Pathology Unit, Department of Medical Sciences, University of Turin and Città Della Salute E Della Scienza University Hospital, Via Santena 7, 10126, Turin, Italy.
Department of Neuropathology, Heidelberg University Hospital, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.
Virchows Arch. 2024 Feb;484(2):181-194. doi: 10.1007/s00428-023-03632-4. Epub 2023 Sep 2.
Molecular profiling has transformed the diagnostic workflow of CNS tumors during the last years. The latest WHO classification of CNS tumors (5th edition), published in 2021, pushed forward the integration between histopathological features and molecular hallmarks to achieve reproducible and clinically relevant diagnoses. To address these demands, pathologists have to appropriately deal with multiple molecular assays mainly including DNA methylation profiling and DNA/RNA next generation sequencing. Tumor classification by DNA methylation profiling is now a critical tool for many diagnostic tasks in neuropathology including the assessment of complex cases, to evaluate novel tumor types and to perform tumor subgrouping in hetereogenous entities like medulloblastoma or ependymoma. DNA/RNA NGS allow the detection of multiple molecular alterations including single nucleotide variations, small insertions/deletions (InDel), and gene fusions. These molecular markers can provide key insights for diagnosis, for example, if a tumor-specific mutation is detected, but also for treatment since targeted therapies are progressively entering the clinical practice. In the present review, a brief, but comprehensive overview of these tools will be provided, discussing their technical specifications, diagnostic value, and potential limitations. Moreover, the importance of molecular profiling will be shown in a representative series of CNS neoplasms including both the most frequent tumor types and other selected entities for which molecular characterization plays a critical role.
分子谱分析在过去几年中改变了中枢神经系统肿瘤的诊断工作流程。2021 年发布的最新版《世界卫生组织中枢神经系统肿瘤分类》(第 5 版)推动了病理组织学特征与分子标志物的融合,以实现可重复和具有临床相关性的诊断。为了满足这些需求,病理学家必须妥善处理多种分子检测方法,主要包括 DNA 甲基化谱分析和 DNA/RNA 下一代测序。通过 DNA 甲基化谱分析进行肿瘤分类,现在是神经病理学许多诊断任务的重要工具,包括评估复杂病例、评估新肿瘤类型以及对像髓母细胞瘤或室管膜瘤这样的异质性实体进行肿瘤亚组分类。DNA/RNA NGS 可以检测多种分子改变,包括单核苷酸变异、小插入/缺失(InDel)和基因融合。这些分子标志物可以为诊断提供关键信息,例如,如果检测到肿瘤特异性突变,也可以为治疗提供信息,因为靶向治疗正在逐步进入临床实践。在本次综述中,将简要但全面地介绍这些工具,讨论它们的技术规格、诊断价值和潜在的局限性。此外,还将通过一系列具有代表性的中枢神经系统肿瘤来展示分子谱分析的重要性,包括最常见的肿瘤类型和其他选择的实体,这些实体的分子特征起着关键作用。
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