ArticleModern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc2021
Interobserver variability in the assessment of stromal tumor-infiltrating lymphocytes (sTILs) in triple-negative invasive breast carcinoma influences the association with pathological complete response: the IVITA study.
Article in Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
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Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Automated scoring methods for quantitative interpretation of Tumour infiltrating lymphocytes (TILs) in breast cancer: a systematic review.BMC cancer · 2024Pooled it
- Artificial intelligence-powered spatial analysis of tumor microenvironment in patients with non-small cell lung cancer with acquired resistance to EGFR tyrosine kinase inhibitor.Journal for immunotherapy of cancer · 2025Trial
- Longitudinal evaluation of tumor-infiltrating lymphocyte scoring using automated region of interest registration in breast cancer.Breast cancer research : BCR · 2026Article
- Analysis of computational tumor-infiltrating lymphocytes in breast cancer from the results of the TIGER challenge.Nature communications · 2026Article
- Estimating tumour immune infiltration: methodological convergence across histology and spatial technologies.Briefings in bioinformatics · 2026Review
- Level of estrogen receptor expression, histological grade, and computationally assessed stromal TILs on pre-treatment biopsies predict pathological complete response to neoadjuvant chemotherapy in ER-positive/HER2-negative breast cancer.Virchows Archiv : an international journal of pathology · 2026Article
- Deep learning-driven recognition of panoramic tumor microenvironment features in H&E sections and its application.Journal for immunotherapy of cancer · 2026Review
- TILseg: Automated Whole Slide-Level Spatial Scoring of Tumor-Infiltrating Lymphocytes Reveals Prognostic Patterns in Triple Negative Breast Cancer.medRxiv : the preprint server for health sciences · 2026Article
- Integration of Gene Expression and Digital Histology to Predict Treatment-Specific Responses in Breast Cancer.medRxiv : the preprint server for health sciences · 2025Article
- A New Tool to Decrease Interobserver Variability in Biomarker Annotation in Solid Tumor Tissue for Spatial Transcriptomic Analysis.Current issues in molecular biology · 2025Article
- High tumor expression of CTLA4 identifies lymph node-negative basal-like breast cancer patients with excellent prognosis.Communications medicine · 2025Article
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- Prediction and analysis of tumor infiltrating lymphocytes across 28 cancers by TILScout using deep learning.NPJ precision oncology · 2025Article
- Risk perception of patients with ductal carcinomaHistology and histopathology · 2025Review
- Clinico-pathological factors predicting pathological response in early triple-negative breast cancer.NPJ breast cancer · 2025Article
- Targeting low-risk triple-negative breast cancer: a review on de-escalation strategies for a new era.Translational breast cancer research : a journal focusing on translational research in breast cancer · 2025Review
- The Potential Diagnostic Application of Artificial Intelligence in Breast Cancer.Current pharmaceutical design · 2025Review
- Enhancing AI Research for Breast Cancer: A Comprehensive Review of Tumor-Infiltrating Lymphocyte Datasets.Journal of imaging informatics in medicine · 2024Review
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Abstract
High stromal tumor-infiltrating lymphocytes (sTILs) in triple-negative breast cancer (TNBC) are associated with pathological complete response (pCR) after neoadjuvant chemotherapy (NAC). Histopathological assessment of sTILs in TNBC biopsies is characterized by substantial interobserver variability, but it is unknown whether this affects its association with pCR. Here, we aimed to investigate the degree of interobserver variability in an international study, and its impact on the relationship between sTILs and pCR. Forty pathologists assessed sTILs as a percentage in digitalized biopsy slides, originating from 41 TNBC patients who were treated with NAC followed by surgery. Pathological response was quantified by the MD Anderson Residual Cancer Burden (RCB) score. Intraclass correlation coefficients (ICCs) were calculated per pathologist duo and Bland-Altman plots were constructed. The relation between sTILs and pCR or RCB class was investigated. The ICCs ranged from -0.376 to 0.947 (mean: 0.659), indicating substantial interobserver variability. Nevertheless, high sTILs scores were significantly associated with pCR for 36 participants (90%), and with RCB class for eight participants (20%). Post hoc sTILs cutoffs at 20% and 40% resulted in variable associations with pCR. The sTILs in TNBC with RCB-II and RCB-III were intermediate to those of RCB-0 and RCB-I, with lowest sTILs observed in RCB-I. However, the limited number of RCB-I cases precludes any definite conclusions due to lack of power, and this observation therefore requires further investigation. In conclusion, sTILs are a robust marker for pCR at the group level. However, if sTILs are to be used to guide the NAC scheme for individual patients, the observed interobserver variability might substantially affect the chance of obtaining a pCR. Future studies should determine the 'ideal' sTILs threshold, and attempt to fine-tune the patient selection for sTILs-based de-escalation of NAC regimens. At present, there is insufficient evidence for robust and reproducible sTILs-guided therapeutic decisions.
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