Diffuse gliomas to date and beyond 2016 WHO Classification of Tumours of the Central Nervous System
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INVITED REVIEW ARTICLE
Diffuse gliomas to date and beyond 2016 WHO Classification of Tumours of the Central Nervous System Hiromi Onizuka1,2 · Kenta Masui2 · Takashi Komori3 Received: 25 January 2020 / Accepted: 16 April 2020 © Japan Society of Clinical Oncology 2020
Abstract The updated 2016 World Health Organization (WHO) Classification of Tumours of the Central Nervous System (CNS) has incorporated molecular parameters into pathological diagnosis, for the first time in the molecular era. While it has led to the more precise diagnoses of well-understood entities and the better comprehension of less-understood entities, its practical application has also created some concerns whether or not genotypes predominate over phenotypes in tumor diagnostics. In response to these concerns, the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy–Not Official WHO (cIMAPCT-NOW) was established under the sponsorship of the International Society of Neuropathology to provide a forum to evaluate and recommend proposed changes to future CNS tumor classifications. cIMPACT has thus far published five updates on the proposal and clarification of existing and new terms and entities. Also, recent studies have shown that WHO grading based on histology has lost its prognostic relevance, which necessitates novel, improved grading criteria. We herein highlight the current status of clinical application of WHO 2016 classification and cIMPACT proposals, and the future endeavor to incorporate DNA methylation profiling of the CNS tumors for better clinical decision-making to achieve a goal of precision medicine for each patient with brain tumors. Keywords 2016 WHO CNS · cIMPACT-NOW · Diffuse gliomas · Pediatric-type gliomas · WHO grading (3–6 words)
Introduction For the past century, the classification of brain tumors has been based largely on concepts of histogenesis and tumors have been classified according to their microscopic similarities with their putative cells of origin. However, the classical * Hiromi Onizuka [email protected] Kenta Masui masui‑[email protected] Takashi Komori komori‑[email protected] 1
Department of Surgical Pathology, Tokyo Women’s Medical University Hospital, 8‑1 Kawada‑cho, Shinjuku‑ku, Tokyo 162‑8666, Japan
2
Division of Pathological Neuroscience, Department of Pathology, Tokyo Women’s Medical University, 8‑1 Kawada‑cho, Shinjuku‑ku, Tokyo 162‑8666, Japan
3
Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, 2‑6‑1 Musashidai, Fuchu, Tokyo 183‑0042, Japan
morphology-based diagnostics of the tumor has reached a limit by the discoveries of tumor entities containing multilineage cell population, which has not matched the conventional tumor classification model and grading system.[1–3]. Studies over the past two decades with the emergence of next-generation sequencing (NGS) technique have clarified the genetic basis of tumorigenesis in the common and some rarer brain tumor entities, raising the possibility that such
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