• Fabio Perrotta, Matthew Nankivell, Jana B Adizie, Usman Maqsood, Mohamed Elshafi, Syeda Jafri, Andrew D Lerner, Ian Woolhouse, Mohammed Munavvar, Matthew Evison, Richard Booton, David R Baldwin, Samuel M Janes, Keith M Kerr, Andrea Bianco, Lonny Yarmus, and Neal Navani.
• Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy; Lungs for Living Research Centre, UCL Respiratory, University College London, London, England. Electronic address: fabio.perrotta@unimol.it.
• Chest. 2020 Sep 1; 158 (3): 1230-1239.

BackgroundProgrammed death-ligand 1 (PD-L1) expression on cancer cells is a clinically important biomarker to select patients with non-small cell lung cancer (NSCLC) for treatment with programmed death-1/PD-L1 inhibitors. Clinical trials of immunotherapy in patients with NSCLC have required histologic evidence for PD-L1 testing; in clinical practice, cytologic samples commonly are acquired in patients with advanced disease.Research QuestionThis study aims to investigate whether endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples are adequate for PD-L1 testing in NSCLC.Study Design And MethodsThis study investigates the sampling adequacy of EBUS-TBNA for PD-L1 testing when compared with other methods. Furthermore, the relationship between clinicopathologic characteristics and PD-L1 expression in the study population have been examined. Five hundred seventy-seven NSCLC specimens were analyzed from consecutive patients with NSCLC across six centers in the United Kingdom and one center in the United States between January 2015 and December 2016.ResultsIn the EBUS-TBNA group (189 specimens), the overall percentage of patients with successful PD-L1 testing was 94.7%. There was no significant difference in sampling adequacy with other methods of tissue acquisition. Older patients had higher failure rates of PD-L1 testing (OR, 1.06; P = .008). In multivariate analysis, advanced N-stage (P = .048) and presence of brain metastasis (P < .001) were associated with high PD-L1 expression.InterpretationThis large multicenter study shows that EBUS-TBNA provides samples adequate for PD-L1 testing and that advanced N stage and the presence of brain metastasis are associated with high PD-L1 expression.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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