Louis David N, Perry Arie, Burger Peter, Ellison David W, Reifenberger Guido, von Deimling Andreas, Aldape Kenneth, Brat Daniel, Collins V Peter, Eberhart Charles, Figarella-Branger Dominique, Fuller Gregory N, Giangaspero Felice, Giannini Caterina, Hawkins Cynthia, Kleihues Paul, Korshunov Andrey, Kros Johan M, Beatriz Lopes M, Ng Ho-Keung, Ohgaki Hiroko, Paulus Werner, Pietsch Torsten, Rosenblum Marc, Rushing Elisabeth, Soylemezoglu Figen, Wiestler Otmar, Wesseling Pieter
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Brain Pathol. 2014 Sep;24(5):429-35. doi: 10.1111/bpa.12171. Epub 2014 Sep 10.
Major discoveries in the biology of nervous system tumors have raised the question of how non-histological data such as molecular information can be incorporated into the next World Health Organization (WHO) classification of central nervous system tumors. To address this question, a meeting of neuropathologists with expertise in molecular diagnosis was held in Haarlem, the Netherlands, under the sponsorship of the International Society of Neuropathology (ISN). Prior to the meeting, participants solicited input from clinical colleagues in diverse neuro-oncological specialties. The present "white paper" catalogs the recommendations of the meeting, at which a consensus was reached that incorporation of molecular information into the next WHO classification should follow a set of provided "ISN-Haarlem" guidelines. Salient recommendations include that (i) diagnostic entities should be defined as narrowly as possible to optimize interobserver reproducibility, clinicopathological predictions and therapeutic planning; (ii) diagnoses should be "layered" with histologic classification, WHO grade and molecular information listed below an "integrated diagnosis"; (iii) determinations should be made for each tumor entity as to whether molecular information is required, suggested or not needed for its definition; (iv) some pediatric entities should be separated from their adult counterparts; (v) input for guiding decisions regarding tumor classification should be solicited from experts in complementary disciplines of neuro-oncology; and (iv) entity-specific molecular testing and reporting formats should be followed in diagnostic reports. It is hoped that these guidelines will facilitate the forthcoming update of the fourth edition of the WHO classification of central nervous system tumors.
诸如分子信息等非组织学数据如何能够纳入世界卫生组织（WHO）下一次中枢神经系统肿瘤分类中。为解决这一问题，在国际神经病理学会（ISN）的赞助下，一场由分子诊断领域专家神经病理学家参加的会议在荷兰哈勒姆召开。会议召开前，与会者征求了不同神经肿瘤学专业临床同事的意见。这份“白皮书”列出了会议的建议，会上达成了一项共识，即将分子信息纳入下一次WHO分类应遵循一套既定的“ISN哈勒姆”指南。主要建议包括：（i）诊断实体应尽可能狭义地定义，以优化观察者间的可重复性、临床病理预测和治疗规划；（ii）诊断应采用“分层”方式，组织学分类、WHO分级和分子信息列于“综合诊断”之下；（iii）应针对每个肿瘤实体确定其定义是否需要、建议或不需要分子信息；（iv）一些儿科实体应与其成人对应实体分开；（v）应征求神经肿瘤学互补学科专家对肿瘤分类指导决策的意见；以及（iv）诊断报告应遵循特定实体的分子检测和报告格式。希望这些指南将有助于即将到来的WHO中枢神经系统肿瘤分类第四版的更新。
