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

• Hwang C
• Lee S
• Kim A
• Kim YG
• Ahn SJ
• Park DY

• KMID: 2356224
• DOI: http://doi.org/10.4143/crt.2015.429

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

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  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).

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  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).

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  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

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