Abstract：
OBJECTIVE: 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.
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.
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.
摘要：
目的：静脉浸润（VI）是结直肠癌（CRC）的一个强有力但报道不足的预后因素。改善其检测的努力主要集中在组织学评估上，对组织采样策略的关注较少。这项研究旨在前瞻性地确定在CRC切除中优化VI检测所需的肿瘤块的数量。此外,研究了线性棘突（LS）与壁外静脉侵犯（EMVI）之间的关系。
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。
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。
