title: Absence of extramural venous invasion is an excellent predictor of metastasis-free survival in colorectal carcinoma stage II--a study using tangential tissue sectioning.
abstract: OBJECTIVE
  Extramural venous invasion (EVI) is an important predictor of haematogenous metastasis in colorectal cancer (CRC). However, remarkable discrepancies in incidence rates indicate major problems regarding EVI assessment. The present prospective study applies tangential vessel preparation to CRC resection specimens and correlates results of EVI with metachronous haematogenous metastatic (MHM) spread.
  
  
  METHODS
  Stage II CRC diagnosed at the Institute of Pathology, University Teaching Hospital Feldkirch, Austria over a period of 30 months were analysed and tangential sectioning of the pericolonic tissue was performed. Confirmation, or exclusion of MHM, as assessed by computerised tomography, sonography or biopsy, was recorded.
  
  
  RESULTS
  In 50/79 (63%) cases EVI was detected. In 13/50 (26%), MHM developed. Of the 29/79 (37%) patients without EVI, only one (3.5%) developed MHM. Statistically, the rate of MHM for patients with EVI was independent of adjuvant chemotherapy.
  
  
  CONCLUSIONS
  Tangential sectioning of the tumour periphery in CRC stage II yields a high rate of histologically evaluable extramural veins and permits proper assessment of EVI. Absence of EVI is significantly associated with metastasis-free survival, a finding of potential therapeutic value. On the other hand, one-third of the patients with EVI and circumferential tumour growth develop MHM, a setting in which the option for adjuvant chemotherapy should be considered. This study emphasises the importance of tangential sectioning of the invasive tumour front in CRC compared with the recommended perpendicular technique. The sensitivity and specificity of this method regarding MHM are characterised.
authors.affiliation: Institute for Pathology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
authors.forename: Klaus
authors.initials: K
authors.lastname: Dirschmid
authors.forename: William
authors.initials: W
authors.lastname: Sterlacci
authors.forename: Frank
authors.initials: F
authors.lastname: Oellig
authors.forename: Michael
authors.initials: M
authors.lastname: Edlinger
authors.forename: Zerina
authors.initials: Z
authors.lastname: Jasarevic
authors.forename: Michaela
authors.initials: M
authors.lastname: Rhomberg
authors.forename: Harald
authors.initials: H
authors.lastname: Dirschmid
authors.forename: Felix
authors.initials: F
authors.lastname: Offner
mesh_terms: D000230:Adenocarcinoma / Q000098:blood supply* / Q000401:mortality* / Q000473:pathology; D000368:Aged; D015179:Colorectal Neoplasms / Q000098:blood supply* / Q000401:mortality* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008867:Microtomy / Q000379:methods*; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014680:Veins / Q000473:pathology*