Methylome Profiling of Cartilage Tumors: A Promising New Diagnostic Tool?

DNA methylation and copy number variation (CNV) profiling has emerged as a promising tool for the classification of bone and soft tissue tumors. We evaluated its utility in cartilage tumors, where distinguishing low-grade from high-grade conventional central chondrosarcomas (CSs) and atypical cartilaginous tumors (ACTs) from enchondromas (ECs) is a frequent diagnostic challenge, particularly on biopsy material. We analyzed 214 chondrogenic tumors, including ECs, ACTs, conventional CSs, dedifferentiated chondrosarcomas (DDCSs), and clear cell CSs, and determined their IDH1/2 mutation status. Unsupervised dimensionality reduction of genome-wide DNA methylation patterns revealed 4 clusters among IDH-mutant (MUT) tumors (IDH-MUT-1: mostly ECs and ACTs and some high-grade CSs; IDH-MUT-2: predominantly high-grade CSs; IDH-MUT-3: largely DDCSs; and IDH-MUT-SB: distinct skull base group with a markedly different methylation pattern) and 2 clusters among IDH-wild-type (WT) tumors (IDH-WT-1 and IDH-WT-2: both primarily high-grade CSs, with IDH-WT-2 showing higher tumor grade and more extensive CNVs). Clear cell CSs formed a separate cluster. The amount of CNVs, including loss of CDKN2A, increased with tumor grade, reflecting increased genomic instability during chondrosarcoma progression. Supervised classifiers trained separately, both on methylation and CNV data, and distinguished low-grade and high-grade cartilaginous tumors with area under the curve values of 0.87 to 0.97 and 85% to 90% accuracy. Furthermore, we tested whether DDCSs can be distinguished from metastatic carcinomas and other high-grade sarcomas of the bone. Across 246 reference samples, a supervised classifier achieved 97.2% accuracy (area under the curve, 99.8%) and correctly identified 30 of 32 DDCSs (93.8%). These results indicate that DNA methylation and CNV data analysis provide a valuable tool for distinguishing most low- and high-grade CSs, with additional utility also in differentiating DDCS from morphologic mimics.