Key points are not available for this paper at this time.
Background and aims Evaluation of the programmed cell death ligand‐1 (PD‐L1) combined positive score (CPS) is vital to predict the efficacy of the immunotherapy in triple‐negative breast cancer (TNBC), but pathologists show substantial variability in the consistency and accuracy of the interpretation. It is of great importance to establish an objective and effective method which is highly repeatable. Methods We proposed a model in a deep learning‐based framework, which at the patch level incorporated cell analysis and tissue region analysis, followed by the whole‐slide level fusion of patch results. Three rounds of ring studies (RSs) were conducted. Twenty‐one pathologists of different levels from four institutions evaluated the PD‐L1 CPS in TNBC specimens as continuous scores by visual assessment and our artificial intelligence (AI)‐assisted method. Results In the visual assessment, the interpretation results of PD‐L1 (Dako 22C3) CPS by different levels of pathologists have significant differences and showed weak consistency. Using AI‐assisted interpretation, there were no significant differences between all pathologists ( P = 0.43), and the intraclass correlation coefficient (ICC) value was increased from 0.618 95% confidence interval (CI) = 0.524–0.719 to 0.931 (95% CI = 0.902–0.955). The accuracy of interpretation result is further improved to 0.919 (95% CI = 0.886–0.947). Acceptance of AI results by junior pathologists was the highest among all levels, and 80% of the AI results were accepted overall. Conclusion With the help of the AI‐assisted diagnostic method, different levels of pathologists achieved excellent consistency and repeatability in the interpretation of PD‐L1 (Dako 22C3) CPS. Our AI‐assisted diagnostic approach was proved to strengthen the consistency and repeatability in clinical practice.
Li et al. (2024) studied this question.