The role of the pathologist in the diagnosis and therapy planning of central nervous system tumors. Prognostic and predictive markers

Abstract

Despite advances in imaging methods, the standard of diagnosis and treatment of the tumours of the nervous system remains the histological report issued by a neuropathologist. For reliable, definitive diagnosis, close collaboration with other medical professions is essential, correlation of histological findings with clinical and imaging results is necessary. Neuropathology became a subspecialty because of the specific knowledge and experience it requires. In more complex cases consultation with neuropathologists is important to ensure adequate diagnosis and subsequent treatment. In both establishing the diagnosis and treatment planning, the molecular testing of brain tumors becomes more and more important. These tests are reliably available only in larger centers. Out of the molecular markers, in current practice the investigation of codeletion at 1p/19q, IDH mutations, β-katenin nuclear positivity and MGMT methylation gained acceptance. Besides these tests already in practice, a vast array of potential diagnostic and prognostic markers are being investigated, which in the future may assist in delivering better and more individualized therapy.