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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Glial tumours are the most common primary tumours of the central nervous system &#40;CNS&#41;&#46; Glioblastoma is the most aggressive primary brain tumour and has the highest incidence &#40;2&#46;96 individuals per 100&#44;000 population&#41;&#44; followed by anaplastic astrocytoma &#40;0&#46;49 per 100&#44;000 population&#41;&#44; oligodendroglioma &#40;0&#46;34 per 100&#44;000 population&#41;&#44; diffuse astrocytoma &#40;0&#46;13 per 100&#44;000 population&#41; and anaplastic oligodendroglioma &#40;0&#46;10 per 100&#44;000 population&#41;&#46; The survival of these patients depends on the type of tumour&#46; The most deadly is glioblastoma&#44; with a five-year survival rate of 3&#37;&#44; followed by anaplastic astrocytoma&#44; with a five-year survival rate of 28&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">To assess the survival of these patients&#44; prognostic factors such as tumour size&#44; age&#44; extent of resection or cell lineage have been reported&#46; The following useful molecular markers can be added in the diagnosis of gliomas&#58; MGMT&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> isocitrate dehydrogenase &#40;IDH&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6&#44;7</span></a> 1p&#47;19q co-deletion<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">8&#44;9</span></a> or p53&#44; known for influencing the natural history and prognosis of these tumours&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3&#44;5&#44;10&#8211;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2016&#44; the World Health Organization &#40;WHO&#41; published the new classification of tumours of the CNS&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> which shows a series of substantial changes with respect to the previous classification from 2007&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a> The most significant change is the use of molecular genetic markers&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a> with genetic data appearing for the first time in the naming of glial tumours &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; This new classification of gliomas is determined by the mutation status of the IDH gene &#40;IDH1 most common or IDH2&#41; and the presence or absence of the 1p&#47;19q co-deletion&#44; making it possible to differentiate astrocytomas according to the IDH mutation status&#44; mutated or not mutated &#40;wild type&#41;&#44; and to diagnose as oligodendrogliomas tumours in which the co-deletion and the mutated IDH gene are present&#46; The term NOS &#40;not otherwise specified&#41; is introduced to indicate gliomas in which it has not been possible to carry out this molecular testing&#44; or in which this testing has not been conclusive&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore&#44; new diagnostic codes are introduced according to molecular genetics and morphology&#58; diffuse astrocytoma&#44; IDH-mutant&#47;wild type or NOS&#59; glioblastoma&#44; IDH mutant&#47;wild type or NOS&#59; oligodendroglioma&#44; IDH-mutant and with 1p&#47;19q co-deletion or NOS&#44; etc&#46; With this new classification&#44; the former diagnosis of oligoastrocytoma disappears&#46; Despite the importance of genetics&#44; histopathology is not neglected&#44; as it is the first step to define the type of tumour and its grade of aggressiveness&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">13&#44;15&#44;16</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Taking into account this major change&#44; the possibility that there are several diagnostic changes in these tumours is raised&#44; generating doubts regarding the prognosis and the treatment of the patients&#46; The objective of this paper was to analyse and evaluate the impact caused by the change in the diagnosis of gliomas using this new classification in a series of cases diagnosed at our centre&#44; based on epidemiological&#44; therapeutic and prognostic variables&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This was a retrospective analysis of 147 cases of glial tumours in patients treated at the Hospital General Universitario Gregorio Mara&#241;&#243;n &#91;Gregorio Mara&#241;&#243;n General University Hospital&#93; in Madrid&#46; Within this sample&#44; the cases were selected with diagnostic review when molecular testing was introduced in comparison with the previous morphological diagnosis&#46; This study was approved by the Ethics Committee of the Hospital Gregorio Mara&#241;&#243;n &#40;study code OMSGC-2017&#41;&#44; respecting the basic ethical principles and standards that are derived from the current revision &#40;revised version from Fortaleza&#44; 2013&#41; of the Declaration of Helsinki approved by the World Medical Association&#44; the Oviedo Convention and the current regulatory requirements listed in Spanish legislation&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The inclusion criteria were as follows&#58; patients diagnosed with a primary brain tumour in the Hospital General Universitario Gregorio Mara&#241;&#243;n in whom tumour resection surgery or a diagnostic biopsy was performed between January 2012 and June 2016&#44; with a diagnosis of tumours of astrocytic or oligodendroglial lineage&#44; with a complete medical history and with a minimum follow-up of six months&#46; The cases in which a glial tumour was diagnosed were reviewed in the histological study&#44; and molecular genetic testing was performed by studying the IDH mutations and the presence&#47;absence of 1p&#47;19q co-deletion&#46; The IDH1 mutation was analysed using immunohistochemistry techniques&#44; and sequencing of the IDH gene may have been performed with polymerase chain reaction &#40;PCR&#41; in those patients with negative IDH who were highly suspected of being carriers of the mutation due to low grade or oligodendroglial lineage in the histological study&#46; In contrast&#44; the 1p&#47;19q co-deletion was studied using fluorescence in situ hybridisation &#40;FISH&#41; techniques&#46; In those situations in which it was not possible to obtain a result from the study &#40;deceased patients or impossibility of performing the 1p&#47;19q co-deletion study&#41;&#44; or if the result was not conclusive&#44; the diagnosis of glioma NOS was given&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The epidemiological variables collected in the study were age of the patients and gender&#59; the therapeutic variables were the type of surgical treatment &#40;surgical resection or diagnostic biopsy&#41; and the complementary treatment &#40;conservative&#44; radiotherapy&#44; radiotherapy and chemotherapy or chemotherapy alone&#41;&#44; and the prognostic variables were the tumour grade&#44; the glial lineage&#44; the presence of the IDH mutation&#44; the presence of the 1p&#47;19q co-deletion&#44; the date of diagnosis and the date of death&#46; The cases in which the initial histological diagnosis changed after the application of molecular genetics were collected&#46; The extent of resection or the radiological variables of surgical resection were not studied&#44; given that it was not an objective of this study&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Regarding the statistical analysis&#44; this was performed with the IBM SPSS Statistics 24&#46;0 program&#46; For the qualitative variables&#44; the Chi-square test<span class="elsevierStyleSup">2</span> or the Fisher&#39;s exact test was used&#46; The analysis of survival was performed with Kaplan&#8211;Meier curves&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">In this study&#44; data were collected from 147 patients with glial tumours who underwent operations during the period from 1 January 2012 to 30 June 2016 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In this series&#44; 52&#37; of patients were male and 48&#37; female&#44; with the median overall age being 56 &#40;1&#8211;81&#41;&#44; and with more than 85&#37; of the patients over the age of 40&#46; After the analysis of 147 cases by initial histological study&#44; the following results were obtained&#58; 3 &#40;2&#37;&#41; ependymomas&#44; 11 &#40;7&#46;5&#37;&#41; grade <span class="elsevierStyleSmallCaps">ii</span> astrocytomas&#44; 20 &#40;13&#46;6&#37;&#41; grade <span class="elsevierStyleSmallCaps">iii</span> astrocytomas&#44; 25 &#40;17&#37;&#41; grade <span class="elsevierStyleSmallCaps">ii</span> oligodendrogliomas&#44; 10 &#40;6&#46;8&#37;&#41; grade <span class="elsevierStyleSmallCaps">iii</span> oligodendrogliomas and 78 &#40;53&#46;1&#37;&#41; glioblastomas &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Of these patients&#44; the molecular diagnosis was obtained in 74 cases &#40;50&#46;3&#37;&#41;&#58; 3 &#40;4&#37;&#41; ependymomas&#44; 6 &#40;8&#46;1&#37;&#41; grade <span class="elsevierStyleSmallCaps">ii</span> astrocytomas&#44; 20 &#40;27&#37;&#41; grade <span class="elsevierStyleSmallCaps">ii</span> oligodendrogliomas&#44; 7 &#40;9&#46;5&#37;&#41; grade <span class="elsevierStyleSmallCaps">iii</span> astrocytomas&#44; 7 &#40;9&#46;5&#37;&#41; grade <span class="elsevierStyleSmallCaps">iii</span> oligodendrogliomas and 31 &#40;41&#46;9&#37;&#41; glioblastomas&#44; with the remainder of the cases diagnosed as gliomas NOS &#40;73 cases&#59; 49&#46;7&#37;&#41; due to the impossibility of performing genetic testing or when this was considered inconclusive&#58; 5 diffuse astrocytomas NOS&#44; 13 anaplastic astrocytomas NOS&#44; 5 oligodendrogliomas NOS&#44; 3 anaplastic oligodendrogliomas NOS and 47 glioblastomas NOS&#46; Out of all the cases studied&#44; the analysis of the IDH1 mutation was obtained in 95 tumours &#40;64&#46;62&#37;&#41; and the analysis of the 1p&#47;19q co-deletion was obtained in 66 tumours &#40;44&#46;89&#37;&#41;&#46; Of the 74 glial tumours in which complete genetic testing was performed&#44; in 23 cases &#40;31&#37;&#41; the diagnosis changed&#44; with the histological diagnosis of oligodendroglioma predominating in 20 patients &#40;87&#37;&#41; as an initial histological diagnosis &#40;69&#46;6&#37; grade <span class="elsevierStyleSmallCaps">ii</span> and 17&#46;4&#37; grade <span class="elsevierStyleSmallCaps">iii</span>&#41;&#44; and with these 20 cases becoming astrocytomas&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In summary&#44; after applying genetic testing in these 74 patients&#44; the following changes were obtained in the molecular diagnosis&#58; 3 &#40;2&#37;&#41; ependymomas&#44; 21 &#40;14&#46;3&#37;&#41; grade <span class="elsevierStyleSmallCaps">ii</span> astrocytomas&#44; 11 &#40;7&#46;5&#37;&#41; grade <span class="elsevierStyleSmallCaps">iii</span> astrocytomas&#44; 5 &#40;3&#46;4&#37;&#41; grade <span class="elsevierStyleSmallCaps">ii</span> oligodendrogliomas&#44; 5 &#40;3&#46;4&#37;&#41; grade <span class="elsevierStyleSmallCaps">iii</span> oligodendrogliomas and 29 &#40;19&#46;7&#37;&#41; glioblastomas &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The statistical analysis was performed with all the patients who underwent complete genetic testing &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>74&#41;&#44; in whom the diagnosis changed on 23 occasions &#40;31&#37;&#41;&#46; Of these tumours 20 &#40;87&#37;&#41; were diagnosed initially as oligodendrogliomas&#44; with 16 &#40;69&#46;6&#37;&#41; classified as grade <span class="elsevierStyleSmallCaps">ii</span> and 4 &#40;17&#46;4&#37;&#41; grade <span class="elsevierStyleSmallCaps">iii</span>&#46; All the oligodendrogliomas which changed diagnosis were re-diagnosed as astrocytomas&#46; The three remaining tumours corresponded to two &#40;8&#46;7&#37;&#41; glioblastomas which became grade <span class="elsevierStyleSmallCaps">iii</span> oligodendrogliomas and one &#40;4&#46;3&#37;&#41; grade <span class="elsevierStyleSmallCaps">ii</span> astrocytoma which became a grade <span class="elsevierStyleSmallCaps">ii</span> oligodendroglioma with the new classification&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">When we evaluated the change of diagnosis of the glial tumours in relation to the epidemiological variables&#44; a trend of a greater change of diagnosis was obtained in young patients &#40;&#60;40&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;065&#44; mainly with a previous diagnosis of oligodendroglioma&#44; and with no statistically significant relationship to gender&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">With regard to the relationship between molecular findings and frequency of diagnostic change&#44; of the 23 cases in which the diagnosis changed&#44; IDH1 was positive on 16 occasions &#40;69&#46;6&#37;&#41;&#44; in a statistically significant manner &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#44; and the 1p&#47;19q co-deletion was negative on 20 occasions &#40;87&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Regarding cell lineage&#44; in our series&#44; of the 27 oligodendrogliomas detected with molecular testing&#44; 20 &#40;74&#37;&#41; changed diagnosis due to having negative co-deletion&#44; becoming astrocytomas&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">With regard to the treatment variables in the series analysed &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>74&#41;&#44; we observed that the surgical treatment received in this group of patients was neuronavigation-guided biopsy in 10 cases &#40;13&#46;51&#37;&#41; and surgical resection in 64 cases &#40;86&#46;48&#37;&#41;&#46; On the other hand&#44; the complementary treatment received was&#58; conservative in 16 cases &#40;21&#46;62&#37;&#41;&#44; holocranial radiotherapy in 17 cases &#40;22&#46;97&#37;&#41; concomitant radiotherapy and chemotherapy in 40 cases &#40;54&#46;05&#37;&#41; and chemotherapy alone in one case &#40;0&#46;01&#37;&#41;&#46; In addition&#44; the treatment of the subgroup of patients in whom the diagnosis changed &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41; was surgical resection on 23 occasions &#40;100&#37;&#41;&#44; followed by conservative treatment in 7 &#40;30&#46;43&#37;&#41;&#44; holocranial radiotherapy in 8 &#40;34&#46;78&#37;&#41; and concomitant radiotherapy and chemotherapy in 8 &#40;34&#46;78&#37;&#41;&#46; No significant variations were obtained with regard to treatment&#46; This was probably due to the small sample size&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Finally&#44; in relation to survival&#44; a Kaplan&#8211;Meier curve was performed &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; with a mean follow-up of 16 months&#44; in which a mean survival of 1046 days was obtained in patients in whom the diagnosis was changed by molecular testing and&#44; on the other hand&#44; a mean survival of 654 days was observed in those in whom the diagnosis did not change &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41;&#46; Taking into account the mean survival by histological grade&#44; no significant differences were observed between the tumours with or without a change in diagnosis&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> describes the mean survival times for each histological group in relation to the presence of a change in diagnosis&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">The new WHO classification of tumours of the CNS issued in 2016<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> is the greatest change in the diagnosis of gliomas since the first WHO classification in 1979&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a> and obliges neuro-oncologists to manage new concepts of molecular genetics&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Throughout history&#44; the classification of CNS tumours has had different approaches in accordance with the medical-surgical and histological knowledge of the time&#46; The first classification&#44; described in 1926&#44; was that of Bailey and Cushing&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">18</span></a> which was based on prognostic variables of survival for each histological tumour type of the nervous system&#46; Subsequently&#44; other notable classifications were developed&#44; such as that of Kernohan<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a> &#40;1949&#41;&#44; which started to differentiate tumours into four grades according to their grade of aggressiveness&#44; or that of St&#46; Anne-Mayo<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">20&#44;21</span></a> &#40;1988&#41;&#44; which differentiated astrocytomas and oligodendrogliomas into grades based on four histological parameters&#58; mitosis&#44; atypia&#44; necrosis and neovascularisation&#46; Based on previous classifications&#44; the WHO created its own classification in 1979<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a> and has been adding changes into its successive publications in 1993&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">22</span></a> 2000&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a> 2007<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a> and up to the most recent publication&#44; in 2016&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The most relevant change in this new 2016 classification is the addition of molecular genetics&#46; Additionally&#44; there are some conceptual changes with regard to the cellular subtypes of astrocytomas and ependymomas&#44; and some specific changes&#44; such as the disappearance of <span class="elsevierStyleItalic">gliomatosis cerebri</span> as a tumour subtype&#44; considering it from now on as a type of tumour growth of the different subtypes of gliomas&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Taking into account all of the changes incorporated&#44; an algorithm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; to follow is established in order to correctly define a glial tumour&#44; using molecular genetics&#46; This algorithm means that the presence of mixed glial tumours &#40;oligoastrocytomas&#41; is substantially reduced&#44; although it also implies that in the centres in which there is difficulty reaching a diagnosis&#44; or in which it is not possible to analyse any mutation&#44; the glial tumour is described as NOS&#46; This algorithm starts with the histological study of the glial lineage prior to the detection of mutations &#40;IDH1 or 1p&#47;19q co-deletion&#41;&#44; those most known in relation to this type of tumour&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The first mutated gene which was associated with gliomas was IDH&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6&#44;24&#44;25</span></a> This gene&#44; a cellular oncometabolite that&#44; when it is mutated&#44; inhibits alpha-ketoglutarate-dependent enzymes&#44; has an important role in the epigenetic profile of the cell&#44; inhibits differentiation and stimulates tumourigenesis&#46; The relationship between IDH1 and IDH2 mutations has been demonstrated with low-grade glial tumours and secondary glioblastomas&#44; with the IDH1 mutation being the most common&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Other genes&#44; such as alpha thalassemia <span class="elsevierStyleSmallCaps">X</span>-linked mental retardation syndrome &#40;ATRX&#41;&#44; are also associated with gliomas&#46; ATRX<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a> regulates the remodelling of chromatin and encodes a protein which is found in endothelial cells&#44; cortical neurons and inflammatory cells&#46; When this gene is mutated&#44; no expression of the protein is observed in immunohistochemistry &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#44; and it is associated with tumours of astrocytic origin&#46; Currently&#44; the mutation in the ATRX gene is still not considered necessary for the diagnosis of astrocytomas&#44; but in many centres&#44; such as ours&#44; it is being analysed with increasing frequency&#46; Nevertheless&#44; it is important to highlight that the mutation in the ATRX gene excludes the 1p&#47;19q co-deletion which is present in oligodendrogliomas&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">It is important to highlight that genetics has managed to associate certain mutations with some types of gliomas&#44; which helps us to categorise them correctly&#44; as is the case of the RELA fusion-positive ependymoma or the diffuse midline glioma with the H3 K27M mutation&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">This study tries to analyse in depth the role of the introduction of molecular genetics for the diagnosis of certain types of brain gliomas&#44; with the objective of improving targeted cancer therapy for these patients in the future&#46; Using this molecular classification&#44; we can distinguish possible causes for variations in the expected survival for certain astrocytomas or oligodendrogliomas which have been incorrectly diagnosed&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> It is suggested that the field in which the application of genetics may be most useful is in low-grade tumours&#44;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">29&#44;30</span></a> as&#44; despite the fact that they are not benign&#44; adequate&#44; well-focused and early treatment may increase the mean survival time&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">31&#44;32</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">For this reason&#44; it has been observed that the genotype enables an improved prognostic classification and a consequent adaptation of treatment&#46; Multiple studies have demonstrated that further development is expected in the field of molecular genetics&#44; through the use of markers other than IDH1 and 1p&#47;19q co-deletion&#44; such as the aforementioned ATRX&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a> EGFR&#44; polysomy 7&#44; 10q deletion&#44; TERT prom&#44; BRAF&#44; PTEN and H3F3A&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">11&#44;33</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In our study&#44; we obtained a greater tendency for a change of morphological diagnosis in young patients &#40;&#60;40 years&#41; at the expense of IDH1-positivity and 1p&#47;19q co-deletion-negativity&#46; Furthermore&#44; we have observed that the greatest change in diagnosis was obtained in patients with initial oligodendroglioma&#44; in particular low grade&#44; due to obtaining negative 1p&#47;19q co-deletion&#44; despite the morphology being more typical of oligodendroglioma&#46; Regarding patients&#8217; prognosis&#44; it is observed in this series that patients with glial tumours which change diagnosis have a longer survival period&#46; However&#44; taking into account that the tumours in which the diagnosis did not vary are mostly high-grade tumours &#40;glioblastomas&#41;&#44; we can conclude that these data are not clinically relevant&#46; In addition&#44; in terms of the survival analysis by histological subgroups&#44; no significant differences were obtained between tumours with a diagnostic change and those without a diagnostic change&#46; Therefore&#44; particularly due to the limited sample size and the short follow-up for this type of condition&#44; we do not observe any differences in the survival rate in this study after the change in diagnosis&#46; Despite this&#44; it is interesting to note that the majority of glial tumours which have a change in diagnosis are oligodendrogliomas&#44; and that&#44; despite becoming astrocytomas&#44; at least in the established follow-up&#44; the improved prognosis of the former is maintained&#46; On the other hand&#44; it has been reported that patients diagnosed with glioblastoma multiforme have a lower incidence and a lower survival rate after changes to the diagnosis due to the new classification&#44; as&#44; with the help of molecular genetics&#44; the number of incorrectly diagnosed glial tumours is decreasing&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5&#44;34</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In terms of this study&#39;s limitations&#44; the following factors stand out&#58; the absence of significance in relation to many of the variables analysed&#44; probably due to the small sample and to the limited follow-up that we have for these tumours&#59; the non-randomisation in the selection of patients and the retrospective nature of the study&#46; These factors are due&#44; above all&#44; to the fact that the use of this classification and of the molecular genetics techniques to carry it out&#44; have only started very recently&#46; Moreover&#44; the analysis in greater depth of clinical variables and of treatment &#40;extent of resection&#44; radiotherapy and chemotherapy treatment regimens&#44; disease-free survival&#44; re-treatments&#44; among others&#41; may allow for a greater knowledge to be gained of the impact of tumours with discordant histology and molecular findings&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0145" class="elsevierStylePara elsevierViewall">In our experience&#44; the new WHO classification of tumours of the CNS<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> using molecular genetics is a major breakthrough which has generated a new clinical framework&#46; The detection of glial tumours with morphological patterns of one lineage and discordant molecular findings has involved diagnostic reclassifications of a considerable percentage of glial tumours in which this has been reviewed&#46; In this study&#44; the main finding in reclassified tumours has been the absence of 1p&#47;19q co-deletion in most initial oligodendrogliomas&#44; which leads to the change to astrocytomas&#46; In addition&#44; a tendency to a greater frequency of this change of diagnosis has been detected in younger patients and in low-grade gliomas&#46; In any case&#44; the limited sample size and the short follow-up prevents more in-depth conclusions in this phase of the study&#46; However&#44; this study forms part of a more complete study with an extended follow-up period to evaluate possible prognostic conclusions and therapeutic implications&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors state that there are no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this project is to assess diagnostic reclassification based on molecular data over morphology in a series of glial tumours since the introduction of the 2016 WHO classification of brain tumours&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective review of glial tumours &#40;oligodendrogliomas and astrocytomas&#41; treated in our centre between January 2012 and June 2016 in which a review of diagnosis was performed when molecular studies were added&#46; Statistical analysis included evaluation of variables of epidemiology&#44; morphology and molecular data &#40;mainly IDH mutation and 1p19q codeletion&#41;&#44; diagnostic changes after new classification was considered&#44; and clinical impact in cases of diagnostic reclassification&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">From a total of 147 glial tumours reviewed in our centre&#44; molecular diagnosis was obtained in 74 cases &#40;50&#46;3&#37;&#41;&#46; Initial diagnosis changed in 23 cases &#40;31&#37;&#41;&#44; and 20 &#40;87&#37;&#41; of them had a prior histological diagnosis of oligodendroglioma &#40;69&#46;6&#37; grade <span class="elsevierStyleSmallCaps">ii</span> and 17&#46;4&#37; grade <span class="elsevierStyleSmallCaps">iii</span>&#41;&#46; Only 3 of these 23 cases diagnosis changed from astrocytoma to oligodendroglioma&#46; Among reclassified tumours&#44; there was a common molecular pattern&#44; as findings showed mutant IDH in 16 cases &#40;69&#46;6&#37;&#41; and no codeletion in 20 cases &#40;87&#37;&#41;&#46; According to the cell of origin&#44; of the whole group of 27 oligodendrogliomas in our series &#40;reclassified and non-reclassified&#41;&#44; 20 cases &#40;74&#37;&#41; became astrocytomas&#44; despite typical oligodendroglial morphology&#44; due to absence of 1p19q codeletion&#46; There was a trend for diagnosis reclassification in younger patients &#40;&#60;40 years&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;065&#44; mainly in those with a prior diagnosis of oligodendroglioma&#44; with no statistical differences based on gender or clinical data&#46; Besides&#44; reclassification was more common among tumours with mutant IDH &#40;69&#46;6&#37;&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#44; than those with wild type IDH&#46; In terms of survival&#44; despite receiving different treatments&#44; no significant changes were detected between reclassified and non-reclassified tumours after a mean follow-up of 16 months&#44; partly related to lower grade of these lesions&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Within the spectrum of the glial tumours treated in our institution&#44; this new classification including molecular genetics over morphological data has provided marked diagnostic changes&#46; These changes appear mainly in tumours previously diagnosed as oligodendrogliomas and in younger patients&#44; with molecular patterns of mutant IDH and 1p19q codeletion&#46; Although diagnosis reclassification may affect clinic&#44; prognosis or therapeutic management of these tumours&#44; deeper and prospective studies on these specific aspects are needed&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este trabajo es evaluar el cambio del diagn&#243;stico molecular sobre el histol&#243;gico de una serie de tumores gliales al revisar el diagn&#243;stico con la clasificaci&#243;n de la OMS de 2016&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiza un estudio retrospectivo de los tumores gliales &#40;oligodendrogliomas y astrocitomas&#41; tratados en nuestro centro entre enero de 2012 y junio de 2016&#44; y una revisi&#243;n diagn&#243;stica seg&#250;n su estudio molecular&#46; Se lleva a cabo el an&#225;lisis estad&#237;stico de variables epidemiol&#243;gicas&#44; histol&#243;gicas y de gen&#233;tica molecular &#40;mutaciones en IDH y presencia de codeleci&#243;n 1p19q&#41;&#44; variaci&#243;n en el diagn&#243;stico al introducir la nueva clasificaci&#243;n tumoral e impacto cl&#237;nico de dicha reclasificaci&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 147 casos de tumores gliales revisados&#44; se obtuvo el diagn&#243;stico molecular en 74 casos &#40;50&#44;3&#37;&#41;&#46; En 23 casos &#40;31&#37;&#41; cambi&#243; el diagn&#243;stico&#44; predominando en 20 &#40;87&#37;&#41; el diagn&#243;stico previo de oligodendroglioma &#40;69&#44;6&#37; grado <span class="elsevierStyleSmallCaps">ii</span> y 17&#44;4&#37; grado <span class="elsevierStyleSmallCaps">iii</span>&#41;&#46; Solo 3 de los 23 casos cambiaron de diagn&#243;stico inicial astrocitario al oligodendroglial&#46; Respecto al patr&#243;n molecular en estos 23 casos&#44; se detect&#243; IDH mutado en 16 &#40;69&#44;6&#37;&#41; y codeleci&#243;n 1p19q negativa en 20 &#40;87&#37;&#41;&#46; Seg&#250;n la estirpe celular&#44; de los 27 oligodendrogliomas de esta serie&#44; 20 &#40;74&#37;&#41; cambiaron de diagn&#243;stico por tener la codeleci&#243;n negativa&#44; pasando a ser astrocitomas&#46; Se observ&#243; una tendencia a un mayor cambio de diagn&#243;stico en pacientes j&#243;venes &#40;&#60;40 a&#241;os&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;065&#44; mayoritariamente con diagn&#243;stico previo de oligodendrogliomas&#44; sin relaci&#243;n con el sexo&#46; Adem&#225;s&#44; se detect&#243; una mayor frecuencia de cambio de diagn&#243;stico entre los tumores con IDH mutado &#40;69&#44;6&#37;&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#46; Respecto a la supervivencia o el patr&#243;n cl&#237;nico&#44; no se detectaron cambios significativos entre los tumores con o sin cambio diagn&#243;stico&#44; a pesar de no recibir tratamiento de elecci&#243;n&#44; tras un seguimiento medio de 16 meses&#44; en probable relaci&#243;n con el bajo grado lesional&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Dentro del espectro de tumores astrocitarios y oligodendrogliales en nuestro centro&#44; la clasificaci&#243;n diagn&#243;stica con gen&#233;tica molecular evidencia importantes cambios respecto al diagn&#243;stico morfol&#243;gico&#46; Estos cambios afectan especialmente a los diagn&#243;sticos previos de oligodendrogliomas y a los pacientes j&#243;venes en los casos revisados&#44; y con patrones moleculares de mutaci&#243;n en la IDH y de ausencia de codeleci&#243;n 1p19q&#46; Si bien se pueden plantear dudas respecto a la cl&#237;nica&#44; el pron&#243;stico y el tratamiento realizado en estos casos&#44; se requieren estudios espec&#237;ficos en estos aspectos para lograr unas conclusiones apropiadas&#46;</p></span>"
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            "identificador" => "abst0030"
            "titulo" => "Materiales y m&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Valera-Mel&#233; M&#44; Mateo Sierra O&#44; Sola Vendrell E&#44; Guzm&#225;n de Villoria L JA&#44; Carvajal D&#237;az L&#44; Gil de Sagredo del Corral &#211;L&#44; et al&#46; Evaluaci&#243;n del impacto del cambio diagn&#243;stico de los gliomas aplicando la nueva clasificaci&#243;n de la OMS de 2016 sobre una serie de casos&#46; Neurocirugia&#46; 2019&#59;30&#58;19&#8211;27&#46;</p>"
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        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Louis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagnostic algorithm of the new 2016 WHO classification of gliomas&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of patients diagnosed with glial tumours in the period between January 2012 and June 2016&#46; Application of the new WHO classification from 2016&#46; &#40;1&#41; Patients in whom complete molecular testing was performed by studying IDH1 mutation and 1p&#47;19q co-deletion&#46; &#40;2&#41; Molecular tests not performed or not conclusive&#46; &#40;3&#41; Oligodendroglioma as the final diagnosis after the application of genetic testing&#46; NOS&#58; not otherwise specified&#59; OLIGO&#58; oligodendroglioma&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curve survival analysis&#46; Mean survival time of 654 days in patients in whom the diagnosis did not change and 1046 days in patients in whom the diagnosis did change&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Histological and immunohistochemistry images of a patient diagnosed histologically with astrocytoma grade <span class="elsevierStyleSmallCaps">ii</span>&#44; reclassified as oligodendroglioma grade <span class="elsevierStyleSmallCaps">ii</span> after detecting 1p&#47;19q co-deletion&#46; Haematoxylin&#8211;eosin with typical astrocytic pattern&#44; ATRX negative&#44; IDH1-mutant&#44; Ki-67 of 1&#37;&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">NOS&#58; not otherwise specified&#59; WHO&#58; World Health Organization&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Relationship of all patients of the series &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>147&#41; with gliomas with histological diagnosis and molecular diagnosis after applying molecular testing by studying IDH mutation and 1p&#47;19q co-deletion&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tumour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Histological diagnosis <br>&#40;WHO 2007&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Molecular diagnosis <br>&#40;WHO 2016&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ependymoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Astrocytoma grade <span class="elsevierStyleSmallCaps">ii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;7&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Astrocytoma grade <span class="elsevierStyleSmallCaps">iii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;13&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;7&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oligodendroglioma grade <span class="elsevierStyleSmallCaps">ii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oligodendroglioma grade <span class="elsevierStyleSmallCaps">iii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;6&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glioblastoma multiforme&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;53&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;19&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glioma&#44; NOS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;49&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparison between histological and molecular diagnosis in our series &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>147&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">WHO&#58; World Health Organization&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Patients with glial tumours whose diagnosis changed after genetic testing &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41;&#46; 87&#37; of the tumours for which the diagnosis changed were previously considered oligodendrogliomas&#44; with 69&#46;6&#37; grade <span class="elsevierStyleSmallCaps">ii</span> and 17&#46;4&#37; grade <span class="elsevierStyleSmallCaps">iii&#46;</span></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Histological diagnosis &#40;WHO 2007&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Molecular diagnosis<br>&#40;WHO 2016&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Astrocytoma grade <span class="elsevierStyleSmallCaps">ii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Astrocytoma grade <span class="elsevierStyleSmallCaps">ii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;69&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oligodendroglioma grade <span class="elsevierStyleSmallCaps">ii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;69&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Oligodendroglioma grade <span class="elsevierStyleSmallCaps">ii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oligodendroglioma grade <span class="elsevierStyleSmallCaps">iii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;17&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Oligodendroglioma grade <span class="elsevierStyleSmallCaps">iii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glioblastoma multiforme&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glioblastoma multiforme&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;17&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Diagnostic changes observed in 23 cases of glial tumours&#46;</p>"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Evaluation of the diagnostic change of glial tumours in relation to the molecular study performed&#58; detection of IDH1 mutation and presence&#47;absence of 1p&#47;19q co-deletion&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">IDH&#44; co-deletion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Significance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diagnostic change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IDH-mutant&#47;wild type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#46;6&#47;30&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No diagnostic change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IDH-mutant&#47;wild type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;5&#47;72&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diagnostic change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1p&#47;19q co-deletion &#43;&#47;&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#47;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No diagnostic change&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Astro&#58; astrocytoma&#59; Epend&#58; ependymoma&#59; GBM&#58; glioblastoma&#59; Oligo&#58; oligodendroglioma&#59; SV&#58; survival&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Mean survival times of the 74 glial tumours which underwent genetic testing stratified by glial subtype and histological grades&#46;</p>"
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                0 => """
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No diagnostic change</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnostic change</th><th class="td" title="table-head  " align="center" valign="top" scope="col">Significance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Histology&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">659&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">544&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oligo <span class="elsevierStyleSmallCaps">II</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1089&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1163&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;302&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Astro <span class="elsevierStyleSmallCaps">III</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oligo <span class="elsevierStyleSmallCaps">III</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1141&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">365&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;221&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GBM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">466&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">221&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;086&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epend&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1066&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Survival by histological grade of the 74 glial tumours which underwent genetic testing&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology and etiology of gliomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Ohgaki"
                            1 => "P&#46; Kleihues"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00401-005-0991-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Neuropathol"
                        "fecha" => "2005"
                        "volumen" => "109"
                        "paginaInicial" => "93"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15685439"
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                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changing incidence and improved survival of gliomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            0 => "V&#46;K&#46;Y&#46; Ho"
                            1 => "J&#46;C&#46; Reijneveld"
                            2 => "R&#46;H&#46; Enting"
                            3 => "H&#46;P&#46; Bienfait"
                            4 => "P&#46; Robe"
                            5 => "B&#46;G&#46; Baumert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejca.2014.05.019"
                      "Revista" => array:6 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24972545"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Population-based study on incidence&#44; survival rates&#44; and genetic alterations of low-grade diffuse astrocytomas and oligodendrogliomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Okamoto"
                            1 => "P&#46;L&#46; di Patre"
                            2 => "C&#46; Burkhard"
                            3 => "S&#46; Horstmann"
                            4 => "B&#46; Jourde"
                            5 => "M&#46; Fahey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00401-004-0861-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Neuropathol"
                        "fecha" => "2004"
                        "volumen" => "108"
                        "paginaInicial" => "49"
                        "paginaFinal" => "56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15118874"
                            "web" => "Medline"
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            ]
            3 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival rates and patterns of care for patients diagnosed with supratentorial low-grade gliomas&#58; data from the SEER program&#44; 1973&#8211;2001"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;B&#46; Claus"
                            1 => "P&#46;M&#46; Black"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/cncr.21733"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "2006"
                        "volumen" => "106"
                        "paginaInicial" => "1358"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16470608"
                            "web" => "Medline"
                          ]
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              ]
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              "identificador" => "bib0195"
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              "referencia" => array:1 [
                0 => array:2 [
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Vol. 30. Issue 1.
Pages 19-27 (January - February 2019)
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Vol. 30. Issue 1.
Pages 19-27 (January - February 2019)
Clinical Research
Assessment of the impact of glioma diagnostic reclassification following the new 2016 WHO classification on a series of cases
Evaluación del impacto del cambio diagnóstico de los gliomas aplicando la nueva clasificación de la OMS de 2016 sobre una serie de casos
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Marc Valera-Meléa,
Corresponding author
marcvaleram@gmail.com

Corresponding author.
, Olga Mateo Sierraa, Emma Sola Vendrellb, Juan Adán Guzmán de Villoria L.c, Lorena Carvajal Díaza, Óscar Lucas Gil de Sagredo del Corrala, Roberto García Leala
a Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Servicio de Anatomía Patológica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
c Servicio de Neurorradiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Table 1. Comparison between histological and molecular diagnosis in our series (n=147).
Table 2. Diagnostic changes observed in 23 cases of glial tumours.
Table 3. Evaluation of the diagnostic change of glial tumours in relation to molecular testing.
Table 4. Survival by histological grade of the 74 glial tumours which underwent genetic testing.
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Abstract
Background and objectives

The aim of this project is to assess diagnostic reclassification based on molecular data over morphology in a series of glial tumours since the introduction of the 2016 WHO classification of brain tumours.

Materials and methods

Retrospective review of glial tumours (oligodendrogliomas and astrocytomas) treated in our centre between January 2012 and June 2016 in which a review of diagnosis was performed when molecular studies were added. Statistical analysis included evaluation of variables of epidemiology, morphology and molecular data (mainly IDH mutation and 1p19q codeletion), diagnostic changes after new classification was considered, and clinical impact in cases of diagnostic reclassification.

Results

From a total of 147 glial tumours reviewed in our centre, molecular diagnosis was obtained in 74 cases (50.3%). Initial diagnosis changed in 23 cases (31%), and 20 (87%) of them had a prior histological diagnosis of oligodendroglioma (69.6% grade ii and 17.4% grade iii). Only 3 of these 23 cases diagnosis changed from astrocytoma to oligodendroglioma. Among reclassified tumours, there was a common molecular pattern, as findings showed mutant IDH in 16 cases (69.6%) and no codeletion in 20 cases (87%). According to the cell of origin, of the whole group of 27 oligodendrogliomas in our series (reclassified and non-reclassified), 20 cases (74%) became astrocytomas, despite typical oligodendroglial morphology, due to absence of 1p19q codeletion. There was a trend for diagnosis reclassification in younger patients (<40 years), p=0.065, mainly in those with a prior diagnosis of oligodendroglioma, with no statistical differences based on gender or clinical data. Besides, reclassification was more common among tumours with mutant IDH (69.6%), p=0.003, than those with wild type IDH. In terms of survival, despite receiving different treatments, no significant changes were detected between reclassified and non-reclassified tumours after a mean follow-up of 16 months, partly related to lower grade of these lesions.

Conclusions

Within the spectrum of the glial tumours treated in our institution, this new classification including molecular genetics over morphological data has provided marked diagnostic changes. These changes appear mainly in tumours previously diagnosed as oligodendrogliomas and in younger patients, with molecular patterns of mutant IDH and 1p19q codeletion. Although diagnosis reclassification may affect clinic, prognosis or therapeutic management of these tumours, deeper and prospective studies on these specific aspects are needed.

Keywords:
WHO 2016 classification
Molecular genetics
IDH
Codeletion 1p19q
Astrocytoma
Oligodendroglioma
Resumen
Antecedentes y objetivo

El objetivo de este trabajo es evaluar el cambio del diagnóstico molecular sobre el histológico de una serie de tumores gliales al revisar el diagnóstico con la clasificación de la OMS de 2016.

Materiales y métodos

Se realiza un estudio retrospectivo de los tumores gliales (oligodendrogliomas y astrocitomas) tratados en nuestro centro entre enero de 2012 y junio de 2016, y una revisión diagnóstica según su estudio molecular. Se lleva a cabo el análisis estadístico de variables epidemiológicas, histológicas y de genética molecular (mutaciones en IDH y presencia de codeleción 1p19q), variación en el diagnóstico al introducir la nueva clasificación tumoral e impacto clínico de dicha reclasificación.

Resultados

De los 147 casos de tumores gliales revisados, se obtuvo el diagnóstico molecular en 74 casos (50,3%). En 23 casos (31%) cambió el diagnóstico, predominando en 20 (87%) el diagnóstico previo de oligodendroglioma (69,6% grado ii y 17,4% grado iii). Solo 3 de los 23 casos cambiaron de diagnóstico inicial astrocitario al oligodendroglial. Respecto al patrón molecular en estos 23 casos, se detectó IDH mutado en 16 (69,6%) y codeleción 1p19q negativa en 20 (87%). Según la estirpe celular, de los 27 oligodendrogliomas de esta serie, 20 (74%) cambiaron de diagnóstico por tener la codeleción negativa, pasando a ser astrocitomas. Se observó una tendencia a un mayor cambio de diagnóstico en pacientes jóvenes (<40 años), p=0,065, mayoritariamente con diagnóstico previo de oligodendrogliomas, sin relación con el sexo. Además, se detectó una mayor frecuencia de cambio de diagnóstico entre los tumores con IDH mutado (69,6%), p=0,003. Respecto a la supervivencia o el patrón clínico, no se detectaron cambios significativos entre los tumores con o sin cambio diagnóstico, a pesar de no recibir tratamiento de elección, tras un seguimiento medio de 16 meses, en probable relación con el bajo grado lesional.

Conclusiones

Dentro del espectro de tumores astrocitarios y oligodendrogliales en nuestro centro, la clasificación diagnóstica con genética molecular evidencia importantes cambios respecto al diagnóstico morfológico. Estos cambios afectan especialmente a los diagnósticos previos de oligodendrogliomas y a los pacientes jóvenes en los casos revisados, y con patrones moleculares de mutación en la IDH y de ausencia de codeleción 1p19q. Si bien se pueden plantear dudas respecto a la clínica, el pronóstico y el tratamiento realizado en estos casos, se requieren estudios específicos en estos aspectos para lograr unas conclusiones apropiadas.

Palabras clave:
Clasificación OMS 2016
Genética molecular
IDH
Codeleción 1p19q
Astrocitoma
Oligodendroglioma

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