{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T17:59:44Z","timestamp":1788026384367,"version":"build-2784847793"},"reference-count":69,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T00:00:00Z","timestamp":1761436800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T00:00:00Z","timestamp":1761436800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain Pathology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The fifth edition of the WHO classification of CNS Tumors (WHO CNS5) has revised the diagnostic and grading criteria for Adult\u2010type Diffuse Gliomas (ADGs) by integrating molecular parameters with histologic features. Conducting molecular testing for most ADGs is now crucial in fulfilling the WHO CNS5 diagnostic criteria. However, due to additional costs and technical barriers, implementing molecular diagnostics is often not feasible in Low\u2010Income Countries (LICs) and Lower Middle\u2010Income Countries (LMICs). Therefore, practical approaches are needed for diagnosis in resource\u2010restrained settings. Hence, the Asian Oceanian Society of Neuropathology (AOSNP), through the \u2018ADAPTR\u2019 (Adapting Diagnostic Approaches for Practical Taxonomy in Resource\u2010Restrained Regions) initiative, aimed to provide resource\u2010stratified recommendations for diagnosing ADGs based on available resources while adhering to the WHO guidelines as much as possible. ADAPTR identified different resource levels (RLs) of diagnostic pathology services, ranging from RL I to RL V, with RL I to RL IV being applicable to the LMICs, and provides recommendations for a \u2018Histology\u2010oriented integrated diagnosis format\u2019 for each tumor type at different RLs. In addition, diagnostic flow charts for ADGs have been generated to suit these RLs. The emphasis is mainly on using histopathological approaches with immunohistochemistry, while molecular testing recommendation is categorized as \u2018can be considered\u2019, \u2018highly recommended\u2019 or \u2018obligatory\u2019, to reach the next level diagnosis. In each RL, either a WHO CNS5 diagnosis with an accompanying CNS WHO grade or an ADAPTR descriptive diagnosis with an associated ADAPTR histologic grade is provided, depending on the context. ADAPTR recommendations are therefore a practical adaptation of the WHO CNS5 guidelines that will suit routine diagnostic practices in resource\u2010restrained regions.<\/jats:p>","DOI":"10.1111\/bpa.70046","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T05:45:07Z","timestamp":1761543907000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["<scp>AOSNP<\/scp>\n                    \u2010\n                    <scp>ADAPTR<\/scp>\n                    resource level\u2010based recommendations on practical diagnostic strategies for\n                    <scp>WHO CNS5<\/scp>\n                    adult\u2010type diffuse gliomas"],"prefix":"10.1111","volume":"36","author":[{"given":"Vani","family":"Santosh","sequence":"first","affiliation":[{"name":"Department of Neuropathology National Institute of Mental Health and Neuro Sciences  Bengaluru India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4315-9316","authenticated-orcid":false,"given":"Chitra","family":"Sarkar","sequence":"additional","affiliation":[{"name":"Department of Pathology All India Institute of Medical Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3067-6557","authenticated-orcid":false,"given":"Shilpa","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Neuropathology National Institute of Mental Health and Neuro Sciences  Bengaluru India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2614-2213","authenticated-orcid":false,"given":"Ho\u2010Keung","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Anatomical and Cellular Pathology Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junji","family":"Shibahara","sequence":"additional","affiliation":[{"name":"Department of Pathology Kyorin University of Medicine, Shinkawa, Mitaka  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6392-150X","authenticated-orcid":false,"given":"Maysa","family":"Al\u2010Hussaini","sequence":"additional","affiliation":[{"name":"Department of Cell Therapy and Applied Genomics King Hussein Cancer Center  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Buckland","sequence":"additional","affiliation":[{"name":"Department of Neuropathology Royal Prince Alfred Hospital, Camperdown  Sydney NWS Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8681-1597","authenticated-orcid":false,"given":"Sung\u2010Hye","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Pathology Seoul National University, College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarik","family":"Tihan","sequence":"additional","affiliation":[{"name":"Department of Pathology, Neuropathology Unit University of Miami Miller School  Miami USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5453-5201","authenticated-orcid":false,"given":"Pieter","family":"Wesseling","sequence":"additional","affiliation":[{"name":"Department of Pathology Amsterdam University Medical Centers\/VU University  Utrecht The Netherlands"},{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David N.","family":"Louis","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Komori","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology Tokyo Metropolitan Neurological Hospital, Tokyo Metropolitan Hospital Organization  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,26]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"8","volume-title":"Central nervous system tumours","author":"Louis DN","year":"2021"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.5858\/2008-0432-CCR.1"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.5858\/2007-131-1636-PSIDCA"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23830"},{"issue":"1","key":"e_1_2_10_6_1","first-page":"14","article-title":"The challenge of global health","volume":"86","author":"Garrett L","year":"2007","journal-title":"Foreign Aff"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.4103\/0028-3886.253572"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2017-204638"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10014-019-00337-y"},{"key":"e_1_2_10_10_1","first-page":"25","volume-title":"Astrocytoma, IDH\u2010mutant","author":"Brat DJ","year":"2021"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02893360"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.pap.0000163957.21409.52"},{"issue":"4","key":"e_1_2_10_13_1","first-page":"754","article-title":"Proliferative index in astrocytic tumours","volume":"50","author":"Rathi KR","year":"2007","journal-title":"Indian J Pathol Microbiol"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20011115)92:10<2720::AID-CNCR1626>3.0.CO;2-Z"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13000-018-0711-2"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-009-0595-z"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-014-1370-3"},{"key":"e_1_2_10_18_1","volume-title":"Tumours of the central nervous system (CNS) reporting guide","author":"Wesseling P","year":"2024"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/bpa.12173"},{"issue":"5","key":"e_1_2_10_20_1","first-page":"6","article-title":"Searching for a cut\u2010off point for p53 immunohistochemistry as evidence of TP53 mutations","volume":"12","author":"Caliskan I","year":"2024","journal-title":"Free Neuropathol"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/CM9.0000000000002446"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/bpa.13062"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/nop\/npy041"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noad100"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/bpa.12832"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noab106"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/COC.0000000000000490"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noy132"},{"key":"e_1_2_10_29_1","first-page":"27","volume-title":"Astrocytoma, IDH\u2010mutant","author":"Brat DJ","year":"2021"},{"key":"e_1_2_10_30_1","first-page":"37","volume-title":"WHO classification of Tumours editorial board. Central nervous system tumours","author":"Reifenberger G","year":"2021"},{"key":"e_1_2_10_31_1","first-page":"54","volume-title":"WHO classification of Tumours editorial board. Central nervous system tumours","author":"Louis DN","year":"2021"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10014-020-00392-w"},{"key":"e_1_2_10_33_1","first-page":"56","volume-title":"WHO classification of Tumours editorial board. Central nervous system tumours","author":"Hawkins CE","year":"2021"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noae048"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.4103\/glioma.glioma_27_18"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10014-023-00468-3"},{"issue":"1","key":"e_1_2_10_37_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00401-023-02654-1","article-title":"De novo replication repair deficient glioblastoma, IDH\u2010wildtype\u201d is a distinct glioblastoma subtype in adults that may benefit from immune checkpoint blockade","volume":"147","author":"Hadad S","year":"2023","journal-title":"Acta Neuropathol"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/bpa.13201"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/bpa.13329"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1328374"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-17-0560"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-024-03297-z"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A7916"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A8894"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A5070"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A6983"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15051512"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40478-023-01573-2"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/neup.12014"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41379-020-00701-w"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41379-019-0310-0"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pathol.2023.01.005"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/neup.13005"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2021-0331-OA"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1093\/noajnl\/vdaf060"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI0215529"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noac111"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-019-02025-9"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40478-021-01194-7"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-019-02123-8"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-018-1826-y"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70350-4"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.3171\/2022.9.FOCUS22427"},{"issue":"12","key":"e_1_2_10_64_1","first-page":"1519","article-title":"CDKN2A homozygous deletion is a strong adverse prognosis factor in diffuse malignant IDH\u2010mutant gliomas","volume":"21","author":"Appay R","year":"2019","journal-title":"Neuro Oncol"},{"key":"e_1_2_10_65_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-016-1545-1"},{"key":"e_1_2_10_66_1","volume-title":"Closing the gap: research and cancer care imperatives for adolescents and young adults with cancer (NIH Publication No. 06\u20106067)","author":"Adolescent and Young Adult Oncology Progress Review Group","year":"2006"},{"key":"e_1_2_10_67_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noaa258"},{"key":"e_1_2_10_68_1","doi-asserted-by":"publisher","DOI":"10.1111\/bpa.70035"},{"key":"e_1_2_10_69_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1628195"},{"key":"e_1_2_10_70_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noad008"}],"container-title":["Brain Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bpa.70046","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/bpa.70046","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bpa.70046","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:15:52Z","timestamp":1770855352000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/bpa.70046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,26]]},"references-count":69,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/bpa.70046"],"URL":"https:\/\/doi.org\/10.1111\/bpa.70046","archive":["Portico"],"relation":{},"ISSN":["1015-6305","1750-3639"],"issn-type":[{"value":"1015-6305","type":"print"},{"value":"1750-3639","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,26]]},"assertion":[{"value":"2025-06-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70046"}}