Abstract
Recent research has shown that tumor-infiltrating lymphocytes (TILs) are correlated with improved survival in a continuous fashion in primary breast cancers. Additionally, the TIL score on breast core biopsies has been shown to correlate with higher rates of pathological complete response after neoadjuvant chemotherapy. In 2014, an International TIL Working Group created a standardized evaluation method for scoring TILs. We sought to determine the interobserver variability in scoring TILs after training among three pathologists with different levels of experience. Fifty-five cases of diagnostic core biopsies from 2010 to 2012 of primary breast carcinoma were selected for the cohort. Prior to scoring the breast biopsies, the evaluators reviewed the standardized scoring method from the 2014 TIL Working Group. The biopsies were assessed for the average percent of stromal lymphocytes in increments of 5%. Each of the cases was scored by the three pathologists who were blinded to the other’s results. The scores were then tabulated and Kendall’s correlation coefficient was calculated using SPSS software from IBM. Values of Kendall’s concordance less than 0.4 can be considered poor agreement, values between 0.4 and 0.59 are fair, between 0.6 and 0.74 are good, and above 0.75 is excellent agreement. The stromal TIL scores ranged from 1% to 90%. The calculated Kendall’s correlation coefficients varied from 0.704 to 0.762 between the three evaluators. Minor interobserver disagreements were attributed to heterogeneity within the tumor, with alternating areas of relatively scant and dense stromal lymphocytic infiltration. The data show that with adequate training, a high degree of correlation is possible between observers at varying levels of experience on core needle biopsies. Scoring TILs on core needle biopsy may be used as an additional biomarker to estimate a patient’s response to neoadjuvant therapy.
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