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. 2022 Apr:166:143-149.
doi: 10.1016/j.lungcan.2022.03.002. Epub 2022 Mar 5.

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

Rogier Butter  1 , Liesbeth M Hondelink  2 , Lisette van Elswijk  3 , Johannes L G Blaauwgeers  4 , Elisabeth Bloemena  5 , Rieneke Britstra  5 , Nicole Bulkmans  6 , Anna Lena van Gulik  7 , Kim Monkhorst  8 , Mathilda J de Rooij  9 , Ivana Slavujevic-Letic  9 , Vincent T H B M Smit  2 , Ernst-Jan M Speel  10 , Erik Thunnissen  5 , Jan H von der Thüsen  11 , Wim Timens  12 , Marc J van de Vijver  1 , David C Y Yick  13 , Aeilko H Zwinderman  14 , Danielle Cohen  2 , Nils A 't Hart  15 , Teodora Radonic  16
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Free article

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

Rogier Butter et al. Lung Cancer. 2022 Apr.
Free article

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.

Keywords: Diagnostic reliability; Immunohistochemistry; Interobserver variability; Non-small cell lung cancer (NSCLC); programmed death-ligand 1 (PD-L1).

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