Transforming molecular neuropathology for adult brain tumour patients in the UK: Insights on implementation, adoption, and patient access (2021-2024)

Abstract Background Molecular neuropathology is evolving rapidly, driven by novel genomic technologies, national policies, and the urgent need for precision brain tumor care. Inequity in access to genomic testing highlighted in previous reports warrants further investigation. Methods We analyzed anonymized data from 21 United Kingdom (UK) neuro-oncology centers (covering an estimated 84% of the population) collected in 2021 and 2024 via the Tessa Jowell Centre of Excellence for Adults program. We assessed trends in genomic testing (including methylation arrays, gene panels, whole genome sequencing [WGS]), tumor snap freezing, turnaround times (TATs), and auditing. Results From 2021 to 2024, total genomic tests submitted across the 21 centers increased 128% from 2946 to 6730, while glioma cases increased 18% (from 3159 to 3722). Methylation arrays, gene panels, and WGS samples submitted rose by 342%, 174%, and 291%, respectively. Centers requesting WGS increased from 4/21 (19%) to 15/21 (71%), with 90% centers (19/21) reporting snap freezing of brain tumor samples in 2024 (mean 173, range 0-650 samples frozen per center). Mean molecular diagnosis TATs rose from 16 to 21 days; centers meeting a 14-day TAT dropped from 48% (10/21) to 30% (6/20). Auditing of TATs increased from 6/21 (29%) to 18/21 (86%). Conclusions UK molecular neuropathology testing grew substantially 2021-2024. However, variations in testing and snap freezing, and bottlenecks in diagnostic TATs, emphasize the need for: (1) targeted training and investment in rapid technologies to ensure sustainable service delivery; (2) focus on remaining inequities and (3) continued engagement with national benchmarking initiatives.