DNA methylation-based profiling for paediatric CNS tumour diagnosis and treatment

• Verfasst von: Pickles, Jessica C. [VerfasserIn]
• Verfasst von: Kurian, Kathreena M [VerfasserIn]
• Verfasst von: Nicoll, James A R [VerfasserIn]
• Verfasst von: Mitchell, Clare [VerfasserIn]
• Verfasst von: Capper, David [VerfasserIn]
• Verfasst von: Sill, Martin [VerfasserIn]
• Verfasst von: Deimling, Andreas von [VerfasserIn]
• Verfasst von: Pfister, Stefan [VerfasserIn]
• Verfasst von: Jones, David T. W. [VerfasserIn]
• Titel: DNA methylation-based profiling for paediatric CNS tumour diagnosis and treatment
• Titelzusatz: a population-based study
• Verf.angabe: Jessica C Pickles, Amy R Fairchild, Thomas J Stone, Lorelle Brownlee, Ashirwad Merve, Shireena A Yasin, Aimee Avery, Saira W Ahmed, Olumide Ogunbiyi, Jamie Gonzalez Zapata, Abigail F Peary, Marie Edwards, Lisa Wilkhu, Carryl Dryden, Dariusz Ladon, Mark Kristiansen, Catherine Rowe, Kathreena M Kurian, James A R Nicoll, Clare Mitchell, Tabitha Bloom, David A Hilton, Safa Al-Sarraj, Lawrence Doey, Paul N Johns, Leslie R Bridges, Aruna Chakrabarty, Azzam Ismail, Nitika Rathi, Khaja Syed, G Alistair Lammie, Clara Limback-Stanic, Colin Smith, Antonia Torgersen, Frances Rae, Rebecca M Hill, Steven C Clifford, Yura Grabovska, Daniel Williamson, Matthew Clarke, Chris Jones, David Capper, Martin Sill, Andreas von Deimling, Stefan M Pfister, David T W Jones, Darren Hargrave, Jane Chalker, Thomas S Jacques
• Jahr: 2020
• Jahr des Originals: 2019
• Umfang: 9 S.
• Fussnoten: Available online 27 November 2019 ; Gesehen am 07.04.2020
• Titel Quelle: Enthalten in: The lancet child & adolescent health
• Ort Quelle: Kidlington, Oxford : Elsevier, 2017
• Jahr Quelle: 2020
• Band/Heft Quelle: 4(2020), 2, Seite 121-130
• ISSN Quelle: 2352-4650
• DOI: doi:10.1016/S2352-4642(19)30342-6
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1694156230

Abstract

Background - Marked variation exists in the use of genomic data in tumour diagnosis, and optimal integration with conventional diagnostic technology remains uncertain despite several studies reporting improved diagnostic accuracy, selection for targeted treatments, and stratification for trials. Our aim was to assess the added value of molecular profiling in routine clinical practice and the impact on conventional and experimental treatments. - Methods - This population-based study assessed the diagnostic and clinical use of DNA methylation-based profiling in childhood CNS tumours using two large national cohorts in the UK. In the diagnostic cohort—which included routinely diagnosed CNS tumours between Sept 1, 2016, and Sept 1, 2018—we assessed how the methylation profile altered or refined diagnosis in routine clinical practice and estimated how this would affect standard patient management. For the archival cohort of diagnostically difficult cases, we established how many cases could be solved using modern standard pathology, how many could only be solved using the methylation profile, and how many remained unsolvable. - Findings - Of 484 patients younger than 20 years with CNS tumours, 306 had DNA methylation arrays requested by the neuropathologist and were included in the diagnostic cohort. Molecular profiling added a unique contribution to clinical diagnosis in 107 (35%; 95% CI 30-40) of 306 cases in routine diagnostic practice—providing additional molecular subtyping data in 99 cases, amended the final diagnosis in five cases, and making potentially significant predictions in three cases. We estimated that it could change conventional management in 11 (4%; 95% CI 2-6) of 306 patients. Among 195 historically difficult-to-diagnose tumours in the archival cohort, 99 (51%) could be diagnosed using standard methods, with the addition of methylation profiling solving a further 34 (17%) cases. The remaining 62 (32%) cases were unresolved despite specialist pathology and methylation profiling. - Interpretation - Together, these data provide estimates of the impact that could be expected from routine implementation of genomic profiling into clinical practice, and indicate limitations where additional techniques will be required. We conclude that DNA methylation arrays are a useful diagnostic adjunct for childhood CNS tumours. - Funding - The Brain Tumour Charity, Children with Cancer UK, Great Ormond Street Hospital Children's Charity, Olivia Hodson Cancer Fund, Cancer Research UK, and the National Institute of Health Research.