Wednesday, December 8, 2021

WHO Boosts Molecular Classification in Brain Tumors: Headaches From 14 Day Rule

The November 2021 issue of CAP TODAY includes a cover story by Karin Titus on the sharply growing role of molecular classification in the diagnosis of brain tumors.   Molecular testing has become critical for major decisions both in tumor classification (tumor type) as well as in tumor grading.

See the article here.

Genomics are used for classifying types of brain cancer (e.g. two major and different lines of astrocytomas) as well as tumor grading.  Methylation patterns are also rising in importance for tumor classification.   Great news for molecular pathology and for better patient diagnostics.

14 Day Rule Collides with Inpatient DRGs

If the specimens were outpatient specimens, the 14 day rule now has an exception for human (but not microbial) molecular testing.  However, there is no exception for any kind of testing, or molecular testing, on inpatient specimens.  The molecular tests are bundled to the fixed DRG price, and most brain tumor specimens will be inpatient specimens.  That means the lab has to incur hundreds of dollars of new, and bundled, costs unless the physician's order for molecular testing is made at least14 days after the patient's discharge.

Worth thinking about the policy and patient care implications.  The article, which features comments from Arie Perry of UCSF and Daniel Brat of Northwestern, notes that a new CAP guideline for brain tumor testing will appear shortly in Arch Pathol Lab Med.  The article is based primarily on the recently completed 2021 WHO guidelines for brain tumor diagnosis and classification.


Brings back some memories for me; I'm a board certified neuropathologist and served on the Northwestern faculty 1997-2001 before moving into business positions.