The 2007 WHO classification of tumours of the central nervous system — TEI-tagged view

David N. Louis, Hiroko Ohgaki, Otmar D. Wiestler, Webster K. Cavenee, Peter C. Burger, Anne Jouvet, Bernd W. Scheithauer, Paul Kleihues · 2007 · medicine · doi:10.1007/s00401-007-0243-4 · TEI xml · tagged edition · index · concepts · authors
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Tags on this paper every tag the record carries, whether or not the words occur in the text below — a number is how many papers in the corpus carry that tag; a tag with no number is unique to this paper
Variants a previously defined, overarching entity a new entity an unusual histopathological pattern CNS PNET Supratentorial PNET the WHO system the St Anne/Mayo classification tumour grade the choice of therapies expert-consensus69
Method, as described: an international Working Group of 25 pathologists and geneticists convened for one meeting in November 2006, with contributions from more than 70 experts overall

Our tag layer for this paper

Cross-disciplinary analysis
content-tags & facets: phenomenon · claim-type · cross-domain-transfer · mechanism · claim-relation · replication-status · limitation — grounded in the full text
phenomenona classification whose grade label decides therapy while spanning outcomes from death within a year to 80% five-year survival— “Despite these variables, patients with WHO grade II tumours typically survive more than 5 years and those with grade III tumours survive 2–3 years. The prognosis of patients with WHO grade IV tumours depends largely upon whether effective treatment regimens are available. The majority of glioblastoma patients, particularly the elderly…
claim-typemethod— “The international classification of human tumours published by the World Health Organization (WHO) was initiated through a resolution of the WHO Executive Board in 1956 and the World Health Assembly in 1957. Its objectives have remained the same until today: to establish a classification and grading of human tumours that is accepted and used…
method — evidence— “This also applies to the fourth edition; a group of 25 pathologists and geneticists convened at the German Cancer Research Center in Heidelberg in November 2006 and the results of their deliberations and those of an additional 50 contributors are contained in the 2007 WHO classification of tumours of the central nervous system [ 35 ].”
object of study — evidence— “The Working Group distinguished between clinico-pathological entities, variants of entities and histological patterns. To be included in the WHO classification, two or more reports from different institutions were considered mandatory. In addition, a new entity had to be characterized by distinctive morphology, location, age distribution and…
research question — evidence— “Tumours of the CNS often display a significant histopathological heterogeneity. Surgical pathologists need to know such divergent patterns of differentiation but not every pattern warrants designation as a variant, since some patterns do not have distinct clinical or genetic features. The WHO Working Group for the fourth edition proposed that…
contribution — evidence— “Histological variants were added if there was evidence of a different age distribution, location, genetic profile or clinical behaviour; these included pilomyxoid astrocytoma, anaplastic medulloblastoma and medulloblastoma with extensive nodularity. The WHO grading scheme and the sections on genetic profiles were updated and the rhabdoid…
mechanismA THREE-RANK MEMBERSHIP VOCABULARY WITH PUBLISHED ADMISSION RULES: `The Working Group distinguished between clinico-pathological entities, variants of entities and histological patterns. To be included in the WHO classification, two or more reports from different institutions were considered mandatory. In addition, a new entity had to be characterized by distinctive morphology, location, age distribution and biologic behaviour, and not simply by an unusual histopathological pattern.` An evidence threshold, an independence requirement and three ranks of thinghood - the most complete published set of admission rules for a class in this corpus— “The Working Group distinguished between clinico-pathological entities, variants of entities and histological patterns. To be included in the WHO classification, two or more reports from different institutions were considered mandatory. In addition, a new entity had to be characterized by distinctive morphology, location, age distribution and…mechanisms[0]
mechanismAND THE AUTHORITY SAYS ITS OWN PAST ADMISSIONS FAILED ITS OWN RULE: `histological variants have been introduced if there was evidence that a particular morphological pattern was associated with a different biological or clinical behaviour. Admittedly, in retrospect, this criterion was not always fulfilled.` Four editions of a standard, and the fourth says the first three admitted things they should not have— “Throughout the history of the WHO Blue Book series, histological variants have been introduced if there was evidence that a particular morphological pattern was associated with a different biological or clinical behaviour. Admittedly, in retrospect, this criterion was not always fulfilled. In the fourth edition of the WHO Classification…mechanisms[1]
mechanismAND AN ENTITY IS DEMOTED TO A DESCRIPTIVE PHRASE, WITH ITS CODE REDIRECTED: `Medulloblastoma with myogenic differentiation was previously termed MEDULLOMYOBLASTOMA ... since its clinical features and genetic profile are similar to those of other medulloblastomas, this lesion is no longer considered A DISTINCT ENTITY and it is suggested that the code for medulloblastoma (9470/3) be applied.` The name survives as a description and loses its standing as a thing - and melanotic medulloblastoma goes the same way in the next paragraph— “Medulloblastoma with myogenic differentiation was previously termed medullomyoblastoma (ICD-O: 9472/3). The code remains but since its clinical features and genetic profile are similar to those of other medulloblastomas, this lesion is no longer considered a distinct entity [ 14 , 34 ] and it is suggested that the code for medulloblastoma…mechanisms[2]
mechanismAND A CLASS IS PARKED WITH THE CONDITION FOR ITS PROMOTION NAMED: `If future clinical trials show a difference in prognosis and/or response to therapy, the small cell glioblastoma may be reconsidered as a variant of glioblastoma with a distinct ICD-O code.` A pre-registered promotion criterion for a category - and the glioneuronal tumour with neuropil-like islands is parked the same way, needing `more cases with genetic analysis and clinical follow-up`— “If future clinical trials show a difference in prognosis and/or response to therapy, the small cell glioblastoma may be reconsidered as a variant of glioblastoma with a distinct ICD-O code.”mechanisms[3]
mechanismAND THE DISSENT IS PRESERVED WITH THE RIVAL NAMES: `At the WHO consensus meeting, the designation of these tumours was controversial. Some participants proposed the term `OLIGOASTROCYTOMA WHO GRADE IV` or `OLIGODENDROGLIAL GLIOBLASTOMA MULTIFORME`. The majority of pathologists thought that more clinico-pathological data should be available before this tumour is considered a new disease entity.` The losing names are printed, and the interim label - `glioblastoma with oligodendroglioma component` - is explicitly provisionalmechanisms[4]
mechanismAND A TERM IS NARROWED, WITH ITS DEPRECATED SYNONYMS LISTED: `In the past, the term pituicytoma was also applied to other tumours in the sellar and suprasellar region, particularly granular cell tumours and pilocytic astrocytomas. Presently, it is reserved for low-grade glial neoplasms that originate in the neurohypophysis ... Less preferred terms for pituicytoma include `POSTERIOR PITUITARY ASTROCYTOMA` and ... `INFUNDIBULOMA`.` Our `alternatives` layer again, in a real classification, with a preference order
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mechanisms[5]
mechanismAND A PREFIX IS ADDED BECAUSE ANOTHER FIELD USES THE SAME NAME: the previous edition's `supratentorial primitive neuroectodermal tumours` becomes the more general PNET, and then `Since this designation is also used for similar ... tumours at extracerebral sites, the WHO Working Group proposes to add the prefix CNS to these entities, in order to avoid any confusion.` A name disambiguated by construction rather than by context
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mechanisms[6]
mechanismAND THE GRADING SCHEME DISCLAIMS ITSELF AND IS OPTIONAL: `The WHO classification ... includes a grading scheme that is A `MALIGNANCY SCALE` ranging across a wide variety of neoplasms rather than a strict histological grading system. It is widely used, but not a requirement for the application of the WHO classification.` The instrument that decides radiation and chemotherapy is declared not to be part of the classification it accompanies
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mechanisms[7]
mechanismAND ONE GRADE LABEL SPANS UNDER A YEAR AND OVER 80% FIVE-YEAR SURVIVAL: `The majority of glioblastoma patients ... succumb to the disease within a year. For those with other grade IV neoplasms, the outlook may be considerably better. For example, cerebellar medulloblastomas and germ cell tumours such as germinomas, both WHO grade IV lesions, are rapidly fatal if untreated, while state-of-the-art radiation and chemotherapy result in 5-year survival rates exceeding 60 and 80%.` A class whose members are not alike in the thing the class predicts
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mechanisms[8]
mechanismAND THE GRADES OF THE NEW ENTITIES ARE PROVISIONAL BECAUSE n IS SMALL: `since the number of cases of some newly defined entities is limited, the assignment of grades remains preliminary, pending publication of additional data and long-term follow-up.` Angiocentric glioma rests on 28 reported cases, RGNT on 17, spindle cell oncocytoma on ten from three institutions - and the grade decides the therapy
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mechanisms[9]
mechanismAND TWO GRADING SYSTEMS USE ONE NUMBER FOR DIFFERENT THINGS: `This system is similar to the St Anne/Mayo classification, with the only major difference being grade I; in the WHO system, grade I is assigned to the more circumscribed pilocytic astrocytoma, whereas the St Anne/Mayo classification assigns grade 1 to an exceedingly rare diffuse astrocytoma without atypia.` Same label, different extension, and both live in the same clinics
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mechanisms[10]
mechanismAND THE CRITERION FOR THE TOP GRADE VARIES BY AUTHOR: `For WHO grade IV, some authors accept only the criterion of endothelial proliferation, i.e. an apparent multi-layering of endothelium. The WHO classification also accepts glomeruloid microvascular proliferations. Necrosis may be of any type; perinecrotic palisading need not be present.` The classification is more permissive than some of its users, and says which way
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mechanisms[11]
extends the third edition of the WHO Blue Book (Kleihues & Cavenee 2000), which first incorporated genetic profiles as aids to the definition of brain tumours
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claim_relations[0]
critiques the series' own earlier variant admissions - 'Admittedly, in retrospect, this criterion was not always fulfilled'
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claim_relations[1]
contradicts the St Anne/Mayo grading of astrocytomas at grade I, which assigns the number to a different tumour
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claim_relations[2]
sense`entity` (clinico-pathological) - admitted only on TWO OR MORE REPORTS FROM DIFFERENT INSTITUTIONS plus distinctive morphology, location, age distribution and biologic behaviour, and NOT on an unusual histopathological pattern alone
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senses[0]
sense`variant` - reliably identifiable histologically and with some relevance for clinical outcome, but STILL PART OF a previously defined overarching entity
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senses[1]
sense`pattern of differentiation` - an identifiable histological appearance WITHOUT distinct clinical or pathological significance; the rank for things that look different and do not behave differently
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senses[2]
sense`WHO grade` - a `malignancy scale` across all neoplasms rather than a histological grading system, explicitly NOT a requirement for applying the classification, and preliminary for the new entities because their case numbers are small
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senses[3]
controlrequiring two or more reports from DIFFERENT INSTITUTIONS before a lesion may be admitted as an entity — held
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— rules out a single centre's case series becoming a worldwide diagnostic category
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controls[0]
controlthe three-rank scheme itself - refusing varianthood to patterns without distinct clinical or genetic features — partial
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— rules out a recognisable appearance being mistaken for a distinct disease
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controls[1]
controlmarking the grades of newly defined entities as preliminary until case numbers and follow-up accumulate — failed
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— rules out nothing at the bedside - the grade still decides radiation and chemotherapy while it is provisional
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controls[2]
weightthe third edition of the WHO Blue Book (Kleihues & Cavenee 2000), which first incorporated genetic profiles as aids to the definition of brain tumours — 0.95
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claim_relations[0]
weightthe series' own earlier variant admissions - 'Admittedly, in retrospect, this criterion was not always fulfilled' — 0.85
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claim_relations[1]
weightthe St Anne/Mayo grading of astrocytomas at grade I, which assigns the number to a different tumour — 0.85
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claim_relations[2]
noteVariants —part-of→ a previously defined, overarching entity — 'VARIANTS WERE DEFINED…' The rank is defined by containment, not by resemblance - and the paper then demotes medullomyoblastoma out of entityhood and parks small cell glioblastoma below varianthood, so all three ranks are exercised in one document
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concept_edges[0]
relationVariants —part-of→ a previously defined, overarching entity — a variant is recognisable and clinically relevant but does not leave its parent entity - which is exactly what separates it from a new entity
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concept_edges[0]
weightVariants —part-of→ a previously defined, overarching entity — 0.95
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concept_edges[0]
notea new entity —distinct-from→ an unusual histopathological pattern — 'a new entity…' A published statement of what does NOT count, which the corpus has only in the ENCODE blacklist and in bishop2017's exclusionary-criteria section. Note the conjunction: the abstract's rule for VARIANTS uses OR across the same four properties, and this rule for ENTITIES uses AND
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concept_edges[1]
relationa new entity —distinct-from→ an unusual histopathological pattern — an unusual appearance is explicitly insufficient - a new entity needs distinctive morphology AND location AND age distribution AND biologic behaviour
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concept_edges[1]
weighta new entity —distinct-from→ an unusual histopathological pattern — 0.95
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concept_edges[1]
noteCNS PNET —same-as→ Supratentorial PNET — 'THE TERM CNS…' The reason is a cross-field collision: 'tumours AT EXTRACEREBRAL…' A rename that changes nothing about the object and everything about the reader - and the old name keeps the code
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concept_edges[2]
relationCNS PNET —same-as→ Supratentorial PNET — the prefixed name is declared synonymous with the existing ICD-O term, so the rename carries no change of extension - only a change of who can be confused
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concept_edges[2]
weightCNS PNET —same-as→ Supratentorial PNET — 0.95
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concept_edges[2]
auditthe WHO system —distinct-from→ the St Anne/Mayo classification — Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but the span says the WHO system is SIMILAR to the St Anne/Mayo classification with one major difference; distinct-from is loose.
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concept_edges[3]
notethe WHO system —distinct-from→ the St Anne/Mayo classification — 'This system is…' Two systems, one number, different referents, both live - and a grade decides whether a patient gets radiation
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concept_edges[3]
relationthe WHO system —distinct-from→ the St Anne/Mayo classification — the two astrocytoma grading systems agree everywhere except grade I, where they assign the same number to different tumours
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concept_edges[3]
weightthe WHO system —distinct-from→ the St Anne/Mayo classification — 0.95
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concept_edges[3]
notetumour grade —causes→ the choice of therapies — 'Histological grading is…' Read against two other sentences in the same paper: the scale is 'NOT A REQUIREMENT…', and for the new entities 'THE ASSIGNMENT…'. An optional, provisional label with a treatment attached
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concept_edges[4]
relationtumour grade —causes→ the choice of therapies — the grade is a key factor in choosing therapy, and in particular in deciding adjuvant radiation and chemotherapy protocols
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concept_edges[4]
weighttumour grade —causes→ the choice of therapies — 0.95
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concept_edges[4]
outcomecontrol — held
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controls[0]
outcomecontrol — partial
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controls[1]
outcomecontrol — failed
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controls[2]
limitationTWO DISTINCT ENTITIES SHARE ONE CODE, SO THE REGISTRY CANNOT SEE WHAT THE CLASSIFICATION DISTINGUISHES: `the rosette-forming glioneuronal tumour (RGNT) corresponds to WHO grade I. It shares the new ICD-O code 9509/1 with the papillary glioneuronal tumour (PGNT).` Anaplastic and large cell medulloblastoma likewise share 9474/3. The paper says ICD-O `assures that histopathologically stratified population-based incidence and mortality data become available` - and the stratification stops one level above the entities the same paper just created
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limitations[0]
limitationAND A PATTERN IS NOT A VARIANT, WHICH LEAVES REAL DIFFERENCES UNNAMED: `Surgical pathologists need to know such divergent patterns of differentiation but not every pattern warrants designation as a variant, since some patterns do not have distinct clinical or genetic features.` The rank is decided by consequence, not by appearance - so a reliably recognisable thing can have no name in the system
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limitations[1]
limitationAND THE WORKING GROUP IS ONE MEETING: `a group of 25 pathologists and geneticists convened at the German Cancer Research Center in Heidelberg in November 2006 and the results of their deliberations and those of an additional 50 contributors are contained in the 2007 WHO classification.` No voting rule, no agreement threshold and no dissent count is reported - against bishop2017 and staab2017, which publish all three
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limitations[2]
limitationAND THE NEW-VARIANT RULE IS LOOSER IN THE ABSTRACT THAN IN THE TEXT: the abstract says `Histological variants were added if there was evidence of a different age distribution, location, genetic profile or clinical behaviour` - four alternatives joined by OR - while the Entities section requires a new ENTITY to have distinctive morphology AND location AND age distribution AND biologic behaviour. The conjunction changes between the two statements of the same rule family
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limitations[3]
limitationTHE SHARED-CODE ACT IS PERFORMED THREE TIMES IN THIS PAPER AND THE CORPUS RECORDED IT ONCE. Already tagged: RGNT `shares the new ICD-O code 9509/1 with the papillary glioneuronal tumour`. Also in the text, untagged until now: `the 2007 WHO classification recommends the term `EXTRAVENTRICULAR NEUROCYTOMA` and proposes an ICD-O code identical to that of central neurocytoma (9506/1)`. The existing tag says `TWO DISTINCT ENTITIES SHARE ONE CODE, SO THE REGISTRY CANNOT SEE WHAT THE CLASSIFICATION DISTINGUISHES` - that sentence is equally true of 9506/1, and one instance made a policy look like a slip.
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limitations[4]
Content tags
content-observations: finding · quantity · variable · definition · key-term — grounded in the full text
finding
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content_tags.findings[0]
finding
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content_tags.findings[1]
finding
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content_tags.findings[2]
finding
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content_tags.findings[3]
finding
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content_tags.findings[4]
finding
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content_tags.findings[5]
finding
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content_tags.findings[6]
finding
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content_tags.findings[7]
finding
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content_tags.findings[8]
quantitytwo or more reports from different institutions, mandatory —
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content_tags.quantities[0]
quantity25 pathologists and geneticists at one meeting in November 2006, plus about 50 further contributors —
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content_tags.quantities[1]
quantitymost glioblastoma patients dead within a year; 5-year survival above 60% (medulloblastoma) and 80% (germinoma) —
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content_tags.quantities[2]
variablebiologic behaviour
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content_tags.variables[0]
definitionWHO grade
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content_tags.definitions[1]
definitionclinico-pathological entities
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content_tags.definitions[2]
definitionvariants of entities
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
content_tags.definitions[3]
definitionhistological patterns
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
content_tags.definitions[4]
Concepts
terms this paper carries, each with the sentence it was cut from — the layer that joins one paper to another. Terms with no quote yet are on CONCEPTS.html.
conceptVariants — not defined in this paper's own words; the middle rank: recognisable, clinically relevant, and inside an existing entity
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
concepts[0]
concepta previously defined, overarching entity — not defined in this paper's own words; the parent class a variant remains inside
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
concepts[1]
concepta new entity — not defined in this paper's own words; the top rank, admitted only on the four-way characterisation plus two independent reports
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
concepts[2]
conceptan unusual histopathological pattern — not defined in this paper's own words; what is explicitly NOT sufficient to make a new entity
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
concepts[3]
conceptCNS PNET — not defined in this paper's own words; the prefixed name adopted to avoid collision with the extracerebral use of PNET
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
concepts[4]
conceptSupratentorial PNET — not defined in this paper's own words; the ICD-O term the new name is declared synonymous with
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
concepts[5]
conceptthe WHO system — not defined in this paper's own words; this classification's grading scheme
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
concepts[6]
conceptthe St Anne/Mayo classification — not defined in this paper's own words; the rival astrocytoma grading scheme that assigns grade 1 to something else
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
concepts[7]
concepttumour grade — not defined in this paper's own words; the malignancy-scale label attached to every entity
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
concepts[8]
conceptthe choice of therapies — not defined in this paper's own words; what the grade decides - adjuvant radiation and chemotherapy protocols
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
concepts[9]
Statistics — cross-field join keys
field-invariant statistical terms, used in their statistical sense (gated on a number / symbol / test). A p-value or a standard deviation means the SAME thing in physics, biology, psychology and sociology — so these are the strongest cross-field join keys. Grounded verbatim.
a label that predicts opposite outcomes inside itself
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
content_tags.statistics[0]

When we have changed our mind. Some entries in the table begin with a word in capitals and the reason for it. EVIDENCE CORRECTED — the finding still stands, but we had quoted the wrong sentence from the paper, and the quotation has been replaced with the right one. RETRACTED — the entry itself was wrong; it stays on the page, marked, with the reason, rather than being deleted. WITHDRAWN AND REPLACED — the entry was wrong, and a corrected version of it appears in the entries below. Each mark carries its own reason, in brackets, because the reasons differ from one entry to the next. An entry we have WITHDRAWN is removed from this page and kept in the record, with its reason. A line reading Audit and a date is a later re-reading of the entry against its whole sentence: DOUBTFUL means it was kept, and the reason says what is loose about it. Quotation marks inside the tagger's sentence. Where a tag is the tagger's own sentence, a phrase in quotation marks inside it is borrowed from the paper — the tagger's wording around it is not. The paper's own sentence is the evidence quote for that row; on this page it is withheld with the article, and the article is at its publisher. Nothing inside quotation marks anywhere on this page is ours: if it is quoted, it is the paper's. Whose words a concept carries. A concept entry records a term the paper itself uses, so the term, the sense given for it, and its evidence are the paper's own words, quoted where the paper fixes them. This is the opposite of a sense entry in the tag table, which is the tagger's sentence about how the paper uses a term. Where a concept entry could not be grounded in the paper's words, the entry says so on its own row.

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