RESULTS: 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).
CONCLUSIONS: Our findings demonstrate the impact of tissue sampling and quality of gross examination on VI detection and may inform practices in future CRC protocols.
结果:制定了标准化的组织采样方案,并前瞻性地应用于217例CRC切除[AJCC第8版,1期(n=32);2期(n=84);3期(n=87);4期(n=14);和新辅助治疗后(n=46)]。对所有肿瘤块进行弹性蛋白染色。在55%的病例中发现了VI(EMVI=37%;仅IMVI=18%)。VI检测的灵敏度随着提交的肿瘤块数量的增加而增加[一个块(35%),三个街区(66%),五个街区(84%),六个街区(95%)和七个街区(97%)]。对EMVI观察到类似的发现[一个区块(35%),三个街区(73%),五个街区(89%),六个街区(96%)和七个街区(96%)]。在22%的标本中宏观鉴定了LS。在没有给予新辅助治疗的情况下,EMVI与LS显著相关(LS+病例为71%,LS-病例为29%;P<0.001)。此外,与不靶向LS的肿瘤阻滞相比,靶向LS的肿瘤阻滞的EMVI发生率高5倍(P<0.001).
结论:我们的研究结果证明了组织采样和大体检查质量对VI检测的影响,并可能为将来的CRC方案提供指导。