Article Text
PDF
Abstract
In 2016, the WHO incorporated molecular markers, in addition to histology, into the diagnostic classification of central nervous system (CNS) tumours. This improves diagnostic accuracy and prognostication: oligo-astrocytoma no longer exists as a clinical entity; isocitrate dehydrogenase (IDH) mutant and 1p/19q co-deleted oligodendroglioma is a smaller category with better prognosis; IDH wild-type ‘low-grade’ glioma has a much poorer prognosis; and glioblastoma is divided into IDH mutant (with an better prognosis than pre-2016 glioblastoma) and IDH wild type (with a poorer prognosis). Previous advice based on phenotype alone will change with respect to median survival, best management plan and response to treatment. There are implications for routine neuropathology reporting and future trial design. Cases that are difficult to classify may need more advanced molecular genetic classification through DNA methylation-based classification of CNS tumours (Heidelberg Classifier). We discuss the practical implications.
- tumours
- glioma
- molecular markers
- WHO classification
- IDH
Statistics from Altmetric.com
Footnotes
Correction notice Figure 2 was duplicated as Figure 1. Figure 1 was therefore replaced with the correct version.
Contributors RG conceived the idea of the manuscript. EM developed the design of the manuscript, performed the literature research and drafted the article. OC drafted the figures. RG, EM and OC subsequently implemented and made revisions to the manuscript, the references and the figures. All authors have revised and approved the final manuscript.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned. Externally peer reviewed by Jeremy Rees, London, UK, and Fiona McKevitt, Sheffield, UK.
Read the full text or download the PDF:
Other content recommended for you
- A simple algorithmic approach using histology and immunohistochemistry for the current classification of adult diffuse glioma in a resource-limited set-up
- Isocitrate dehydrogenase mutations in diffuse gliomas: clinical and aetiological implications
- Potential biomarkers and challenges in glioma diagnosis, therapy and prognosis
- Sex-specific aspects of epidemiology, molecular genetics and outcome: primary brain tumours
- Contemporary management of low-grade glioma: a paradigm shift in neuro-oncology
- WT1 expression increases with malignancy and indicates unfavourable outcome in astrocytoma
- Phosphorylated Hsp27 is mutually exclusive with ATRX loss and the IDH1R132H mutation and may predict better prognosis among glioblastomas without the IDH1 mutation and ATRX loss
- Hallmarks of glioblastoma: a systematic review
- TET2 promoter methylation in low-grade diffuse gliomas lacking IDH1/2 mutations
- Gene of the month: IDH1