Diffuse Astrocytoma and Oligodendroglioma: An Integrated Diagnosis and Management

Abstract

For the first time, the WHO classification of brain tumors has introduced molecular parameters in the diagnosis of brain tumors. Together with embryonal tumors, the diffuse gliomas have suffered significant changes in diagnosis, prognosis, and response to treatment. A new concept of "integrated diagnosis" comes to combine the classical diagnosis with the molecular one. While it is still impossible to disregard the histopathological component, according to the new rule ("molecular beats histology") makes molecular parameters dominant in the final diagnosis. Currently, the diffuse gliomas (oligodendroglial or astrocytic) are nosologically closer than the astrocytomas with a diffuse growth pattern, and the astrocytomas with a more circumscribed growth pattern defined by the presence of the IDH mutation. The family tree was redefined by the presence of the IDH mutation and of the 1p/19q codeletion. The implementation of this new concept in clinical practice will improve patient management, as well as the design of clinical trials and experimental studies. This must also be seen as a model for diagnosis setting in the new molecular era.

High-order radiomics features based on T2 FLAIR MRI predict multiple glioma immunohistochemical features: A more precise and personalized gliomas management

“…However, the first step is to validate if the radiomics is effective in identifying the molecular biomarkers. So in the current study, we try to use radiomics features to initially identify four markers of Ki-67, vimentin, S-100 and CD34, which are histological markers recommended in several gliomas diagnosis [9,10,20,46]. In the Ki-67, S-100, vimentin and CD34 radiomics models established in this study, GLCM and RLM were significant predictive features, their radiomics map showed significantly different distribution in Fig 8. The Ki-67 expression of case i was different from case ii and iii, and the GLCM and RLM also showed differences.…”

“…The WHO 2016 classification of CNS tumors also introduces both of the phenotype and the genotype into daily diagnosis and makes it possible to lead a more precise diagnosis of the various entities toward a personalized management of brain tumors. Besides the genomic markers mentioned in the WHO 2016, the concept of molecular diagnosis also promotes immunohistochemical assays to involve more molecular biomarkers besides those for traditional gliomas grading, leading to more precise pathological subtype and better prognostic prediction [9,10]. In recent years, great progress was obtained in the molecular pathology of neuro-tumors and a series of molecular markers have been found to be helpful in the clinical differential diagnosis and prognosis predicting of gliomas, among which Ki-67, vimentin, CD34 and S-100 are four vital biological behavior biomarkers [11][12][13][14][15].…”

“…Vimentin is often co-stained with GFAP, Ki-67 and P53 for diffuse astrocytoma as its enhancement factors for cell motility and invasion [17], high vimentin expression could be taken as a prognostic factor for treatment difficulty or poor survival [12,18]. S-100 is quite useful in the diagnosis of poorly differentiated tumors thus is often involved in most of glioblastomas immunohistological diagnosis [10]. CD34 is popular as a vessel marker and is demonstrated to regulate the glioma angiogenesis and could help gliomas grading [19].…”