Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, ON, Canada.
Department of Pathology, University Health Network, Toronto, ON, Canada.
Histopathology. 2023 Dec;83(6):891-902. doi: 10.1111/his.15030. Epub 2023 Aug 14.
Venous 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.
A 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).
Our findings demonstrate the impact of tissue sampling and quality of gross examination on VI detection and may inform practices in future CRC protocols.
静脉侵犯（VI）是结直肠癌（CRC）强有力但报告不足的预后因素。为提高其检测效果，人们主要致力于组织取样策略的改进，而较少关注组织学评估。本研究旨在前瞻性确定CRC 切除标本中需要多少肿瘤块才能优化 VI 检测。此外，还研究了线性毛刺（LS）与外膜静脉侵犯（EMVI）之间的关系。
开发了一种标准化的组织取样方案，并前瞻性地应用于 217 例 CRC 切除术[第 8 版 AJCC，I 期（n=32）；II 期（n=84）；III 期（n=87）；IV 期（n=14）；和新辅助治疗后（n=46）]。所有肿瘤块均进行弹力纤维染色。55%的病例中发现 VI（EMVI=37%；IMVI 单独存在 18%）。随着送检肿瘤块数量的增加，VI 的检测敏感性也随之增加[一个块（35%）、三个块（66%）、五个块（84%）、六个块（95%）和七个块（97%）]。EMVI 也观察到类似的结果[一个块（35%）、三个块（73%）、五个块（89%）、六个块（96%）和七个块（96%）]。22%的标本肉眼可见 LS。在未接受新辅助治疗的情况下，EMVI 与 LS 显著相关（LS+病例中为 71%，LS-病例中为 29%；P<0.001）。此外，与未靶向 LS 的肿瘤块相比，靶向 LS 的肿瘤块 EMVI 发生率高 5 倍（P<0.001）。
我们的研究结果表明组织取样和大体检查质量对 VI 检测的影响，可能为未来 CRC 方案提供实践依据。
