Low-grade glioma with high-risk molecular features: IDH-wildtype (per WHO 5th ed., reclas...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-GLIOMA-LOW-GRADE-HIGH-RISK-BIOLOGY`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-GLIOMA-LOW-GRADE`
Sources	`SRC-EANO-GBM-2024` `SRC-NCCN-CNS-2025` `SRC-WHO-LNSC-2023`

Red Flag Origin

Definition	Low-grade glioma with high-risk molecular features: IDH-wildtype (per WHO 5th ed., reclassified as glioblastoma molecular features even if histologically low-grade), CDKN2A/B homozygous deletion, TERT-promoter mutation in IDH-wildtype, or 1p/19q intact astrocytoma with poor risk score
Clinical direction	intensify
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "finding": "idh_wildtype",
      "value": true
    },
    {
      "finding": "cdkn2a_b_homozygous_deletion",
      "value": true
    },
    {
      "finding": "tert_promoter_mutation",
      "value": true
    },
    {
      "finding": "histology_grade_3_features",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

Per WHO 5th ed.: IDH-wildtype diffuse astrocytoma with EGFR amp / +7-10 / TERT-promoter mutation is reclassified as "glioblastoma, IDH-wildtype" regardless of histology grade — these patients are managed under GBM (DIS-GBM) algorithm, not LGG. Per EANO 2024 + NCCN-CNS LGG: CDKN2A/B homozygous deletion in IDH-mut astrocytoma confers grade 4 behavior. Direction INTENSIFY — shifts to GBM-like management (Stupp protocol or aggressive RT + chemotherapy). STUB — requires clinical co-lead signoff.

Used By

Indications

IND-GLIOMA-LOW-GRADE-1L-RT-PCV - IND-GLIOMA-LOW-GRADE-1L-RT-PCV