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Issues of Diagnostic Review in Brain Tumor Studies: From the Brain Tumor Epidemiology Consortium

¹ Division of Epidemiology/Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois; ² Department of Radiation Sciences and Oncology, Umeå University Hospital; ³ Department of Medical Biosciences-Pathology, Umeå University, Umeå, Sweden; Departments of ⁴ Pathology and ⁵ Epidemiology, University of Texas M. D. Anderson Cancer Center, Houston, Texas; ⁶ Case Comprehensive Cancer Center, Case Western University School of Medicine, Cleveland, Ohio; ⁷ Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland; ⁸ Division of Molecular Histopathology, Department of Pathology, Addenbrooke's Hospital, Cambridge, United Kingdom; ⁹ Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland; ¹⁰ Central Brain Tumor Registry of the United States, Hinsdale, Illinois; ¹¹ Department of Pathology, Duke University Medical Center, Durham, North Carolina; ¹² Cancer and Radiation Epidemiology Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel; ¹³ Sackler School of Medicine, Tel Aviv University, Israel; ¹⁴ University of California-San Francisco, San Francisco, California; and ¹⁵ Division of Epidemiology, School of Public Health, University of California, Berkeley, California

Requests for reprints: Faith G. Davis, School of Public Health, University of Illinois at Chicago, 1603 West Taylor, M/C 923 Chicago, IL 60612. Phone: 312-996-5019; Fax: 312-413-2025. E-mail: fayed{at}uic.edu

Epidemiologists routinely conduct centralized single pathology reviews to minimize interobserver diagnostic variability, but this practice does not facilitate the combination of studies across geographic regions and institutions where diagnostic practices differ. A meeting of neuropathologists and epidemiologists focused on brain tumor classification issues in the context of protocol needs for consortial studies (http://epi.grants.cancer.gov/btec/). It resulted in recommendations relevant to brain tumors and possibly other rare disease studies. Two categories of brain tumors have enough general agreement over time, across regions, and between individual pathologists that one can consider using existing diagnostic data without further review: glioblastomas and meningiomas (as long as uniform guidelines such as those provided by the WHO are used). Prospective studies of these tumors benefit from collection of pathology reports, at a minimum recording the pathology department and classification system used in the diagnosis. Other brain tumors, such as oligodendroglioma, are less distinct and require careful histopathologic review for consistent classification across study centers. Epidemiologic study protocols must consider the study specific aims, diagnostic changes that have taken place over time, and other issues unique to the type(s) of tumor being studied. As diagnostic changes are being made rapidly, there are no readily available answers on disease classification issues. It is essential that epidemiologists and neuropathologists collaborate to develop appropriate study designs and protocols for specific hypothesis and populations. (Cancer Epidemiol Biomarkers Prev 2008;17(3):484–9)