神经病理在弥漫性低级别胶质瘤治疗中的作用：系统性回顾和证据支持的临床实践指南
The role ofneuropathology in the management of patients with diffuse low grade glioma: Asystematic review and evidence-based clinical practice guideline.
J Neurooncol. 2015Dec;125(3):531-49
写在前面：胶质瘤的众多分子生物学检测，看来不是每个都是必须的。我们不是巴菲特，我们中国人都缺钱，所以拒绝一股脑儿的全都检测才是上策！
●目标人群：≥18岁的成人疑似低级别弥漫性胶质瘤
？问题：确诊成人低级别弥漫性胶质瘤最适当的神经病理学技术是什么？
！建议：
1. 对有代表性的外科切除的病变标本，进行组织病理学分析的结果，应当被用来提供低级别弥漫性胶质瘤的诊断（LEVEL I）。
2. 冰冻切片和细胞病理学分析/涂片一起，应当被用来帮助术中诊断低级别弥漫性胶质瘤。切除的标本优于活检标本，能降低潜在的取样误差（LEVEL III）。
●目标人群：组织学上已经被确诊为WHO 2级弥漫性胶质瘤。
？问题：成人（≥18岁）组织学上确诊的WHO2级弥漫性胶质瘤是否必须要检测IDH1突变？如果需要，那么最合适的方法是？
！建议：通过IDH1 R132H抗体和或IDH1/2突变热点测序得IDH基因突变评价是低级别弥漫性胶质瘤高度特异性的检查。推荐作为低级别胶质瘤分类和诊断的附加检查（LEVEL II）。
●目标人群：组织学上确诊的 WHO2级弥漫性胶质瘤。
？问题：组织学上确诊的 成人（≥18岁的）WHO2级弥漫性胶质瘤，1p/19q缺失是否作为必须的检查？如果是，哪种方法最好？
！建议：1p/19q杂合性缺失检测，可通过FISH，阵列-CGH或PCR等方法来检测，建议作为判断少枝胶质细胞肿瘤预后和选择治疗方案时使用（LEVEL III）。
●目标人群：组织学上确诊的WHO2级弥漫性胶质瘤
？问题：组织学上确诊的 成人（≥18岁的）WHO2级弥漫性胶质瘤，MGMT启动子甲基化检测是否必须？如果是，怎样的检测方法最好？
！建议：没有足够的证据来推荐将MGMT启动子甲基化检测作为低级别弥漫性胶质瘤的常规检查。只推荐那些参加适当设计的临床试验的群体来做此类检测。
●目标人群：组织学上确诊的WHO2级弥漫性胶质瘤
？问题：组织学上确诊的 成人（≥18岁的）WHO2级弥漫性胶质瘤，Ki-67/MIB1免疫组化检测是否必须？如果是，哪种方法最合适？
！建议：Ki67/MIB1免疫组化检查在用来评价预后方面是值得推荐的（LEVEL III）。
JNeurooncol. 2015 Dec;125(3):531-49. doi: 10.1007/s11060-015-1909-8. Epub 2015Nov 3.
Therole of neuropathology in the management of patients with diffuse low gradeglioma: A systematic review and evidence-based clinical practice guideline.
CahillDP1, Sloan AE2, Nahed BV3, Aldape KD4, Louis DN5, Ryken TC6, Kalkanis SN7,Olson JJ8.
Authorinformation
Abstract
TARGETPOPULATION:
Adultpatients (age ≥18 years) who have suspected low-grade diffuse glioma.
QUESTION:
Whatare the optimal neuropathological techniques to diagnose low-grade diffuseglioma in the adult?
RECOMMENDATION:
LEVELI: Histopathological analysis of a representative surgical sample of the lesionshould be used to provide the diagnosis of low-grade diffuse glioma.
LEVELIII:
Bothfrozen section and cytopathologic/smear evaluation should be used to aid theintra-operative assessment of low-grade diffuse glioma diagnosis. A resectionspecimen is preferred over a biopsy specimen, to minimize the potential forsampling error issues.
TARGETPOPULATION:
Patientswith histologically-proven WHO grade II diffuse glioma.
QUESTION:
Inadult patients (age ≥18 years) with histologically-proven WHO grade II diffuse glioma, istesting for IDH1 mutation (R132H and/or others) warranted? If so, is there apreferred method?
RECOMMENDATION:
LEVELII:
IDHgene mutation assessment, via IDH1 R132H antibody and/or IDH1/2 mutationhotspot sequencing, is highly-specific for low-grade diffuse glioma, and isrecommended as an additional test for classification and prognosis.
TARGETPOPULATION:
Patientswith histologically-proven WHO grade II diffuse glioma.
QUESTION:
Inadult patients (age ≥18 years) with histologically-proven WHO grade II diffuse glioma, istesting for 1p/19q loss warranted? If so, is there a preferred method?
RECOMMENDATION:
LEVELIII:
1p/19qloss-of-heterozygosity testing, by FISH, array-CGH or PCR, is recommended as anadditional test in oligodendroglial cases for prognosis and potential treatmentplanning.
TARGETPOPULATION:
Patientswith histologically-proven WHO grade II diffuse glioma.
QUESTION:
Inadult patients (age ≥18 years) with histologically-proven WHO grade II diffuse glioma, isMGMT promoter methylation testing warranted? If so, is there a preferredmethod?
RECOMMENDATION:
Thereis insufficient evidence to recommend methyl-guanine methyl-transferase (MGMT)promoter methylation testing as a routine for low-grade diffuse gliomas. It isrecommended that patients be enrolled in properly designed clinical trials toassess the value of this and related markers for this target population.
TARGETPOPULATION:
Patientswith histologically-proven WHO grade II diffuse glioma.
QUESTION:
Inadult patients (age ≥18 years) with histologically-proven WHO grade II diffuse glioma, isKi-67/MIB1 immunohistochemistry warranted? If so, is there a preferred methodto quantitate results?
RECOMMENDATION:
LEVELIII:
Ki67/MIB1immunohistochemistry is recommended as an option for prognostic assessment.
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