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Advanced molecular pathology for rare tumours: A national feasibility study and model for centralised medulloblastoma diagnostics

Lookup NU author(s): Dr Stephen Crosier, Dr Debbie Hicks, Dr Ed Schwalbe, Dr Daniel Williamson, Amanda Smith, Dr Janet Lindsey, Professor Simon BaileyORCiD, Professor Steven CliffordORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2021 The Authors. Neuropathology and Applied Neurobiology published by John Wiley & Sons Ltd on behalf of British Neuropathological Society.Aims: Application of advanced molecular pathology in rare tumours is hindered by low sample numbers, access to specialised expertise/technologies and tissue/assay QC and rapid reporting requirements. We assessed the feasibility of co-ordinated real-time centralised pathology review (CPR), encompassing molecular diagnostics and contemporary genomics (RNA-seq/DNA methylation-array). Methods: This nationwide trial in medulloblastoma (<80 UK diagnoses/year) introduced a national reference centre (NRC) and assessed its performance and reporting to World Health Organisation standards. Paired frozen/formalin-fixed, paraffin-embedded tumour material were co-submitted from 135 patients (16 referral centres). Results: Complete CPR diagnostics were successful for 88% (120/135). Inadequate sampling was the most common cause of failure; biomaterials were typically suitable for methylation-array (129/135, 94%), but frozen tissues commonly fell below RNA-seq QC requirements (53/135, 39%). Late reporting was most often due to delayed submission. CPR assigned or altered histological variant (vs local diagnosis) for 40/135 tumours (30%). Benchmarking/QC of specific biomarker assays impacted test results; fluorescent in-situ hybridisation most accurately identified high-risk MYC/MYCN amplification (20/135, 15%), while combined methods (CTNNB1/chr6 status, methylation-array subgrouping) best defined favourable-risk WNT tumours (14/135; 10%). Engagement of a specialist pathologist panel was essential for consensus assessment of histological variants and immunohistochemistry. Overall, CPR altered clinical risk-status for 29% of patients. Conclusion: National real-time CPR is feasible, delivering robust diagnostics to WHO criteria and assignment of clinical risk-status, significantly altering clinical management. Recommendations and experience from our study are applicable to advanced molecular diagnostics systems, both local and centralised, across rare tumour types, enabling their application in biomarker-driven routine diagnostics and clinical/research studies.

Publication metadata

Author(s): Crosier S, Hicks D, Schwalbe EC, Williamson D, Leigh Nicholson S, Smith A, Lindsey JC, Michalski A, Pizer B, Bailey S, Bown N, Cuthbert G, Wharton SB, Jacques TS, Joshi A, Clifford SC

Publication type: Article

Publication status: Published

Journal: Neuropathology and Applied Neurobiology

Year: 2021

Volume: 47

Issue: 6

Pages: 736-747

Print publication date: 01/10/2021

Online publication date: 07/04/2021

Acceptance date: 17/03/2021

Date deposited: 06/10/2021

ISSN (print): 0305-1846

ISSN (electronic): 1365-2990

Publisher: John Wiley and Sons Inc


DOI: 10.1111/nan.12716

PubMed id: 33826763


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