LMI-17: CENTRALIZED PATHOLOGY REVIEW AS A RELIABLE OPTION TO ACHIEVE BETTER OUTCOME OF PATIENTS WITH CENTRAL NERVOUS SYSTEM (CNS) TUMOURS IN A LOW INCOME COUNTRY

INTRODUCTION: Despite the enormous benefits of the genetic detection methods, allowing better survival and cancer cure rates, the economic reality partly explains the difficulty of implementing large scale in developed countries and its introduction in Brazil. In 2014, there was published “National Policy for Integral Attention to People with Rare Diseases” by the Ministry of Health. Although this ordinance provides the realization of molecular genetic tests funded by SUS, there is still a lack of cover for cancer patients, especially the pediatric population. OBJECTIVE: The central pathology review was created from an initiative of non-governmental organization TUCCA (www.tucca.org.br) to provide an accurate diagnosis and molecular exams for brain tumor patients. METHODS: A specialized pathologist was incorporated to pediatric oncology team at Hospital Santa Marcelina to perform review of all cases, conduct clinical trials and participate to multidisciplinary meetings. RESULTS: So far, 450 reviews were performed since 2014. 263 were CNS tumours. Among them, 80 cases were medulloblastoma, 60 low and high grade glioma, 42 ependymomas, 13 glioneuronal tumours and six atypical teratoid rhabdoid tumor. The overall concordance was low (40%) but the rate of discordance was different across tumour types. Medulloblastoma achieved high rate of concordance (96%) and gliomas represented the most discordant rate (65%). CONCLUSION: The diagnosis concordance was low in brain tumours, especially for gliomas. Central pathology review brings high impact to patient survival and better treatment by correct diagnostic classification. This was an important step to initiate cooperative studies in Brazil and Latin America.