Automated PD-L1 Scoring for Non-Small Cell Lung Carcinoma Using Open-Source Software

PD-L1 expression in non-small cell lung cancer (NSCLC) is predictive of response to immunotherapy, but scoring of PD-L1 immunohistochemistry shows considerable interobserver variability. Automated methods may allow more consistent and expedient PD-L1 scoring. We aimed to assess the technical concordance of PD-L1 scores produced using free open source QuPath software with the manual scores of three pathologists. A classifier for PD-L1 scoring was trained using 30 NSCLC image patches. A separate test set of 207 image patches from 69 NSCLC resection cases was used for comparison of automated and manual scores. Automated and average manual scores showed excellent correlation (concordance correlation coeffecient = 0.925), though automated scoring resulted in significantly more 1-49% scores than manual scoring (p = 0.012). At both 1% and 50% thresholds, automated scores showed a level of concordance with our 'gold standard' (the average of three pathologists' manual scores) similar to that of individual pathologists. Automated scoring showed high sensitivity (95%) but lower specificity (84%) at a 1% threshold, and excellent specificity (100%) but lower sensitivity (71%) at a 50% threshold. We conclude that our automated PD-L1 scoring system for NSCLC has an accuracy similar to that of individual pathologists. The detailed protocol we provide for free open source scoring software and our discussion of the limitations of this technology may facilitate more effective integration of automated scoring into clinical workflows.

Automated summary

PD-L1 expression in non-small cell lung cancer is predictive of response to immunotherapy, and automated PD-L1 scoring using QuPath software shows excellent correlation with manual scoring by pathologists. However, automated scoring tends to result in more 1-49% scores compared to manual scoring. Additionally, automated scoring shows high sensitivity but lower specificity at a 1% threshold, and excellent specificity but lower sensitivity at a 50% threshold.