Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Neurol India. 2019 Jan-Feb;67(1):173-182. doi: 10.4103/0028-3886.253572.
Recent advances in the molecular biology of adult diffuse gliomas have brought about a paradigm shift in their diagnostic criteria, as witnessed in the World Health Organization (WHO) 2016 guidelines for central nervous system tumors. It is now mandatory to perform several molecular tests to reach a definitive integrated diagnosis in most of the cases. This comes with additional cost and higher turnaround time, which is not always affordable in developing countries like India. In addition, the non-uniform distribution of advanced research and diagnostic testing centers adds to the difficulty.
The Indian Society of Neuro-oncology (ISNO) multidisciplinary expert panel consisting of neuropathologists, neurosurgeons, and radiation/medical oncologists convened to prepare the national consensus guidelines for approach to diagnosis of adult diffuse gliomas.
Algorithms for arriving at an integrated diagnosis of adult diffuse gliomas predominantly using immunohistochemistry and with minimum possible additional molecular testing were agreed upon, thus addressing the problems of cost, accessibility, and turnaround time. Mandatory and optional tests were proposed for each case scenario.
This document represents the consensus of the various neuro-oncology disciplines involved in diagnosis and management of patients with adult diffuse gliomas. The article reflects a practical adaptation of the WHO recommendations to suit a resource constrained setup.
近年来，成人弥漫性脑胶质瘤的分子生物学研究取得了进展，这导致其诊断标准发生了范式转变，这在 2016 年世界卫生组织（WHO）中枢神经系统肿瘤分类中可见一斑。现在，在大多数情况下，为了做出明确的综合诊断，必须进行多项分子检测。这会带来额外的成本和更长的周转时间，而在印度等发展中国家，这并不总是负担得起的。此外，高级研究和诊断检测中心的分布不均也增加了难度。
印度神经肿瘤学会（ISNO）多学科专家小组由神经病理学家、神经外科医生和放射/肿瘤内科医生组成，他们召开会议制定了成人弥漫性脑胶质瘤诊断方法的国家共识指南。
我们达成了使用免疫组织化学进行成人弥漫性脑胶质瘤综合诊断的算法，尽可能减少额外的分子检测，从而解决了成本、可及性和周转时间的问题。为每种情况提出了强制性和选择性测试。
本文代表了参与成人弥漫性脑胶质瘤诊断和治疗的各个神经肿瘤学科的共识。本文反映了对 WHO 建议的实际改编，以适应资源有限的情况。
