Evalua&on  of  Tumor  Infiltra&ng  Lymphocytes  

(TILs)  in  Lung  Adenocarcinoma  

Guidelines  for  TILs  assessment  from  “Interna4onal  Immuno-­‐Oncology  Biomarker  Working  Group”    

Author:    Gert  van  den  Eynden1  

1-­‐GZA  Hospitals  and  CORE  Antwerp  University,  Antwerp,  Belgium.    

TILs   within   the   borders   of   the  invasive  tumors  are  evaluated    The   invasive   edge   is   included   in  the   evalua4on,   but   not   reported  separately    

Define  area  for  TILs  evalua&on  

Evaluate  TILs  in  this  area  

Exclude  this  area  

TILs   within   the   borders   of   the  invasive  tumors  are  evaluated    The   invasive   edge   is   included   in  the   evalua4on,   but   not   reported  separately    Immune   infiltrates   outside   of   the  tumor  borders  are  not  included    

Define  area  for  TILs  evalua&on  

Evaluate  TILs  in  this  area  

Exlude  this  area  (do  not  include  the  heavy  immune  infiltrates  outside  tumor  border  for  TIL  evalua4on)  

TILs   within   the   borders   of   the   invasive  tumors  are  evaluated    The   invasive   edge   is   included   in   the  evalua4on,  but  not  reported  separately    Immune   infiltrates   outside   of   the   tumor  borders  are  not  included    Areas  with  pure  intra-­‐alveolar  tumor  cell  nests  (‘aerogenic  spread’;  no  desmoplas4c  reac4on)  or  with  pure  lepidic  growth  paUern  (no  desmoplas4c  reac4on)  are  not  included  

Define  area  for  TILs  evalua&on  

Evaluate  TILs  in  this  area  

Exlude  this  area    (the  presence  of  some  ‘aerogenic  spread’  (*)  within  the  area  between  the  thick  and  the  

dashed  line  does  not  make  it  part  of  the  

tumor  area)    *  

*  

TILs   within   the   borders   of   the   invasive  tumors  are  evaluated    The   invasive   edge   is   included   in   the  evalua4on,  but  not  reported  separately    Immune   infiltrates   outside   of   the   tumor  borders  are  not  included    Areas  with  pure  intra-­‐alveolar  tumor  cell  nests  (‘aerogenic  spread’;  no  desmoplas4c  reac4on)  or  with  pure  lepidic  growth  paUern  (no  desmoplas4c  reac4on)  are  not  included  

Define  area  for  TILs  evalua&on  

Evaluate  TILs  in  this  area  

Exlude  this  area    (the  presence  of  some  ‘aerogenic  

spread’  (*)  does  not  make  it  part  of  the  

tumor  area)    *

*  *  

*  

*

*

*

Define  area  for  TILs  evalua&on  

Include  TILs  evalua4on  in  stroma  pertaining  to  fibro-­‐vascular  cores  of  papillary  structures  

Include  TILs  in  this  area  =  stromal  TILs  

Define  area  for  TILs  evalua&on  

Include  TILs  evalua4on  in  stroma  pertaining  to  fibro-­‐vascular  cores  of  papillary  structures  

Define  area  for  TILs  evalua&on  

Include  TILs  evalua4on  in  stroma  pertaining  to  fibro-­‐vascular  cores  of  papillary  structures  

Define  area  for  TILs  evalua&on  

In  cases  with  (par4al)  lepidic  or  intra-­‐alveolar  growth  of  the  carcinoma,  do  not  include  inflammatory  cells  in  intraalveolar  spaces  (oYen  mixed  with  alveolar  macrophages)  

Include  this  area  

Do  not  include  this  area  

•  Areas  of  necrosis  or  fibrosis  are  not  included  in  the  evalua4on  

Define  area  for  TILs  evalua&on  

Do  not  include  TIL    in  this  area  

   

Do  not  include  TIL    in  this  area  

   

Include  TILs  in  this  area  =  stromal  TILs  

 

Include  TILs  in  this  area  =  stromal  TILs  

 

Determine  the  localiza&on  of  inflammatory  infiltrate  

Stromal  TILs  Intraepithelial  TILs  

Determine  type  of  inflammatory  infiltrate  Include  only  mononuclear  infiltrate  (lymphocytes  &  plasma  cells)  

Do  not  include  granulocy4c  infiltrate  in  areas  of  tumor  necrosis  

Determine  type  of  inflammatory  infiltrate  

Include  only  mononuclear  infiltrate  (lymphocytes  &  plasma  cells)  

Do  not  include  granulocy4c  infiltrate  in  areas  of  tumor  necrosis