title: Venous Invasion in Colorectal Cancer: Impact of Morphologic Findings on Detection Rate.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pathology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Chungsu
authors.initials: C
authors.lastname: Hwang
authors.affiliation: Department of Pathology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Sojeong
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Pathology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Ahrong
authors.initials: A
authors.lastname: Kim
authors.affiliation: Department of Pathology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Young-Geum
authors.initials: YG
authors.lastname: Kim
authors.affiliation: Department of Pathology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Sang-Jeong
authors.initials: SJ
authors.lastname: Ahn
authors.affiliation: Department of Pathology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Do Youn
authors.initials: DY
authors.lastname: Park
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D004801:Eosine Yellowish-(YS) / Q000737:chemistry; D005260:Female; D006416:Hematoxylin / Q000737:chemistry; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D009367:Neoplasm Staging; D019043:Vascular Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D014680:Veins / Q000000981:diagnostic imaging / Q000473:pathology*
chemical_list: D004801:Eosine Yellowish-(YS); D006416:Hematoxylin
keywords: Adenocarcinoma; Colon; Elastin; Rectum; Vein