title: Lymphatic invasion identified with D2-40 immunostaining as a risk factor of nodal metastasis in T1 colorectal cancer.
abstract: BACKGROUND
  The management of T1 colorectal cancer after local resection is controversial. Regional lymph node metastasis often occurs, requiring subsequent colonic resection. The aim of this study was to reevaluate the risk factors of nodal metastasis of T1 colorectal cancer, especially to examine lymphatic vessel invasion in serially prepared hematoxylin and eosin sections and D2-40 immunostained sections to determine which is a better indicator of lymph node metastasis of T1 colorectal cancer.
  
  
  METHODS
  The study investigated 120 patients who underwent bowel resection and were histologically diagnosed to have T1 colorectal cancer in Kanagawa Cancer Center Hospital from 1995 to 2005. Serially prepared paraffin sections were stained with hematoxylin and eosin, or immunostained with D2-40 antibody or von Willebrand factor, and reevaluated for lymphatic vessel invasion and other risk factors, including venous invasion, histological grade, depth of submucosal invasion, and budding.
  
  
  RESULTS
  Lymphatic invasion diagnosed with either hematoxylin and eosin staining (p = 0.022), or D2-40 immunostaining (p = 0.001), and budding (p = 0.013) were significant risk factors for lymph node metastasis in the univariate analysis. Venous involvement, histological grade, or depth of submucosal invasion was not significant. The multivariate logistic regression analysis for the three risk factors found lymphatic invasion diagnosed with D2-40 as an independent risk factor (odds ratio 6.048, p = 0.018, CI 1.360-26.89). The sensitivity, specificity, positive predictive value, and negative predictive value were 58 %, 88 %, 35 %, and 95 %, respectively.
  
  
  CONCLUSIONS
  Lymphatic vessel invasion diagnosed with D2-40 was a better indicator to evaluate the risk for lymph node metastasis by T1 colorectal cancer.
authors.affiliation: Kanagawa Cancer Center Hospital Digestive Surgery, 1-1-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan, hiroo.wada@nifty.ne.jp.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Wada
authors.forename: Manabu
authors.initials: M
authors.lastname: Shiozawa
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Sugano
authors.forename: Soichiro
authors.initials: S
authors.lastname: Morinaga
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.forename: Makoto
authors.initials: M
authors.lastname: Akaike
authors.forename: Yohei
authors.initials: Y
authors.lastname: Miyagi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012307:Risk Factors
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C500987:monoclonal antibody D2-40