The role of neuropathology in the management of newly diagnosed glioblastoma: a systematic review and evidence-based clinical practice guideline

AbstractTarget PopulationThese recommendations apply to adult patients with newly diagnosed or suspected glioblastoma (GBM)QuestionFor adult patients with newly diagnosed GBM does testing forIsocitrate Dehydrogenase 1 or2 (IDH1/2) mutations afford benefit beyond standard histopathology in providing accurate classification and outcome prognostication?Level IIIIDH1/2 mutational status by immunohistochemistry (IHC) and/or sequencing is suggested for classification and prognostic information.Level III Non-canonicalIDH1/2 mutations are very rare in patients aged 55 or older and universal testing of variant mutations by sequence analysis is not suggested for this age range.QuestionFor adult patients with lower grade infiltrating astrocytomas (WHO grades II and III) can the IDH-wildtype status designation supersede histopathology to predict prognosis and biologic relevance to eventual behavior as a GBM?Level III The designation of infiltrating astrocytomas (WHO grades II and III) as IDH-wildtype is not suggested as sufficient for a higher grade designation alone.Level III It is suggested that IDH-wildtype WHO grades II and III astrocytomas be tested for molecular-genetic alterations typical of IDH-wildtype GBM such asEGFR amplification, gain of chromosome 7/loss of chromosome 10 andTERT-p mutation to substantiate prediction of behavior similar to IDH-wildtype glioblastoma.Level III It is suggested that a diagnosis of diffuse astrocytic glioma, IDH-wildtype, with molecular features o...
Source: Journal of Neuro-Oncology - Category: Cancer & Oncology Source Type: research