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 NI FEATURE: PATHOLOGY PANORAMA - COMMENTARY
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 173--182

ISNO consensus guidelines for practical adaptation of the WHO 2016 classification of adult diffuse gliomas


1 Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
2 Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
3 Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
4 Department of Neurosurgery, King Edward Memorial Hospital, Mumbai, Maharashtra, India
5 Department of Neuropathology, Christian Medical College, Vellore, Tamil Nadu, India
6 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
7 Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
8 Department of Neurosurgery, Yashoda Superspeciality Hospitals, Secunderabad, Telangana, India
9 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
10 Department of Neurosurgery, Park Clinic, Kolkata, West Bengal, India
11 Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India

Correspondence Address:
Prof. Vani Santosh
Department of Neuropathology, NIMHANS, Bangalore - 560 029, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.253572

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Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.






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