Design,Establishment And Clinical Application Of Structured Pathological Reporting System For Glioma

Glioma is one of the most common primary central nervous system(CNS)tumors with the characters of high invasiveness,diffuse growth and postoperative recurrence.It is one of the tumors with highest 5-year motality second only to pancreatic cancer and lung cancer in China,with an annual incidence of 5-8/100 000.In 2016,the World Health Organization(WHO)Classification of Tumors of the Central Nervous System 4th Revised Edition introduced molecular features into CNS tumor classification for the first time,providing more reliable evidence for precise diagnosis and treatment of glioma and increasing the complexity of pathological reports.At present,the vast majority of tumor pathological reports are still using unstructured narrative reporting formats.Although narrative reports have the advantages of fluent writing,good flexibility and convenient for pathologists to describe pathological features in detail,they are also prone to non-standard wording or data omission.The great differences in structure,content and style of pathological reports between different institutions and pathologists,as well as the difficulties in converting unstructured reports into structured and computer readable data formats,have affected the acquisition and utilization of pathological data.After nearly two decades of development,structured pathological reports of tumors have gradually developed into complex reports with standardized reporting language,structured data storage and automatic coding,which are widely used in common tumors in developed contries in Europe and American.Standardized structured pathological reports can not only improve the efficiency and standardization of report entry,but also ensure the accuracy,completeness and consistency of reports.Structurally stored data will also facilitate the communication and exchange of pathological information.The newly published Classification of Tumors of the Central Nervous System 5th Edition in 2021 classifies diffuse glioma into adult-type and pediatric-type and simplifies the classification of adult-type diffuse gliomas,which also introduces molecular features into grading for the first time.In Classification of Tumors of the Central Nervous System 5th Edition,isocitrate dehydrogenase(IDH)mutant astrocytic tumor will be diagnosed as grade 4with necrosis or microvascular hyperplasia,or cyclin-dependent kinase inhibitor 2A/B homozygous deletions.IDH wild-type astrocytic tumor will be diagnosed as grade 4 if it has grade 4 histological characteristics,or at least has one molecular change of telomerase reverse transcriptase promoter mutation,epidermal growth factor receptor amplification or combination of whole chromosome 7 gain and whole chromosome 10 loss.The reclassification and grading of previously diagnosed gliomas according to Classification of Tumors of the Central Nervous System 5th Edition will help to understand the influence of new edition on pathological diagnosis and its clinical significance.The main results and significance of this study are as follows:1.According to the WHO Classification of Central Nervous System Tumors,The International Collaboration on Cancer Reporting data sets for the reporting of tumors of the CNS and relevant domestic and foreign diagnostic and therapeutic norms,the standard input language and automatic generation rules of the reporting system were formulated and a structured pathological reporting system for glioma was established and applied to clinical pathological diagnosis practice.The reports generated by the system have standardized format and content.The system can automatically generate International Classification of Diseases for Oncology codes and integrate diagnostic results and directly store and manage structured pathological data.It not only improves the efficiency and standardization of pathological report entry,but also promotes the acquisition and utilization of tumor pathological data.2.Comparing the reporting rates of five key indicators including tumor lacation,tumor size,histological type,grade and integrated diagnosis between narrative and structured reports,the reporting rates of the five key indicators in structured pathological reports reached100% and the percentage of reports containing the five key indicators increased from 87.6%of narrative reports to 100% of structured reports.Structured pathological reports significantly improved the completeness and accuracy of reports.3.By searching the pathological results in the system and accomplishing the tests of the new grade 4 molecular grading indicators of Classification of Tumors of the Central Nervous System 5th Edition,only one histologic grade 3 astrocytoma out of twenty-nine lower grade IDH mutant astrocytomas was found cyclin-dependent kinase inhibitor 2A homozygous deletion.Three histological grade 2 and six histological 3 out of twenty lower grade IDH wild-type gliomas were found at least one change of telomerase reverse transcriptase promoter mutation,epidermal growth factor receptor amplification or combination of whole chromosome 7 gain and whole chromosome 10 loss.By integrating histomorphological and molecular characteristics,one hundred and nineteen cases of adult diffuse glioma were integratedly diagnosed,including thirty-two cases of astrocytoma,IDH-mutant,twenty-nine cases of oligodendroglioma,IDH-mutant and chromosome 1p and 19 q co-deletion,and fiftyeight cases of glioblastoma,IDH-wildtype.Clinical and pathological characteristics were analyzed.The integrated diagnosis and analysis promoted the application of Classification of Tumors of the Central Nervous System 5th Edition in clinical diagnosis and treatment practices.4.By comparing the consistency between immunohistochemical staining and molecular pathology results,it was found that IDH1 p.R132 H immunohistochemical staining is highly consistent with IDH1 molecular detection,which is a reliable alternative method for molecular detection.In IDH-mutant gliomas,alpha thalassemia/mental retardation syndrome X-Linked protein and p53 immunohistochemical staining are moderately sensitive and highly specificic in the diagnosis of astrocytoma and can be used as an alternative detection for chromosome 1p and 19 q co-deletion when molecular detections are not avalible.