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High sensitivity of PD-L1 analysis from pleural effusion in nonsmall cell lung cancer

Lars Hagmeyer, Stephan Schäfer, Marianne Engels, Anja Pietzke-Calcagnile, Marcel Treml, Simon-Dominik Herkenrath, Matthias Heldwein, Khosro Hekmat, Sandhya Matthes, Andreas Scheel, Jürgen Wolf, Reinhard Büttner, Winfried Randerath
ERJ Open Research 2021 7: 00787-2020; DOI: 10.1183/23120541.00787-2020
Lars Hagmeyer
1Institute of Pneumology, University of Cologne, Solingen, Germany
2Hospital Bethanien Solingen, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Solingen, Germany
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  • ORCID record for Lars Hagmeyer
  • For correspondence: lars.hagmeyer@klinik-bethanien.de
Stephan Schäfer
3University of Cologne, Institute of Pathology, Cologne, Germany
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Marianne Engels
3University of Cologne, Institute of Pathology, Cologne, Germany
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Anja Pietzke-Calcagnile
1Institute of Pneumology, University of Cologne, Solingen, Germany
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Marcel Treml
1Institute of Pneumology, University of Cologne, Solingen, Germany
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Simon-Dominik Herkenrath
1Institute of Pneumology, University of Cologne, Solingen, Germany
2Hospital Bethanien Solingen, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Solingen, Germany
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Matthias Heldwein
4University Hospital Cologne, Clinic for Cardiac and Thoracic Surgery, Cologne, Germany
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Khosro Hekmat
4University Hospital Cologne, Clinic for Cardiac and Thoracic Surgery, Cologne, Germany
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Sandhya Matthes
2Hospital Bethanien Solingen, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Solingen, Germany
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  • ORCID record for Sandhya Matthes
Andreas Scheel
3University of Cologne, Institute of Pathology, Cologne, Germany
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Jürgen Wolf
5University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
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Reinhard Büttner
3University of Cologne, Institute of Pathology, Cologne, Germany
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Winfried Randerath
1Institute of Pneumology, University of Cologne, Solingen, Germany
2Hospital Bethanien Solingen, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Solingen, Germany
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  • FIGURE 1
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    FIGURE 1

    Flow chart depicting numbers of different samples and corresponding diagnostic procedures. PD-L1: programmed cell death protein ligand 1; SCLC: small cell lung cancer; IHC: immunohistochemistry; ICC: immunocytochemistry.

  • FIGURE 2
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    FIGURE 2

    Proposed clinical algorithm for programmed cell death protein ligand 1 (PD-L1) testing in nonsmall cell lung cancer (NSCLC) patients with pleural effusion (PE).

Tables

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  • TABLE 1

    Anthropometric data and smoking status of 50 patients included

    Sex
     Female17 (34%)
     Male33 (66%)
    Age years72.5 (62.8–76.3)
    Body mass index kg·m−225.7 (23.2–28.5)
    Smoking status
     Never-smoker7 (14%)
     Ex-smoker28 (56%)
     Current smoker15 (30%)

    Data are presented as n (%) or median (interquartile range).

    • TABLE 2

      Summary of malignancy and programmed cell death protein ligand 1 (PD-L1) status

      Pleural effusion nPleural biopsy n
      Cases5050
      Malignancy (+/−/○)36/7/740/10/0
      PD-L1 ≥1% of tumour cells (+/−/nd)19/6/2521/14/15
      PD-L1 ≥50% of tumour cells (+/−/nd)13/12/258/27/15

      +: positive; −: negative; ○: inconclusive; nd: not done.

      • TABLE 3

        Programmed cell death protein ligand 1 (PD-L1) detection in pleural effusion based on all cases with successful PD-L1 analysis. Cross-classification of pleura biopsy and pleura effusion analysis results concerning PD-L1 detection

        PD-L1 expression ≥50% of tumour cells defined as positivePD-L1 expression ≥1% of tumour cells defined as positive
        Pleural biopsyTotalPleural biopsyTotal
        PositiveNegativePositiveNegative
        Pleural effusion
         Positive561112416
         Negative01010235
        Total5162114721
      • TABLE 4

        Programmed cell death protein ligand 1 (PD-L1) detection in pleural effusion based on all cases with successful PD-L1 analysis. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio

        ParameterPD-L1 expression ≥50% of tumour cells defined as positivePD-L1 expression ≥1% of tumour cells defined as positive
        Estimate95% CIEstimate95% CI
        Sensitivity %10046–1008656–97
        Specificity %6336–844312–80
        Positive predictive value %4518–757547–92
        Negative predictive value %10066–1006017–93
        Positive likelihood ratio2.671.42–5.021.500.76–2.95
        Negative likelihood ratio0.00Not defined0.330.07–1.56

      Supplementary Materials

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      • Supplementary Material

        Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

        Table S1 00787-2020.TABLES1

        Table S2 00787-2020.TABLES2

        Table S3 00787-2020.TABLES3

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      High sensitivity of PD-L1 analysis from pleural effusion in nonsmall cell lung cancer
      Lars Hagmeyer, Stephan Schäfer, Marianne Engels, Anja Pietzke-Calcagnile, Marcel Treml, Simon-Dominik Herkenrath, Matthias Heldwein, Khosro Hekmat, Sandhya Matthes, Andreas Scheel, Jürgen Wolf, Reinhard Büttner, Winfried Randerath
      ERJ Open Research Jan 2021, 7 (1) 00787-2020; DOI: 10.1183/23120541.00787-2020

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      High sensitivity of PD-L1 analysis from pleural effusion in nonsmall cell lung cancer
      Lars Hagmeyer, Stephan Schäfer, Marianne Engels, Anja Pietzke-Calcagnile, Marcel Treml, Simon-Dominik Herkenrath, Matthias Heldwein, Khosro Hekmat, Sandhya Matthes, Andreas Scheel, Jürgen Wolf, Reinhard Büttner, Winfried Randerath
      ERJ Open Research Jan 2021, 7 (1) 00787-2020; DOI: 10.1183/23120541.00787-2020
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