Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec;23(8):5121-5127.
doi: 10.1007/s10238-023-01190-2. Epub 2023 Oct 7.

Diagnostic biopsy does not accurately reflect the PD-L1 expression in triple-negative breast cancer

Marek Zdrenka  1 , Adam Kowalewski  1 , Jędrzej Borowczak  2 , Joanna Łysik-Miśkurka  1 , Hanna Andrusewicz  1 , Tomasz Nowikiewicz  3   4 , Łukasz Szylberg  5   6
Affiliations

Diagnostic biopsy does not accurately reflect the PD-L1 expression in triple-negative breast cancer

Marek Zdrenka et al. Clin Exp Med. 2023 Dec.

Abstract

PD-L1 expression is known to predict the benefits of immune checkpoint inhibitor therapy for triple-negative breast cancer (TNBC). We examined whether the PD-L1 expression evaluated in biopsy specimens accurately reflects its expression in the whole tumor. Immunohistochemistry was performed on 81 biopsy and resection specimens from patients with TNBC to determine their PD-L1 status. We found PD-L1-positive tumors in 23 (28%) biopsy specimens and primarily PD-L1-negative tumors in 58 (72%). The PD-L1 status was reevaluated in matching postoperative specimens of primarily PD-L1-negative tumors. Of them, 31% (18/58) were positive, whereas 69% (40/58) were negative. Considering the pre- and postoperative analyses, 41 (51%) patients had PD-L1-positive tumors, while 40 had PD-L1-negative tumors. We found 18 (22%) more PD-L1-positive tumors while examining the resection specimens compared to biopsies, and the difference was statistically significant (p = 0.0038). Diagnostic biopsies do not fully reflect the PD-L1 expression in TNBC. Our results suggest that a significant subset of TNBC patients may be misclassified as PD-L1-negative and disqualified from anti-PD-L1 therapy.

Keywords: Cancer; Diagnosis; PD-L1; Pathology; Triple-negative breast cancer.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
The distribution of PD-L1 status among diagnostic biopsies and matched surgically resected specimens
Fig. 2
Fig. 2
Detailed distribution of PD-L1 expression among primary PD-L1-negative patients in diagnostic biopsy and reevaluated matched resected tumor. Specimens with IC ≥ 1% were considered PD-L1-positive. All specimens with IC < 1% were PD-L1-negative. Some samples showed a slight PD-L1 staining, which did not exceed 1% IC. Those samples were labeled as PD-L1-negative < 1%
Fig. 3
Fig. 3
Cross-section images of a TNBC with marked features of inflammation; b TNBC without marked signs of inflammation; c PD-L1 in TNBC with marked features of inflammation; d PD-L1 in TNBC without marked signs of inflammation; e “dispersed” PD-L1 staining in TNBC; f “aggregated” PD-L1 staining in TNBC; TNBC—triple-negative breast cancer; and PD-L1—programmed cell death ligand 1
See this image and copyright information in PMC

References

    1. Yin L, Duan J-J, Bian X-W, Yu S-C. Triple-negative breast cancer molecular subtyping and treatment progress. Breast Cancer Res. 2020;22:61. doi: 10.1186/s13058-020-01296-5. - DOI - PMC - PubMed
    1. Marra A, Viale G, Curigliano G. Recent advances in triple negative breast cancer: the immunotherapy era. BMC Med. 2019;17:90. doi: 10.1186/s12916-019-1326-5. - DOI - PMC - PubMed
    1. Li Y, Zhang H, Merkher Y, Chen L, Liu N, Leonov S, Chen Y. Recent advances in therapeutic strategies for triple-negative breast cancer. J Hematol Oncol. 2022;15:121. doi: 10.1186/s13045-022-01341-0. - DOI - PMC - PubMed
    1. Juneja VR, McGuire KA, Manguso RT, LaFleur MW, Collins N, Haining WN, Freeman GJ, Sharpe AH. PD-L1 on tumor cells is sufficient for immune evasion in immunogenic tumors and inhibits CD8 T cell cytotoxicity. J Exp Med. 2017;214:895–904. doi: 10.1084/jem.20160801. - DOI - PMC - PubMed
    1. Han Y, Liu D, Li L. PD-1/PD-L1 pathway: current researches in cancer. Am J Cancer Res. 2020;10:727–742. - PMC - PubMed

MeSH terms