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Clinical importance of molecular markers of adult diffuse glioma
  1. Emanuela Molinari1,
  2. Olimpia E Curran2,
  3. Robin Grant3
  1. 1Department of Neurology, Queen Elizabeth University Hospital, Glasgow, UK
  2. 2Neuropathology Unit, Department of Pathology, Western General Hospital, Edinburgh, UK
  3. 3Department of Neurology and Neurosurgery, Western General Hospital, Edinburgh, UK
  1. Correspondence to Dr Robin Grant, Western General Hospital Department of Neurology and Neurosurgery, Edinburgh EH4 2XU, UK; robin.grant{at}


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

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  • 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 Provenance and peer review. Commissioned. Externally peer reviewed by Jeremy Rees, London, UK, and Fiona McKevitt, Sheffield, UK.