PD-L1 expression assessment in Angiosarcoma improves with artificial intelligence support.

Journal: Journal of pathology informatics
Published Date: Aug 1, 2025

Abstract

Tumoral PD-L1 expression is assessed to weigh immunotherapy options in the treatment of various types of cancer. To determine PD-L1 expression, each tumor cell needs to be assessed to calculate the percentage of PD-L1 positive tumor cells, called tumor proportion score (TPS). Pathologists cannot evaluate each cell individually due to time constraints and thus need to approximate TPS, which has been shown to result in low concordance rates. Decision quality could be improved by an AI-based TPS prediction tool which serves as a "second opinion". Establishing such a tool requires a certain amount of training data, which manifests a bottleneck for rare cancer types such as Angiosarcoma. To address this challenge, we developed and open sourced a pipeline that leverages pre-trained and generalist models to achieve strong TPS prediction performance on limited data. Pathologists were asked to reassess patients for which their TPS strongly disagreed with the AI's prediction. In many of these cases, pathologists updated their TPS score, improving their assessment, thus demonstrating the technical feasibility and practical value of AI-based TPS scoring assistance for rare cancers.

Authors

  • F H Reith
    Max Delbrück Center for Molecular Medicine in the Helmholtz Association.
  • A Jarosch
    Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Pathology, Berlin, Germany.
  • J P Albrecht
    Max Delbrück Center for Molecular Medicine in the Helmholtz Association.
  • F Ghoreschi
    Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Dermatology, Berlin, Germany.
  • A Flörcken
    Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Hematology, Oncology, and Tumor Immunology, Berlin, Germany.
  • A Dörr
    Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Hematology, Oncology, and Tumor Immunology, Berlin, Germany.
  • S Roohani
    German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
  • F M Schäfer
    Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute for Radiology, Berlin, Germany.
  • R Öllinger
    Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Surgery, Experimental Surgery, Berlin, Germany.
  • S Märdian
    Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
  • K Tielking
    Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Pathology, Berlin, Germany.
  • P Bischoff
    Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Pathology, Berlin, Germany.
  • N Frühauf
    Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Hematology, Oncology, and Tumor Immunology, Berlin, Germany.
  • F Brandes
    Inselspital, Bern University Hospital, University of Bern, Department of Medical Oncology, Bern, Switzerland.
  • D Horst
    Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Pathology, Berlin, Germany.
  • C Sers
    Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Pathology, Berlin, Germany.
  • D Kainmüller
    Max Delbrück Center for Molecular Medicine in the Helmholtz Association.

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