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The 2021 WHO classification of central nervous system tumors: what neurologists need to know

Pouya Jamshidi1, Daniel J Brat

  • 1Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Current Opinion in Neurology
|October 13, 2022
PubMed
Abstract

Insights

The WHO CNS-5 classification revolutionizes brain tumor diagnosis with molecular insights. This update aids neurologists in personalized treatment and clinical trial enrollment for better outcomes.

Area of Science:

  • Neuro-oncology
  • Molecular Pathology
  • Genomics

Background:

  • The World Health Organization (WHO) Classification of Tumours, Central Nervous System Tumours, Fifth Edition (WHO CNS-5) represents a significant advancement in brain tumor classification.
  • This revision integrates molecular data, reflecting a deeper understanding of brain tumors as distinct biological entities.

Approach:

  • This review highlights key changes in the WHO CNS-5, focusing on their clinical relevance for practicing neurologists.
  • The classification emphasizes molecular genetic alterations for more objective and reproducible diagnoses.

Key Points:

  • Diffuse gliomas are now stratified into adult and pediatric types, with adult types simplified based on IDH and 1p/19q status and molecular grading.
  • Meningioma is unified as a single tumor type with enhanced correlation between molecular alterations, location, morphology, and grade.
  • Ependymomas are classified using an integrated approach combining anatomical location, histopathology, and molecular alterations.
  • New tumor types are recognized, grouped by distinctive molecular characteristics.

Conclusions:

  • The WHO CNS-5 classification facilitates individualized treatment strategies by providing objective, molecular-based diagnoses.
  • This molecular approach enables the enrollment of homogenous patient populations into clinical trials, accelerating the discovery of novel therapeutics.

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