Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi, Japan.
Division of Community and Family Medicine, Jichi Medical University, Tochigi, Japan.
Dig Endosc. 2024 May;36(5):533-545. doi: 10.1111/den.14691. Epub 2023 Oct 25.
Lymphovascular invasion (LVI) is a critical risk factor for lymph node metastasis (LNM), which requires additional surgery after endoscopic resection of T1 colorectal cancer (CRC). However, the impact of additional staining on estimating LNM is unclear. This systematic review aimed to evaluate the impact of additional staining on determining LNM in T1 CRC.
We searched five electronic databases. Outcomes were diagnostic odds ratio (DOR), assessed using hierarchical summary receiver operating characteristic curves, and interobserver agreement among pathologists for positive LVI, assessed using Kappa coefficients (κ). We performed a subgroup analysis of studies that simultaneously included a multivariable analysis for other risk factors (deep submucosal invasion, poor differentiation, and tumor budding).
Among the 64 studies (18,097 patients) identified, hematoxylin-eosin (HE) and additional staining for LVI had pooled sensitivities of 0.45 (95% confidence interval [CI] 0.32-0.58) and 0.68 (95% CI 0.44-0.86), specificities of 0.88 (95% CI 0.78-0.94) and 0.76 (95% CI 0.62-0.86), and DORs of 6.26 (95% CI 3.73-10.53) and 6.47 (95% CI 3.40-12.32) for determining LNM, respectively. In multivariable analysis, the DOR of additional staining for LNM (DOR 5.95; 95% CI 2.87-12.33) was higher than that of HE staining (DOR 1.89; 95% CI 1.13-3.16) (P = 0.01). Pooled κ values were 0.37 (95% CI 0.22-0.52) and 0.62 (95% CI 0.04-0.99) for HE and additional staining for LVI, respectively.
Additional staining for LVI may increase the DOR for LNM and interobserver agreement for positive LVI among pathologists.
淋巴管浸润（LVI）是 T1 结直肠癌（CRC）内镜切除后发生淋巴结转移（LNM）的关键危险因素，需要进一步手术。然而，额外染色对评估 LNM 的影响尚不清楚。本系统评价旨在评估 T1 CRC 中额外染色对确定 LNM 的影响。
我们检索了五个电子数据库。使用分层汇总受试者工作特征曲线评估结局诊断比值比（DOR），使用 Kappa 系数（κ）评估病理学家对阳性 LVI 的观察者间一致性。我们对同时包括其他危险因素（黏膜下深层浸润、分化不良和肿瘤芽生）多变量分析的研究进行了亚组分析。
在确定的 64 项研究（18097 例患者）中，苏木精-伊红（HE）和 LVI 额外染色的汇总敏感性分别为 0.45（95%置信区间 [CI] 0.32-0.58）和 0.68（95% CI 0.44-0.86），特异性分别为 0.88（95% CI 0.78-0.94）和 0.76（95% CI 0.62-0.86），DOR 分别为 6.26（95% CI 3.73-10.53）和 6.47（95% CI 3.40-12.32），用于确定 LNM。在多变量分析中，LVI 额外染色的 LNM DOR（DOR 5.95；95% CI 2.87-12.33）高于 HE 染色（DOR 1.89；95% CI 1.13-3.16）（P=0.01）。HE 和 LVI 额外染色的汇总κ值分别为 0.37（95% CI 0.22-0.52）和 0.62（95% CI 0.04-0.99）。
LVI 额外染色可能增加 LNM 的 DOR 和病理学家对阳性 LVI 的观察者间一致性。
