Comments on the reporting of lymph nodes and tumour budding in the checklist of colorectal carcinoma

Staging in colorectal cancer: problems for pathologists

“…Notably, in our study, we obtained similar results, as all restaged pT3N+ patients had only a single metastatic lymph node, which was found in specimens in which a minimum number of 19 lymph nodes had been originally detected 3 . Accordingly, we have recently proposed that, as an acceptable mean number, at least 20 lymph nodes should be recovered in colorectal cancer dissections 6 . We agree with the authors when they point out that small lymph nodes need to be found, as small metastatic deposits do occur 3,6 .…”

“…Accordingly, we have recently proposed that, as an acceptable mean number, at least 20 lymph nodes should be recovered in colorectal cancer dissections 6 . We agree with the authors when they point out that small lymph nodes need to be found, as small metastatic deposits do occur 3,6 . This is confirmed by our previously mentioned study showing that not only did all restaged pT3N+ patients have a single metastatic lymph node, but it also measured <5 mm in greatest diameter 3 …”

“…6 We agree with the authors when they point out that small lymph nodes need to be found, as small metastatic deposits do occur. 3,6 This is confirmed by our previously mentioned study showing that not only did all restaged pT3N+ patients have a single metastatic lymph node, but it also measured <5 mm in greatest diameter. 3 Another important issue raised by Quirke and Morris is the recommendation, in agreement with the Royal Collage of Pathologists (UK), to use the fifth, rather than the sixth, edition of TNM when dealing with venous invasion and tumour nodules ⁄ deposits in the pericolorectal adipose tissue of a primary carcinoma, without histological evidence of residual lymph node.…”

Tumour deposits classification in colorectal cancer: is TNM5 better than TNM7?

“…Regarding the statement by Quirke et al [1] about differential diagnosis between TDs and tumour budding (TB), although there is no general consensus about TB definition and quantification, we doubt that pathologists could misdiagnose them as TDs [5]. In a recent study, TB was defined as a single or a group of <5 detached tumour cells at the invasive tumour front [6].…”

“…In addition, N-stage should not be based on the personal decision of a pathologist to adhere to TNM5 or TNM7 because the use of two different classifications creates poor reproducibility and stage migration. In daily practice, we believe that TDs should be included in the pathology report, specifying their total number, size (the largest diameter if there are multiple lesions), and association, or not, with large vessels and/or nerves, in order to create more homogeneous groups of patients for enrolment in clinical trials [5,11]. This is crucial to better define the actual prevalence and clinical implication of TDs.…”