed cell death ligand-1 of and specimens in lung 2019; PubMed Scopus Google et et of Programmed between and lung cancer Full Text Full Text PDF PubMed Scopus Google and of PD-L1 expression on cytologic and histologic specimens from in the lung assessed with PD-L1 and PD-L1 Mol 2017; PubMed Scopus Google et A. A. et 1 testing of acquired for the and of non-small cell lung PubMed Scopus Google et et cell for testing for PD-L1 in lung Oncol. Full Text Full Text PDF PubMed Scopus Google et et al.PD-L1 testing on the cytology specimens of non-small cell lung Cancer. 2019; Full Text Full Text PDF PubMed Scopus Google et Y. M. et analysis of PD-L1 expression and in biopsy specimens of non-small cell lung assessment of primary and Cancer. 2019; Full Text Full Text PDF PubMed Scopus Google et Y. et as a for Programmed 1 testing in patients of non-small cell lung Cancer. PubMed Scopus Google to 1 et M. et is for accurate PD-L1 immunohistochemistry assessment on cytology PubMed Scopus Google et Zhang Y. PD-L1 expression in and its with in non-small cell lung PubMed Scopus Google et of PD-L1 using cell in patients with non-small-cell lung PubMed Scopus Google et Y. L. et cell from for PD-L1 in advanced compared with histology Cancer. PubMed Scopus Google to et A. M. D. D. assessment of PD-L1 immunohistochemistry on paired and cytology specimens from non-small cell lung Cancer. Full Text Full Text PDF PubMed Scopus Google et A. A. A. PD-L1 expression in NSCLC: of cell and between PubMed Scopus Google et M. et analysis of programmed death ligand 1 expression in paired cytologic and histologic specimens of non-small cell lung PubMed Scopus Google et R. et of PD-L1 immunohistochemistry in non-small cell lung PubMed Scopus Google et et of PD-L1 in cell of lung with and of PubMed Scopus Google et R. et for testing in non-small cell lung PubMed Scopus Google et E. et of programmed death ligand 1 (PD-L1) tumor proportion score (TPS) on in advanced non-small cell lung a Oncol. PubMed Scopus Google in a The pooled sensitivity and specificity of cytologic specimens compared with paired histologic specimens at the PD-L1 expression cutoff ≥ 1% were 0.84 (95% CI, 0.77-0.89) and 0.88 (95% CI, 0.82-0.93), respectively, whereas the pooled sensitivity and specificity at the PD-L1 expression cutoff ≥ 50% were 0.78 (95% CI, 0.69-0.86) and 0.94 (95% CI, 0.91-0.96), When only paired specimens acquired without interval treatment were considered, the pooled sensitivity and specificity of cytologic specimens at PD-L1 expression cutoff ≥ 1% were 0.84 (95% CI, 0.76-0.90) and 0.89 (95% CI, 0.82-0.94), respectively, whereas the pooled sensitivity and specificity at cutoff ≥ 50% were 0.80 (95% CI, 0.71-0.89) and 0.94 (95% CI, 0.91-0.96), of values and and pooled in and specificity of cytologic specimens for assessment of programmed cell death ligand-1 (PD-L1) expression ≥ 1% vs paired histologic samples. and specificity of cytologic specimens for assessment of PD-L1 expression ≥ 50% vs paired histologic and specificity of cytologic specimens, acquired without interval for assessment of programmed cell death ligand-1 (PD-L1) expression ≥ 1% vs paired histologic samples. and specificity of cytologic specimens, acquired without interval for assessment of PD-L1 expression ≥ 50% vs paired histologic total of paired cytologic specimens were with paired acquired in the absence of interval The pooled sensitivity and specificity of cytologic specimens compared with paired histologic specimens at the PD-L1 expression cutoff ≥ 1% were (95% CI, and 0.84 (95% CI, respectively, whereas the pooled sensitivity and specificity at the PD-L1 expression cutoff ≥ 50% were 0.78 (95% CI, and (95% CI, When only paired specimens acquired without interval treatment were considered, the pooled sensitivity and specificity of cytologic specimens at PD-L1 expression cutoff ≥ 1% were (95% CI, and 0.78 (95% CI, respectively, whereas the pooled sensitivity and specificity at cutoff ≥ 50% were (95% CI, and (95% CI, The diagnostic accuracy of cytologic blocks, most paired cytologic specimens, was from direct smears. Cytologic cell a higher sensitivity direct at both the 1% and 50% PD-L1 expression cutoffs, whereas pooled specificity was The most was by The pooled analysis of paired specimens evaluated with the the (95% CI, at the ≥ 1% cutoff and 0.80 (95% CI, at the ≥ 50% in and assessment using a risk of in a of were of in the of the and reference between of cytologic and histologic specimens and and of assessment of the is in an of the of patients with NSCLC, and use to be by tumor cell PD-L1 cell lung cancer Scholar the systematic the diagnostic accuracy of cytologic specimens for assessment of PD-L1 expression in patients with was evaluated paired histologic specimens. Pooled sensitivity of cytologic specimens at the clinically relevant PD-L1 expression cutoffs of ≥ 1% and ≥ 50% was 84% and 78%, respectively, whereas specificity of cytologic specimens at these same cutoffs was 88% and 94%, respectively. in the of patients in paired were acquired in the absence of interval pooled sensitivity at the ≥ 50% cutoff was higher at 80%, whereas the estimated pooled specificity was the analysis the accuracy of cytologic specimens for assessment of PD-L1 expression in patients with NSCLC. Cytologic specimens, acquired through an in the and of lung first-line in the of patients with with et for non-small cell lung and of lung cancer, of clinical practice Full Text Full Text PDF PubMed Scopus Google Scholar The acquired provide for and and advanced The for the Study of Y. of PD-L1 in Cancer. for the Study of Scholar of PD-L1 testing in lung cancer the use of cytologic for of PD-L1 of of of the clinical to of patients with advanced with cytologic specimens Y. of PD-L1 in Cancer. for the Study of Scholar use for PD-L1 assessment the between the specimens acquired in and the histologic for in the clinical of L. M. et immune of non-small-cell lung of cytologic and histologic through J Med. PubMed Scopus Google Scholar The of using cytologic for assessment of PD-L1 expression has by et M. et for PD-L1 testing in non-small cell lung Full Text Full Text PDF PubMed Scopus Google Scholar PD-L1 testing be performed in 95% of L. A. of patients with advanced non-small cell lung cancer with on the of PD-L1 in vs Full Text Full Text PDF PubMed Scopus Google Scholar et the of using cytologic specimens to PD-L1 and of cytologic specimens were of tumor cells for PD-L1 et M. for PD-L1 a systematic review.Lung Cancer. Full Text Full Text PDF PubMed Scopus Google Scholar the of PD-L1 expression between cytologic and histologic specimens. the for cytologic and histologic specimens was (95% CI, and (95% CI, for specimens with ≥ 1% and ≥ 50% of tumor cells PD-L1, E. A. L. death ligand-1 in lung cancer a systematic PubMed Scopus Google Scholar et E. A. L. death ligand-1 in lung cancer a systematic PubMed Scopus Google Scholar the literature of PD-L1 in lung cytologic and clinical the between cytologic and histologic specimens from to analysis by et et al.PD-L1 testing in non-small cell lung cancer a with and of the PubMed Scopus Google Scholar paired specimens from of PD-L1 expression ≥ 1% and ≥ 50% cutoffs, in paired cytologic and biopsy specimens. of paired specimens a of to at the 1% cutoff and at the 50% PD-L1 expression of these performed a has and analyzed the accuracy of cytologic specimens vs paired histologic specimens for assessment of PD-L1 to this systematic The literature was on a total of paired histologic and cytologic specimens, of 1,064 of cytologic cell to for in as to interval treatment between of paired and for performed and clinically relevant The analysis were the or be from the cytologic and biopsy specimens were from the same from the same and at or without interval of PD-L1 expression in cytologic and histologic specimens has to be in from et al.PD-L1 testing in non-small cell lung cancer a with and of the PubMed Scopus Google Scholar of lung cancer with primary tumors and PD-L1 expression ≥ compared with primary in R. et of programmed 1 protein expression between primary and in patients with lung Cancer. PubMed Scopus Google Scholar et A. of Programmed 1 expression with lung histologic and in primary and Full Text Full Text PDF PubMed Scopus Google Scholar in PD-L1 expression in primary and lung a between higher and tumor histologic specimens an reference standard paired cytologic be compared is to has for the of tumor or cytologic in and of tumor cells, compared with the of A. D. L. A. PD-L1 in cytology Scholar the use of cytologic specimens for assessment of PD-L1 expression on ability to treatment to treatment by cytologic specimens. on the of patients with advanced with on PD-L1 in vs histologic specimens, were to be L. A. of patients with advanced non-small cell lung cancer with on the of PD-L1 in vs Full Text Full Text PDF PubMed Scopus Google Scholar the of be of the known and of PD-L1 as a and of PD-L1 expression has A. E. D. of PD-L1 expression and the risk for of PD-L1 immunohistochemistry in non-small cell lung Cancer. Full Text Full Text PDF PubMed Scopus Google M. M. for in non-small cell lung PubMed Scopus Google Scholar and this for of the in PD-L1 levels between paired samples. and and cancer E. A. L. death ligand-1 in lung cancer a systematic PubMed Scopus Google M. et al.PD-L1 immunohistochemistry in clinical of Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar The performed provide into the of of these the of paired acquired in the absence of interval treatment and the diagnostic accuracy of cytologic specimens was at the 50% PD-L1 expression of PD-L1 as a is the absence of a antibodies and on the a was the and in the phase 1 R. et 1 immunohistochemistry a of and clinical in non-small-cell lung Clin Oncol. 2017; PubMed Scopus Google A. D. et al.PD-L1 immunohistochemistry for lung from phase 1 of the PD-L1 Oncol. 2017; Full Text Full Text PDF PubMed Scopus Google Scholar this of assessed PD-L1 expression using the with the sensitivity and in this to to E. et of PD-L1 immunohistochemistry a of diagnostic Full Text Full Text PDF PubMed Scopus Google Scholar with is to for of cytologic The use of for for PD-L1 testing has was in of whereas a of and was The by et A. et death ligand 1 expression in of non-small cell lung is by of PubMed Scopus Google Scholar in PD-L1 expression when using a vs The of cytologic cell with diagnostic accuracy for assessment of PD-L1 expression only the accuracy of direct with a pooled is the diagnostic accuracy of specimens the of in the and accurate and of lung et for non-small cell lung and of lung cancer, of clinical practice Full Text Full Text PDF PubMed Scopus Google M. et cancer and with compared with an Med. 2015; Full Text Full Text PDF PubMed Scopus Google Scholar The of using for and testing is as in a E. M. A. of by with for analysis in patients with non-small cell lung and PubMed Scopus Google Scholar The analysis the sensitivity of for assessment of PD-L1 at the ≥ 50% expression and in the absence of interval treatment between of the paired to is acquired for the or for diagnostic et of and 2016; Full Text Full Text PDF PubMed Scopus Google M. et and of biopsy and cytology specimens for from the of in the of for of of of and of Scholar and can be the cytologic specimens PD-L1 in Cytologic specimens provide an accurate assessment of PD-L1 expression in most patients with NSCLC, at both the ≥ 1% and ≥ 50% cutoffs, when compared with paired histologic specimens. of immunotherapy cytologic specimens for assessment of PD-L1 to the acquired in clinical The to was for this

Topics & Concepts