AOSNP-ADAPTR resource level-based recommendations on practical diagnostic strategies for WHO CNS5 adult-type diffuse...

Area of Science:

• Neuropathology
• Oncology
• Global Health

Background:

• The WHO CNS5 classification integrates molecular data for Adult-type Diffuse Gliomas (ADGs), posing challenges for resource-limited regions.
• Molecular diagnostics are crucial but often inaccessible in Low-Income Countries (LICs) and Lower Middle-Income Countries (LMICs) due to cost and technical barriers.

Purpose of the Study:

• To develop resource-stratified recommendations for diagnosing ADGs in resource-restrained settings.
• To adapt the WHO CNS5 guidelines for practical application in regions with limited diagnostic capabilities.

Main Methods:

• The Asian Oceanian Society of Neuropathology (AOSNP) initiative 'ADAPTR' defined Resource Levels (RLs) from I to V.
• Recommendations were created for a 'Histology-oriented integrated diagnosis format' and diagnostic flow charts for ADGs at different RLs.
• Emphasis was placed on histopathology and immunohistochemistry, with molecular testing recommendations tiered as 'can be considered,' 'highly recommended,' or 'obligatory.'

Main Results:

• ADAPTR provides practical diagnostic approaches for ADGs tailored to varying resource levels (RL I-IV for LMICs).
• Each RL offers either a WHO CNS5 diagnosis with CNS WHO grade or an ADAPTR descriptive diagnosis with an ADAPTR histologic grade.
• The recommendations facilitate diagnosis by prioritizing accessible techniques while outlining the role of molecular testing.

Conclusions:

• ADAPTR offers a feasible adaptation of WHO CNS5 guidelines for routine neuropathology practice in resource-restrained regions.
• These recommendations aim to improve ADG diagnosis and grading in settings facing diagnostic limitations.
• The initiative supports consistent diagnostic practices aligned with global standards despite resource constraints.