title: Comparison of Methods to Identify Lymphatic and Blood Vessel Invasion and their Prognostic Value in Patients with Primary Operable Colorectal Cancer.
abstract: OBJECTIVE
  Lymphatic and blood vessel invasion are important independent prognostic factors in colorectal cancer, but identification of the separate components remains difficult. The aim of the present study was to compare routine hematoxylin and eosin (H&E) and elastica staining with immunohistochemistry using D2-40 and CD31.
  
  
  METHODS
  A total of 75 surgical specimens of colorectal cancer were examined for blood and lymphatic vessel invasion, by comparing stains.
  
  
  RESULTS
  The minimum clinical follow-up of survivors was 5 years. During that time, 45 patients died, 34 from their cancer. Lymphatic invasion by H&E was found in 19% compared to 40% detected with D2-40 (p<0.001). Lymphatic invasion was not associated with T-stage (H&E, p=0.923; D2-40, p=0.724) but was significantly associated with N-stage, (H&E, p=0.001; D2-40, p<0.001). No significant association between lymphatic invasion (H&E or D2-40) and cancer-specific survival was found on univariate analysis. Blood vessel invasion by elastic detection was detected in 53% compared to 32% detected with CD31 (p=0.090). Blood vessel invasion was associated with T-stage, (elastica, p=0.028; CD31, p=0.839) but was not associated with N-stage (elastica, p=0.377; CD31, p=0.519). On univariate analysis of blood vessel invasion was associated with cancer-specific survival (elastica, p=0.009) when detected by elastica, but not when detected by CD31, (p=0.611). Lymphatic invasion (D2-40) was associated with blood vessel invasion (elastic) (p=0.019). On multivariate analysis, blood vessel invasion with elastica had independent prognostic value (hazard ratio=2.55, 95% confidence interval=1.23-5.28; p=0.012).
  
  
  CONCLUSIONS
  The results of the present study indicate that immunohistochemistry using D2-40 improves the identification of lymphatic invasion compared to use of H&E staining only; however, its prognostic value was limited. Elastica staining improves the detection rate of blood vessel invasion (compared to CD31) and venous invasion detected with elastica had independent prognostic value in patients undergoing curative resection for colorectal cancer.
authors.affiliation: Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences-University of Glasgow, Royal Infirmary, Glasgow, U.K. h.van-wyk.1@research.gla.ac.uk.
authors.forename: Hester Catharina
authors.initials: HC
authors.lastname: Van Wyk
authors.affiliation: University Unit of Pathology, College of Medical, Veterinary and Life of Sciences-University of Glasgow, Southern General Hospital, Glasgow, U.K.
authors.forename: Alan K
authors.initials: AK
authors.lastname: Foulis
authors.affiliation: Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences-University of Glasgow, Royal Infirmary, Glasgow, U.K.
authors.forename: Campbell S
authors.initials: CS
authors.lastname: Roxburgh
authors.affiliation: University Unit of Pathology, College of Medical, Veterinary and Life of Sciences-University of Glasgow, Southern General Hospital, Glasgow, U.K.
authors.forename: Clare
authors.initials: C
authors.lastname: Orange
authors.affiliation: Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences-University of Glasgow, Royal Infirmary, Glasgow, U.K.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
authors.affiliation: Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences-University of Glasgow, Royal Infirmary, Glasgow, U.K.
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000503:physiopathology*; D011379:Prognosis
keywords: Colorectal cancer; blood vessel invasion; lymphatic invasion; prognosis