High-yield areas to grade tumor budding in colorectal cancer: A practical approach for pathologists

Mahmoud Aldyab; Richard R Pacheco; Saleh Najjar; Janne V Rand; Hwajeong Lee

doi:10.1016/j.anndiagpath.2022.152085

High-yield areas to grade tumor budding in colorectal cancer: A practical approach for pathologists

Ann Diagn Pathol. 2023 Apr:63:152085. doi: 10.1016/j.anndiagpath.2022.152085. Epub 2022 Dec 23.

Authors

Mahmoud Aldyab¹, Richard R Pacheco², Saleh Najjar³, Janne V Rand⁴, Hwajeong Lee⁵

Affiliations

¹ Department of Pathology, Albany Medical Center, Albany, NY 12208, USA. Electronic address: aldyabm@amc.edu.
² Department of Pathology, Albany Medical Center, Albany, NY 12208, USA. Electronic address: pachecr1@amc.edu.
³ Department of Pathology, Albany Medical Center, Albany, NY 12208, USA.
⁴ Department of Pathology, Albany Medical Center, Albany, NY 12208, USA. Electronic address: randj@amc.edu.
⁵ Department of Pathology, Albany Medical Center, Albany, NY 12208, USA. Electronic address: LeeH5@amc.edu.

PMID: 36577186
DOI: 10.1016/j.anndiagpath.2022.152085

Abstract

Background: Tumor budding (TB) has significant prognostic implication in stage II colorectal cancer (CRC) and is graded based on the International Tumor Budding Consensus Conference (ITBCC) protocol. In the current study, we evaluate tumor budding and its relationship to multiple histologic features in 104 tumors.

Methods: One-hundred four resected CRC cases were retrieved. Tumor bud count and TB grade were compared to the final tumor bud count/TB grade of the tumor per ITBCC protocol. The following high-yield co-features were assessed in each slide: highest T stage, presence of benign mucosa, presence of a precursor lesion, and highest tumor volume.

Results: Twenty-nine (28 %) cases had discrepancies between slide TB grade and final TB grade. The least discrepancies were seen in slides with benign mucosa (7 %) and precursor lesions (7 %). Among stage II patients without high-risk features, no discrepancies were observed in slides with benign mucosa. Slides with deepest invasion (r_s = 1.000, p = 0.01) and benign mucosa (r_s = 0.957, p < 0.001) had the strongest correlation with final tumor bud count in the same stage II subgroup. Similar relationships were observed when comparing final TB grade. Deepest invasion, tumor volume, as well as lymphovascular invasion, when present, also showed strong correlations with final TB grade in the entire cohort (r_s = 0.828-0.845, p < 0.001).

Conclusion: Our study is the first study to evaluate the relationship between TB grade and co-existing histologic features. We highlight the benefit of focusing on slides with high-yield co-features, with the strongest correlation seen in slides with adjacent benign mucosa and precursor lesions.

Keywords: Colon cancer; Tumor budding; epithelial mesenchymal transition.

MeSH terms

Colorectal Neoplasms* / pathology
Consensus
Humans
Neoplasm Staging
Pathologists*
Prognosis