Cancer Res Treat.  2016 Oct;48(4):1222-1228. 10.4143/crt.2015.429.

Venous Invasion in Colorectal Cancer: Impact of Morphologic Findings on Detection Rate

Affiliations
  • 1Department of Pathology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. pdy220@pusan.ac.kr

Abstract

PURPOSE
Venous invasion (VI) is widely accepted as a poor prognostic factor in colorectal cancer (CRC), and is indicated as a high-risk factor determining the use of adjuvant chemotherapy in CRC. However, there is marked interobserver and intraobserver variability in VI identification and marked variability in the real prevalence of VI in CRC.
MATERIALS AND METHODS
We investigated the detection rate of VI in 93 consecutive cases of T3 or T4 CRC based on the following: original pathology report, review of hematoxylin and eosin (H&E) slides with attention to the "protruding tongue" and "orphan arteriole" signs, and elastic stain as the gold standard.
RESULTS
Overall, the detection rate of VI was significantly increased as follows: 14/93 (15.1%) in the original pathology report, 38/93 (40.9%) in review of H&E slides with attention to the "protruding tongue" and "orphan arteriole" signs, and 45/93 (48.4%) using elastic stain. VI detection based on morphologic features showed 77.8% sensitivity and 91.1% specificity and showed a linear correlation (Spearman correlation coefficient, 0.727; p < 0.001) with VI detected by elastic stain. In addition, improved agreement between detection methods (detection on the basis of morphologic features, κ=0.719 vs. original pathology report, κ=0.318) was observed using kappa statistics.
CONCLUSION
Slide review with special attention to the "protruding tongue" and "orphan arteriole" signs could be used for better identification of VI in CRC in routine surgical practice.

Keyword

Colon; Rectum; Adenocarcinoma; Vein; Elastin

MeSH Terms

Adenocarcinoma
Chemotherapy, Adjuvant
Colon
Colorectal Neoplasms*
Elastin
Eosine Yellowish-(YS)
Hematoxylin
Observer Variation
Pathology
Prevalence
Rectum
Sensitivity and Specificity
Veins
Elastin
Eosine Yellowish-(YS)
Hematoxylin

Figure

  • Fig. 1. (A) Protruding tongue sign. The oval tumor mass protruded beyond the tumor border into pericolic fat tissue (H&E staining, ×40). (B) Orphan arteriole sign. Rounded tumor nodules adjacent to an artery without an accompanying vein were seen in the pericolic fat tissue (H&E staining, ×40).

  • Fig. 2. (A) The tumor nodule with orphan arteriole sign was identified (H&E staining, ×100). (B) At high power, endothelial cells of a vessel around the tumor nodule were not identified with some spindle cells (H&E staining, ×400). (C, D) Elastic staining showed the thick fragmented elastic layer of a vessel around the tumor nodule with the orphan arteriole sign (C, elastic stain, ×100; D, elastic stain, ×400).

  • Fig. 3. (A) The tumor nodule with protruding tongue sign was identified (H&E staining, ×100). (B) At high power, endothelial cells or the smooth muscular layer of a vessel around the tumor nodule were not identified (H&E staining, ×400). (C, D) Elastic staining showed the thin elastic layer of a vessel around the tumor nodule with the protruding tongue sign (arrows) (C, elastic stain, ×100, D, elastic stain, ×400).


Reference

References

1. Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, Fitzgibbons PL, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med. 2009; 133:1539–51.
Article
2. Chang HJ, Park CK, Kim WH, Kim YB, Kim YW, Kim HG, et al. A standardized pathology report for colorectal cancer. Korean J Pathol. 2006; 40:193–203.
3. Chapuis PH, Dent OF, Fisher R, Newland RC, Pheils MT, Smyth E, et al. A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer. Br J Surg. 1985; 72:698–702.
Article
4. Harrison JC, Dean PJ, el-Zeky F, Vander Zwaag R. From Dukes through Jass: pathological prognostic indicators in rectal cancer. Hum Pathol. 1994; 25:498–505.
Article
5. Knudsen JB, Nilsson T, Sprechler M, Johansen A, Christensen N. Venous and nerve invasion as prognostic factors in postoperative survival of patients with resectable cancer of the rectum. Dis Colon Rectum. 1983; 26:613–7.
Article
6. Betge J, Pollheimer MJ, Lindtner RA, Kornprat P, Schlemmer A, Rehak P, et al. Intramural and extramural vascular invasion in colorectal cancer: prognostic significance and quality of pathology reporting. Cancer. 2012; 118:628–38.
7. Merkel S, Wein A, Gunther K, Papadopoulos T, Hohenberger W, Hermanek P. High-risk groups of patients with Stage II colon carcinoma. Cancer. 2001; 92:1435–43.
Article
8. Krasna MJ, Flancbaum L, Cody RP, Shneibaum S, Ben Ari G. Vascular and neural invasion in colorectal carcinoma. Incidence and prognostic significance. Cancer. 1988; 61:1018–23.
9. Abdulkader M, Abdulla K, Rakha E, Kaye P. Routine elastic staining assists detection of vascular invasion in colorectal cancer. Histopathology. 2006; 49:487–92.
Article
10. Dirschmid K, Lang A, Mathis G, Haid A, Hansen M. Incidence of extramural venous invasion in colorectal carcinoma: findings with a new technique. Hum Pathol. 1996; 27:1227–30.
Article
11. Messenger DE, Driman DK, McLeod RS, Riddell RH, Kirsch R. Current practice patterns among pathologists in the assessment of venous invasion in colorectal cancer. J Clin Pathol. 2011; 64:983–9.
Article
12. Morris M, Platell C, de Boer B, McCaul K, Iacopetta B. Population-based study of prognostic factors in stage II colonic cancer. Br J Surg. 2006; 93:866–71.
Article
13. Maughan NJ, Morris E, Forman D, Quirke P. The validity of the Royal College of Pathologists' colorectal cancer minimum dataset within a population. Br J Cancer. 2007; 97:1393–8.
Article
14. Kirsch R, Messenger DE, Riddell RH, Pollett A, Cook M, Al-Haddad S, et al. Venous invasion in colorectal cancer: impact of an elastin stain on detection and interobserver agreement among gastrointestinal and nongastrointestinal pathologists. Am J Surg Pathol. 2013; 37:200–10.
15. Howlett CJ, Tweedie EJ, Driman DK. Use of an elastic stain to show venous invasion in colorectal carcinoma: a simple technique for detection of an important prognostic factor. J Clin Pathol. 2009; 62:1021–5.
Article
16. Loughrey MB, Quirke P, Shepherd NA. Dataset for colorectal cancer histopathology reports [Internet]. London: The Royal College of Pathologists;2016. [cited 2016 Feb 5]. Available from: https://www.rcpath.org/resourceLibrary/dataset-for-colorectal-cancer-histopathology-reports--3rd-edition-.html.
17. Stephen A, Brown I, Ellis D, Hawkins N, Hicks S, Hunter A, et al. Colorectal cancer structured reporting protocol [Internet]. Surry Hills: The Royal College of Pathologists of Australasia;2012. [cited 2016 Feb 2]. Available from: http://www.rcpa.edu.au/getattachment/95109a49-9e15-4038-9858-cf314d9c7422/Protocol-colorectal-cancer.aspx.
18. Kojima M, Shimazaki H, Iwaya K, Kage M, Akiba J, Ohkura Y, et al. Pathological diagnostic criterion of blood and lymphatic vessel invasion in colorectal cancer: a framework for developing an objective pathological diagnostic system using the Delphi method, from the Pathology Working Group of the Japanese Society for Cancer of the Colon and Rectum. J Clin Pathol. 2013; 66:551–8.
Article
19. Messenger DE, Driman DK, Kirsch R. Developments in the assessment of venous invasion in colorectal cancer: implications for future practice and patient outcome. Hum Pathol. 2012; 43:965–73.
Article
20. Dawson H, Kirsch R, Driman DK, Messenger DE, Assarzadegan N, Riddell RH. Optimizing the detection of venous invasion in colorectal cancer: the ontario, Canada, experience and beyond. Front Oncol. 2014; 4:354.
Article
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