The Impact of Extramural Venous Invasion in Colorectal Cancer: A Detailed Analysis Based on Tumor Location and Evaluation Methods

Shin, Youngmin; Pyo, Jung‐Soo; Park, Mee Ja

doi:10.1177/1066896919874493

Cited by 4 publications

(4 citation statements)

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“…Venous invasion (VI) is a powerful predictor of haematogenous spread and mortality in colorectal cancer (CRC) 1–14 . This is particularly true for extramural venous invasion (EMVI); prognostic significance of intramural venous invasion (IMVI) alone has been suggested, but is less well‐established 2–4,10,12,13,15,16 .…”

Section: Introductionmentioning

confidence: 99%

“…Venous invasion (VI) is a powerful predictor of haematogenous spread and mortality in colorectal cancer (CRC). [1][2][3][4][5][6][7][8][9][10][11][12][13][14] This is particularly true for extramural venous invasion (EMVI); prognostic significance of intramural venous invasion (IMVI) alone has been suggested, but is less well-established. [2][3][4]10,12,13,15,16 The accurate detection of VI is especially relevant in stage II CRC, where its presence may influence adjuvant treatment decisions.…”

Section: Introductionmentioning

confidence: 99%

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Impact of tissue sampling on detection of venous invasion in colorectal cancer: a prospective analysis

et al. 2023

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AimsVenous invasion (VI) is a powerful yet under‐reported prognostic factor in colorectal cancer (CRC). Efforts to improve its detection have largely focused upon histological assessment, with less attention paid to tissue‐sampling strategies. This study aimed to prospectively determine the number of tumour blocks required to optimise VI detection in CRC resections. In addition, the relationship between linear spiculation (LS) and extramural venous invasion (EMVI) was investigated.Methods and resultsA standardised tissue sampling protocol was developed and applied prospectively to 217 CRC resections [AJCC 8th edition, stage 1 (n = 32); stage 2 (n = 84); stage 3 (n = 87); stage 4 (n = 14); and post‐neoadjuvant therapy (n = 46)]. Elastin stains were performed on all tumour blocks. VI was identified in 55% of cases (EMVI = 37%; IMVI alone = 18%). The sensitivity of VI detection increased with increasing numbers of tumour blocks submitted [one block (35%), three blocks (66%), five blocks (84%), six blocks (95%) and seven blocks (97%)]. Similar findings were observed for EMVI [one block (35%), three blocks (73%), five blocks (89%), six blocks (96%) and seven blocks (96%)]. LS was identified macroscopically in 22% of specimens. In cases where no neoadjuvant therapy had been given, EMVI was significantly associated with LS (71% in LS+ cases versus 29% in LS– cases; P < 0.001). In addition, tumour blocks targeting LS were associated with a fivefold higher rate of EMVI compared with blocks that did not (P < 0.001).ConclusionsOur findings demonstrate the impact of tissue sampling and quality of gross examination on VI detection and may inform practices in future CRC protocols.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of tissue sampling on detection of venous invasion in colorectal cancer: a prospective analysis

et al. 2023

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“…Venous invasion (VI) is a well-established, independent predictor of hematogenous metastasis and mortality in colorectal cancer (CRC) 1–13. This is particularly true for VI involving vessels located beyond the muscularis propria, that is, extramural venous invasion (EMVI) 2–4,10,12–15.…”

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confidence: 99%

Routine Elastin Staining in Surgically Resected Colorectal Cancer

Sarı

Cyr

Brar

et al. 2021

American Journal of Surgical Pathology

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Venous invasion (VI) is a powerful yet underreported prognostic factor in colorectal cancer (CRC). Its detection can be improved with an elastin stain. We evaluated the impact of routine elastin staining on VI detection in resected CRC and its relationship with oncologic outcomes. Pathology reports from the year before (n=145) and the year following (n=128) the implementation of routine elastin staining at our institution were reviewed for established prognostic factors, including VI. A second review, using elastin stains, documented the presence/absence, location, number, and size of VI foci. The relationship between VI and oncologic outcomes was evaluated for original and review assessments. VI detection rates increased from 21% to 45% following implementation of routine elastin staining (odds ratio [OR]=3.1; 95% confidence interval [CI]: 1.8-5.3; P<0.0001). The second review revealed a lower VI miss rate postimplementation than preimplementation (22% vs. 48%, respectively; P=0.007); this difference was even greater for extramural VI–positive cases (9% vs. 38%, respectively; P=0.0003). Missed VI cases postimplementation had fewer VI foci per missed case (P=0.02) and a trend towards less extramural VI than those missed preimplementation. VI assessed with an elastin stain was significantly associated with recurrence-free survival (P=0.003), and cancer-specific survival (P=0.01) in contrast to VI assessed on hematoxylin and eosin alone (P=0.053 and 0.1, respectively). The association between VI and hematogenous metastasis was far stronger for elastin-detected VI (OR=11.5; 95% CI: 3.4-37.1; P<0.0001) than for hematoxylin and eosin–detected VI (OR=3.7; 95% CI: 1.4-9.9; P=0.01). Routine elastin staining enhances VI detection and its ability to stratify risk in CRC and should be considered for evaluation of CRC resection specimens.

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“…T here is substantial evidence supporting the prognostic significance of venous invasion (VI), and in particular extramural venous invasion, in colorectal cancer (CRC). [1][2][3][4][5][6][7][8][9][10] The detection of VI is most important in resected stage II cancers where it may influence adjuvant treatment decisions. In addition, the absence of VI may identify a subset of stage III CRC with a favorable prognosis.…”

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confidence: 99%

Feasibility and Performance of Elastin Trichrome as a Primary Stain in Colorectal Cancer Resection Specimens

Shivji

Kak

Reid

et al. 2021

American Journal of Surgical Pathology

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Venous invasion (VI) is a powerful prognostic factor in colorectal cancer (CRC) that is widely underreported. The ability of elastin stains to improve VI detection is now recognized in several international CRC pathology protocols. However, concerns related to the cost and time required to perform and evaluate these stains in addition to routine hematoxylin and eosin (H&E) stains remains a barrier to their wider use. We therefore sought to determine whether an elastin trichrome (ET) stain could be used as a “stand-alone” stain in CRC resections, by comparing the sensitivity, accuracy, and reproducibility of detection of CAP-mandated prognostic factors using ET and H&E stains. Representative H&E- and ET-stained slides from 50 CRC resections, including a representative mix of stages and prognostic factors, were used to generate 2 study sets. Each case was represented by H&E slides in 1 study set and by corresponding ET slides from the same blocks in the other study set. Ten observers (3 academic gastrointestinal [GI] pathologists, 4 community pathologists, 3 fellows) evaluated each study set for CAP-mandated prognostic factors. ET outperformed H&E in the assessment of VI with respect to detection rates (50% vs. 28.6%; P<0.0001), accuracy (82% vs. 59%, P<0.0001), and reproducibility (k=0.554 vs. 0.394). No significant differences between ET and H&E were observed for other features evaluated. In a poststudy survey, most observers considered the ease and speed of assessment at least equivalent for ET and H&E for most prognostic factors, and felt that ET would be feasible as a stand-alone stain in practice. If validated by others, our findings support the use of ET, rather than H&E, as the primary stain for the evaluation of CRC resections.

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The Impact of Extramural Venous Invasion in Colorectal Cancer: A Detailed Analysis Based on Tumor Location and Evaluation Methods

Cited by 4 publications

References 29 publications

Impact of tissue sampling on detection of venous invasion in colorectal cancer: a prospective analysis

Impact of tissue sampling on detection of venous invasion in colorectal cancer: a prospective analysis

Routine Elastin Staining in Surgically Resected Colorectal Cancer

Feasibility and Performance of Elastin Trichrome as a Primary Stain in Colorectal Cancer Resection Specimens

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