Clinical implications of the 2021 edition of the WHO classification of central nervous system tumours

• Published in: Nature reviews. Neurology 2022-09, Vol.18 (9), p.515-529
• Main Authors: Horbinski, Craig, Berger, Tamar, Packer, Roger J., Wen, Patrick Y.
• Format: Article
• Language: English
• Subjects: 692/617/375/1922; 692/700/565; Brain cancer; Brain Neoplasms; Central Nervous System Neoplasms - diagnosis; Child; Classification; Clinical trials; Glioma; Humans; Medicine; Medicine & Public Health; Meningeal Neoplasms; Meningioma; Neurology; Pediatrics; Review Article; Tumors; World Health Organization
• ISSN: 1759-4758; 1759-4766
• DOI: 10.1038/s41582-022-00679-w

A new edition of the WHO classification of tumours of the CNS was published in 2021. Although the previous edition of this classification was published just 5 years earlier, in 2016, rapid advances in our understanding of the molecular underpinnings of CNS tumours, including the diversity of clinically relevant molecular types and subtypes, necessitated a new classification system. Compared with the 2016 scheme, the new classification incorporates even more molecular alterations into the diagnosis of many tumours and reorganizes gliomas into adult-type diffuse gliomas, paediatric-type diffuse low-grade and high-grade gliomas, circumscribed astrocytic gliomas, and ependymal tumours. A number of new entities are incorporated into the 2021 classification, especially tumours that preferentially or exclusively arise in the paediatric population. Such a substantial revision of the WHO scheme will have major implications for the diagnosis and treatment of patients with CNS tumours. In this Perspective, we summarize the main changes in the classification of diffuse and circumscribed gliomas, ependymomas, embryonal tumours and meningiomas, and discuss how each change will influence post-surgical treatment, clinical trial enrolment and cooperative studies. Although the 2021 WHO classification of CNS tumours is a major conceptual advance, its implementation on a routine clinical basis presents some challenges that will require innovative solutions. The fifth edition of the WHO classification of CNS tumours was published in 2021. Here, Horbinski and colleagues summarize the main changes in this new edition and discuss how each change will affect post-surgical treatment, clinical trial enrolment and cooperative studies. Key points The new 2021 WHO classification of CNS tumours has further integrated molecular data into the typing, subtyping and grading of major tumour groups. Such integration especially affects the classification of adult-type and paediatric-type diffuse gliomas, circumscribed astrocytic gliomas, ependymomas, embryonal tumours and (to a lesser extent) meningiomas. The strengths of this revised scheme include more accurate conceptualization of CNS tumour types, improved diagnostic accuracy and more reliable prognostic subgroups. Challenges include greater need for faster, more widespread molecular testing, more issues with third party payor reimbursement, and greater difficulty in finding and enrolling patients who are eligible for specific clinical tri