Incorporating Molecular Testing for Gliomas Into Clinical Practice

Craig Horbinski, MD, PhD, director of neuropathology in the Department of Pathology, professor of pathology, neurological surgery, and neuropathology, Feinberg School of Medicine at Northwestern University, discusses the classification of gliomas based on histology and molecular features.

The importance of molecular and genetic testing is highlighted in the updated guidelines from the National Comprehensive Cancer Network (NCCN) for patients with central nervous system (CNS) cancers, including glioma, intracranial and spinal ependymomas, medulloblastoma, limited and extensive brain metastases, leptomeningeal metastases, non-AIDS-related primary CNS lymphomas, metastatic spine tumors, meningiomas, and primary spinal cord tumors.

According to Horbinski, molecular and genetic testing provides diagnostic and prognostic information which helps determine individualized treatments for patients with these cancers.

In the video, Horbinski also discusses how these molecular features are already being incorporated into practice, including with next-generation sequencing, whole genome copy number profiling, methylation profiling, genomic DNA methylation profiling, and more.

Transcription:

0:10 | The molecular revolution in pathology and neural pathology, as it concerns brain tumors, has been going on for now, better part of 2 decades. It culminated more recently with the fifth edition of the World Health Organization that was published in 2021. To the greatest extent, we are incorporating molecular features specific molecular features as part of the diagnostic criteria for a lot of tumors, a lot of tumor subtypes. It's gotten to the point where pretty detailed molecular workup is essential, and it's indispensable for routine neurosurgical practice and neuropathology practice.

0:58 | We do it on a routine basis, specifically for all our gliomas or anything we suspect to be a glioma. We run next-generation sequencing, whole genome copy number profiling, methylation profiling, genomic DNA methylation profiling, and integrate those results in with histopathology. If the histopathology says 1 thing or is a little broad in terms of what the differential could ultimately be, we add in the molecular data and then produce an integrated diagnosis.