Reevaluation of Venous Invasion with Elastic Tissue Stain in Colorectal Cancers

Abstract

Objective: The prognostic importance of venous invasion(VI) in colorectal cancer(CRC) has been known for many years. VI was considered an independent predictor for distant organ metastases. In cases with VI, visceral organ metastases of the tumor occur more rapidly than lymphatic spread. A VI rate of at least 25% was expected in CRC. It was claimed that the use of Elastic Tissue Stain(ETS) increases the VI ratios. In this study, our aim is to reevaluate CRC cases without VI by applying ETS, and to question the routine use of ETS. Materials and Methods: Between 2018- 2020, 166 colorectal resection materials diagnosed with cancer were found. VI negative ones were selected. When determining VI, 77 cases were identified that did not have histochemistry/immunohistochemistry. Tissues of 77 cases were reevaluated after ETS was applied. Results: 49 of the cases were male(63.6%), 28 of them were female(36.4%). The mean age was 63.5 (29-101) years. The mean tumor diameter was 4.85 cm(1-11 cm). Six of the cases(7.8%) had high and 71(92.2%) had low grade. The pT stages of the cases were respectively 3 cases pT1(3.9%), 14 cases pT2(18.2%), 50 cases pT3(65%), 10 cases pT4(12.9%). N stages were pNx in 2 cases(2.6%), pN0 in 57 cases(74%), pN1 in 14 cases (18.2%), and pN2 in 4 cases(5.2%), respectively. ETS preparations were reevaluated. VI was detected after ETS staining in 6(7.8%) of 77 cases. Conclusion: As a result, we recommend the application of vessel wall markers such as ETS to all cases without VI on HE sections. Thus, the errors that may occur in the interpretation of VI, which affect the treatment protocol and survival of the patient, will be reduced.