Predictive Histopathologic Factors for Lymph Node Metastasis in Patients With Nonpedunculated Submucosal Invasive Colorectal Carcinoma

Tominaga, Kenji; Nakanishi, Yukihiro; Nimura, Satoshi; Yoshimura, Kimio; Sakai, Yoshihiro; Shimoda, Tadakazu

doi:10.1007/s10350-004-0751-4

Cited by 128 publications

(103 citation statements)

References 33 publications

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“…Although the implication of budding/sprouting in deeply invasive colorectal cancer was first reported in 1989, 25 many studies have also focused on budding/sprouting as a risk factor of lymph node metastasis in T1 colorectal cancer. [12][13][14][15][26][27][28][29][30][31][32] Some investigators refer to findings similar to budding/sprouting as 'unfavorable histology at the invasive front,' 33 'focal dedifferentiation,' 34 or 'tumor cell dissociation,' 35 although the definition is not always consistent. 13,25,32,36 In the evaluation of budding/sprouting, we adopted the definition of Ueno et al 13 because it is widely used and has good reproducibility.…”

Section: Discussionmentioning

confidence: 99%

A three-tier classification system based on the depth of submucosal invasion and budding/sprouting can improve the treatment strategy for T1 colorectal cancer: a retrospective multicenter study

et al. 2015

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More than 85% of patients with T1 colorectal cancer have no lymph node metastasis and can be cured by endoscopic resection. To avoid unnecessary surgery after complete endoscopic resection, accurate histologic methods for evaluating resected specimens are needed to discriminate those at high risk for lymph node metastasis. A retrospective multi-institutional, cross-sectional study of 806 T1 colorectal cancer patients was conducted. A budding/sprouting score was incorporated for predicting lymph node metastasis in addition to other parameters, including the depth of submucosal invasion, histologic grade, and lymphovascular invasion. Lymph node metastasis was detected in 97 patients. Independent predictors of lymph node metastasis by multivariate analysis were depth of submucosal invasion ≥ 1000 μm (odds ratio (95% confidence interval) = 5.56 (2.14-19.10)) and high-grade budding/sprouting (3.14 (1.91-5.21)). Among lesions with a depth of submucosal invasion ≥ 1000 μm, lymph node metastasis was detected in 59 (29%) of 207 patients with high-grade budding/ sprouting, and in 34 (9%) of 396 with low-grade budding/sprouting. Lymph node metastasis was detected in only 4 (2%) of 203 lesions with a depth of submucosal invasion o 1000 μm. Of these four tumors, three invaded lymphatic and/or venous vessels. Thus, the risk for lymph node metastasis can be classified into three groups: high risk with a depth of submucosal invasion ≥ 1000 μm and high-grade budding/sprouting, intermediate-risk with a depth of submucosal invasion ≥ 1000 μm and low-grade budding/sprouting, and low-risk with a depth of submucosal invasion o1000 μm. These findings revealed that a depth of submucosal invasion ≥ 1000 μm and high-grade budding/sprouting are powerful predictive parameters for lymph node metastasis in T1 colorectal cancer. This three-tier risk classification system will facilitate the decision for additional major surgery for T1 colorectal cancer patients after successful endoscopic treatment.

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Section: Discussionmentioning

confidence: 99%

A three-tier classification system based on the depth of submucosal invasion and budding/sprouting can improve the treatment strategy for T1 colorectal cancer: a retrospective multicenter study

et al. 2015

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“…Identification of the risk factors for LNM is crucial in selecting appropriate therapeutic modalities for submucosal invasive CRC. Various risk factors for LNM have been reported, such as the depth of submucosal invasion (sm3), peritumoral LVI, poorly differentiated cancer, and tumor cell dissociation [13][14][15]. Choi et al demonstrated that LVI was a risk factor for LNM in the univariate analysis [16].…”

Section: Discussionmentioning

confidence: 99%

The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

et al. 2013

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Adenocarcinomas of the colon and rectum are the most common gastrointestinal malignancy, and lymph node metastases are established as a prognostic factor. Lymphovascular invasion has been recognized as an indication of lymph node metastases. This prompted us to investigate the features of primary tumor that may serve as a risk factor for lymphovascular invasion in colorectal carcinoma. Clinical and pathologic tissue data of colorectal carcinoma treated in our hospital were retrieved from the computer files at Haydarpasa Numune Education and Research Hospital, from June 1998 to December 2010, retrospectively. We excluded all patients who have two-thirds distal rectal carcinoma to rule out neoadjuvant treatment bias. Tissues from the specimens were stained with standard hematoxylin and eosin. Clinical data including age and sex of patient, location and diameter of tumor, perineural invasion, peritumoral lymphocytic infiltration, tumor grade, lymphovascular invasion, Pathologic T level (pT), and lymph node metastasis were recorded. Lymphovascular invasion was present only in 43 patients out of 108. Only pT and lymph node metastases were found to be statistically significant related to lymphovascular invasion (p=0.04 and p<0.001). Perineural invasion, pT, and peritumoral lymphocytic infiltration are the factors with p<0.2 in the univariate analysis that were investigated with multivariate analysis, but no factor was found as an independent prognostic factor for lymphovascular invasion. Lymphovascular invasion is significantly related to lymph node metastases. Only pT is found as a factor that increases the lymphovascular invasion.

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“…Among these patients, the histopathological features of 155 have already been reported. 6 The present series of cases did not include any that were treated by endoscopic mucosal resection and transanal mucosal resection; any with post-endoscopic mucosal resection recurrence; or any involving synchronous advanced cancers, familial adenomatous polyposis, or inflammatory bowel disease. The patients comprised 216 men (67.1%) and 106 women (32.9%) with a mean age of 61.4 years (range 30-94 years).…”

Section: Patientsmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Consequently, mucosal colorectal carcinoma is generally treated by endoscopic mucosal resection. [1][2][3][4][5][6][7] Because radical colectomy with lymph node dissection is an invasive treatment, patients with submucosal invasive colorectal carcinoma without lymph node metastasis should be treated by endoscopic mucosal resection, if possible. However, few reports have proposed definite histopathological criteria for additional treatment after endoscopic mucosal resection in patients with submucosal invasive colorectal carcinoma.…”

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confidence: 99%

“…4,7 Many investigators have reported that lymphatic invasion, venous invasion, tumor differentiation, and the degree of submucosal invasion depth are risk factors of lymph node metastasis. [1][2][3][4][5][6][7] Haggitt et al 1 proposed a four-level classification system for pedunculated lesions with invasive carcinoma based on the depth of invasion, and considered that level 4 invasion, which means invasion of carcinoma into the submucosa to a level deeper than the stalk, to be an important clinical prognostic factor for lymph node metastasis. However, this classification is less useful for non-polypoid lesions without a stalk because all such lesions with submucosal invasion are classed as level 4.…”

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confidence: 99%

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Pathological prognostic factors predicting lymph node metastasis in submucosal invasive (T1) colorectal carcinoma

Tateishi

Nakanishi

Taniguchi³

et al. 2010

Modern Pathology

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Lymph node metastasis occurs in as many as 16% of patients with submucosal invasive colorectal carcinoma. We investigated the association between histopathological factors and lymph node metastases in 322 consecutive patients with submucosal invasive colorectal carcinoma who had undergone radical colectomy with lymph node dissection to detect patients at high risk of lymph node metastasis without measuring the depth of submucosal invasion. Lymph node metastasis was found in 46 (14.3%) of 322 patients with submucosal invasive colorectal carcinoma. Univariate analysis showed that each of the following histopathological factors had a significant influence on lymph node metastasis: invasion depth, lymphatic invasion, venous invasion, tumor differentiation, growth pattern of the intramucosal tumor component, complete disruption of the muscularis mucosa due to tumor invasion, and tumor budding at the submucosal invasive front. Multivariate analysis showed that lymphatic invasion (Po0.01), tumor differentiation (Po0.01), and tumor budding (Po0.01) were significantly associated with lymph node metastasis. All 46 cases of lymph node metastasis showed at least one of the following findings: lymphatic invasion, moderately or poorly differentiated tumor grade, tumor budding, or complete disruption of the muscularis mucosa due to tumor invasion. Patients with submucosal invasive colorectal carcinoma that show at least one of three factorslymphatic invasion, moderately or poorly differentiated tumor grade, or tumor budding-are at high risk for lymph node metastasis. All of the patients with lymph node metastasis, who did not have any of these factors, showed a completely disrupted muscularis mucosa.

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Predictive Histopathologic Factors for Lymph Node Metastasis in Patients With Nonpedunculated Submucosal Invasive Colorectal Carcinoma

Cited by 128 publications

References 33 publications

A three-tier classification system based on the depth of submucosal invasion and budding/sprouting can improve the treatment strategy for T1 colorectal cancer: a retrospective multicenter study

A three-tier classification system based on the depth of submucosal invasion and budding/sprouting can improve the treatment strategy for T1 colorectal cancer: a retrospective multicenter study

The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

Pathological prognostic factors predicting lymph node metastasis in submucosal invasive (T1) colorectal carcinoma

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