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- Title
The role of neuropathology in the management of patients with diffuse low grade glioma.
- Authors
Cahill, Daniel; Sloan, Andrew; Nahed, Brian; Aldape, Kenneth; Louis, David; Ryken, Timothy; Kalkanis, Steven; Olson, Jeffrey
- Abstract
Target population: Adult patients (age ≥18 years) who have suspected low-grade diffuse glioma. Question: What are the optimal neuropathological techniques to diagnose low-grade diffuse glioma in the adult? Recommendation: Level I: Histopathological analysis of a representative surgical sample of the lesion should be used to provide the diagnosis of low-grade diffuse glioma. Level III: Both frozen section and cytopathologic/smear evaluation should be used to aid the intra-operative assessment of low-grade diffuse glioma diagnosis. A resection specimen is preferred over a biopsy specimen, to minimize the potential for sampling error issues. Target population: Patients with histologically-proven WHO grade II diffuse glioma. Question: In adult patients (age ≥18 years) with histologically-proven WHO grade II diffuse glioma, is testing for IDH1 mutation (R132H and/or others) warranted? If so, is there a preferred method? Recommendation: Level II: IDH gene mutation assessment, via IDH1 R132H antibody and/or IDH1/2 mutation hotspot sequencing, is highly-specific for low-grade diffuse glioma, and is recommended as an additional test for classification and prognosis. Target population: Patients with histologically-proven WHO grade II diffuse glioma. Question: In adult patients (age ≥18 years) with histologically-proven WHO grade II diffuse glioma, is testing for 1p/19q loss warranted? If so, is there a preferred method? Recommendation: Level III: 1p/19q loss-of-heterozygosity testing, by FISH, array-CGH or PCR, is recommended as an additional test in oligodendroglial cases for prognosis and potential treatment planning. Target population: Patients with histologically-proven WHO grade II diffuse glioma. Question: In adult patients (age ≥18 years) with histologically-proven WHO grade II diffuse glioma, is MGMT promoter methylation testing warranted? If so, is there a preferred method? Recommendation: There is insufficient evidence to recommend methyl-guanine methyl-transferase (MGMT) promoter methylation testing as a routine for low-grade diffuse gliomas. It is recommended that patients be enrolled in properly designed clinical trials to assess the value of this and related markers for this target population. Target population: Patients with histologically-proven WHO grade II diffuse glioma. Question: In adult patients (age ≥18 years) with histologically-proven WHO grade II diffuse glioma, is Ki-67/MIB1 immunohistochemistry warranted? If so, is there a preferred method to quantitate results? Recommendation: Level III: Ki67/MIB1 immunohistochemistry is recommended as an option for prognostic assessment.
- Subjects
NEUROLOGICAL disorders; GLIOMAS; GLIOMA treatment; HISTOPATHOLOGY; BIOPSY; PATIENTS; DIAGNOSIS
- Publication
Journal of Neuro-Oncology, 2015, Vol 125, Issue 3, p531
- ISSN
0167-594X
- Publication type
Article
- DOI
10.1007/s11060-015-1909-8