Versatile, accessible cross-platform molecular profiling of central nervous system tumors: web-based, prospective multi-center validation

Abstract

The 2021 WHO classification underscores the importance of molecular data integration in Central Nervous System (CNS) tumor diagnostics. However, currently used assays have disadvantages due to technical complexity, required equipment and reagent cost, as well as lengthy turnaround times. In response to these challenges, we introduce Rapid-CNS2 and MNP-Flex. Rapid-CNS2, an adaptive sampling-based nanopore sequencing workflow, offers real-time methylation classification and DNA copy-number information within a 30-minute window, suitable for intra-operative settings, followed by comprehensive molecular profiling within 24 h, covering the complete spectrum of diagnostically and therapeutically relevant information for the respective entity. We have prospectively validated Rapid-CNS2 in a multi-center setting on 223 samples. For even more widespread use of methylation-based CNS tumor classification, we developed MNP-Flex, a platform-agnostic methylation classifier encompassing 184 CNS tumor classes. MNP-flex achieved 92% accuracy across a global validation cohort of 78,000 samples spanning five different technologies. These innovations represent a significant advancement in CNS tumor diagnostics, making rapid, actionable molecular insights more widely and more rapidly available, which is crucial for personalized treatment strategies. Their integration streamlines the diagnostic process, broadening access to accurate molecular classification and promising improved patient outcomes in neurooncology on a global scale. MNP-Flex is available as a web-service https://mnp-flex.org and the Rapid-CNS2 workflow is available on Github.