AOSNP-ADAPTR resource level-based recommendations on practical diagnostic strategies for ependymomas

Ependymomas are uncommon primary tumors of the central nervous system (CNS) that affect both children and adults. In recent years, molecular analyses have identified multiple subtypes of ependymal tumors based on location, patterns of CpG island methylation, and gene fusion events. While this knowledge is highly important in progressing diagnostic precision, prognostication, and effective treatments, an unwanted side effect is that best practice diagnostics are often inaccessible because of cost and technical barriers for many low- or lower middle-income countries. The ADAPTR group (Adapting Diagnostic Approaches for Practical Taxonomy in Resource-Restrained Regions) is an initiative of the Asian Oceanian Society of Neuropathology and aims to provide practical guidelines for CNS tumor diagnostics at various levels of pathology resource restrictions. In this manuscript, we propose a practical approach to the diagnosis of ependymal tumors based on ADAPTR resource levels. These recommendations provide a practical adaptation of World Health Organisation Classification of Tumours of the Central Nervous System guidelines suited to routine diagnosis in resource-restrained regions.