Reliability of IDH1-R132H and ATRX and/or p53 immunohistochemistry for molecular subclassification of Grade 2/3 gliomas

Tomohide Nishikawa, Reiko Watanabe, Yotaro Kitano, Akane Yamamichi, Kazuya Motomura, Fumiharu Ohka, Kosuke Aoki, Masaki Hirano, Akira Kato, Junya Yamaguchi, Sachi Maeda, Yuji Kibe, Ryuta Saito, Toshihiko Wakabayashi, Yukinari Kato, Shuta Sato, Tomoyoshi Ogino, Atsushi Natsume, Ichiro Ito

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1 Citation (Scopus)


Since the World Health Organization 2016 classification (2016 WHO), genetic status has been incorporated into the diagnosis of Grade 2/3 gliomas (lower-grade gliomas). Therefore, immunohistochemistry (IHC) of IDH1-R132H, ATRX, and p53 have been used in place of genetic status. We report the associations between histological findings, IHC, and genetic status. We performed IHC of IDH1-R132H, ATRX, and p53 in 76 lower-grade gliomas and discussed its validity based on the 2016 WHO and the upcoming 2021 WHO classification. The sensitivity and specificity of anti-ATRX, p53, and IDH1-R132H IHC were 40.9%/98.1%, 78.6%/85.4%, and 90.5%/84.6%, respectively. Among 21 IDH1-mutant gliomas without 1p/19q codeletion, two gliomas (9.5%) mimicked the so-called classic for oligodendroglioma (CFO) in their morphology. Of the 42 gliomas with 1p/19q codeletion, four cases were difficult to diagnose as oligodendroglioma through morphological examination. Moreover, there were three confusing cases with ATRX mutations but with retained ATRX-IHC positivity. The lessons learned from this study are as follows: (1) ATRX-IHC and p53-IHC should be supplementary to morphological diagnosis, (2) rare IDH mutations other than IDH1 R132H should be considered, and (3) there is no complete alternative test to detect molecular features of glioblastoma under the 2021 WHO classification.

Original languageEnglish
Pages (from-to)14-24
Number of pages11
JournalBrain Tumor Pathology
Issue number1
Publication statusPublished - 2022 Jan


  • ATRX
  • Genetics
  • Glioma
  • Immunohistochemistry
  • Surrogate marker
  • WHO 5th CNS tumor classification 2021
  • p53

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology
  • Cancer Research


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