Читать книгу Intracranial Gliomas Part II - Adjuvant Therapy - Группа авторов - Страница 40

It has been demonstrated that “integrated diagnosis” according to the ISN-Haarlem consensus guidelines reduces interobserver variability and provides markedly improved prognostic accuracy both with regard to PFS and overall survival of patients with diffusely infiltrating gliomas [12]. Nevertheless, although it may suggest a future method for glioma classification, several important issues must be resolved before widespread application of this scheme [4]. First, the optimal balance between morphological and genetic characteristics of the tumor should be defined, since full disregard of well-established histological parameters (e.g., microvascular proliferation and necrosis as prognostic factors) in favor of molecular diagnosis alone does not seem reasonable at all [9]. Second, it is obvious that at present the molecular features of different brain tumors are still not sufficiently understood to allow creation of a complete map of gliomas [4, 37]. Third, currently many parameters of genetic testing and cut-off values are not internationally standardized [14, 53]. For example, 1p/19q co-deletion may be effectively detected both with FISH and with PCR, and while concordance between these methods is high (93%) it is not absolute [6]. Fourth, molecular testing is not readily available in many centers worldwide, even in well-developed countries. For medical practitioners working in developing countries establishment of surrogate markers of genetic analysis using IHC of formalin-fixed paraffin-embedded tissue is highly warranted [4]. Finally, historical data usually lack genetic information, thus cannot be used for direct comparisons with samples classified according to the new scheme. Therefore, some transitional period from cell lineage-oriented to genotype-based, and further to mutational pathways-related classification of gliomas is absolutely necessary [79].