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Blood and lymphatic vessel invasion in pT1 colorectal cancer: an international concordance study
  1. Motohiro Kojima1,
  2. Giacomo Puppa2,
  3. Richard Kirsch3,
  4. Olca Basturk4,
  5. Wendy L Frankel5,
  6. Michael Vieth6,
  7. Alessandro Lugli7,
  8. Kieran Sheahan8,
  9. Matthew Yeh9,
  10. Greg Y Lauwers10,
  11. Mauro Risio11,
  12. Hideyuki Shimazaki12,
  13. Keiichi Iwaya12,
  14. Masayoshi Kage13,
  15. Jun Akiba14,
  16. Yasuo Ohkura15,
  17. Shinichiro Horiguchi16,
  18. Kohei Shomori17,
  19. Ryoji Kushima18,
  20. Shogo Nomura19,
  21. Yoichi Ajioka20,
  22. Volkan Adsay21,
  23. Atsushi Ochiai1
  1. 1Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Chiba, Japan
  2. 2Department of Pathology, HôpitauxUniversitaires de Genève 1, Genève, Switzerland
  3. 3Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
  4. 4Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
  5. 5Department of Pathology, Ohio State University Medical Center E-411 Doan Hall, Columbus, Ohio, USA
  6. 6Institute of Pathology, Bayreuth, Germany
  7. 7Institute of Pathology, University of Bern, Bern, Switzerland
  8. 8Department of Pathology, St. Vincent's University Hospital, Dublin, Ireland
  9. 9Department of Pathology, University of Washington School of Medicine, Seattle, Washington, USA
  10. 10Department of Pathology, Gastrointestinal Pathology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
  11. 11Department of Pathology, Candiolo Cancer Institute—FPO, IRCCS, Torino, Italy
  12. 12Department of Pathology, National Defence Medical College, Saitama, Japan
  13. 13Department of Diagnostic Pathology, Kurume University Hospital, Fukuoka, Japan
  14. 14Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan
  15. 15Department of Pathology, Kyorin University Graduate School of Medicine, Tokyo, Japan
  16. 16Department of Pathology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
  17. 17Division of Pathology, Sanin-Rosai Hospital, Tottori, Japan
  18. 18Division of Diagnostic Pathology, Shiga University of Medical Science Hospital, Shiga, Japan
  19. 19Biostatistical Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
  20. 20Department of Pathology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
  21. 21Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Atsushi Ochiai, Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; aochiai{at}


Aim This study was performed to evaluate the concordance in pathological assessments of blood and lymphatic vessel invasion (BLI) in pT1 colorectal cancers and to assess the effect of diagnostic criterion on consistency in the assessment of BLI.

Methods Forty consecutive patients undergoing surgical resection of pT1 colorectal cancers were entered into this study. H&E-stained, D2-40-stained and elastica-stained slides from the tumours were examined by 18 pathologists from seven countries. The 40 cases were divided into two cohorts with 20 cases each. In cohort 1, pathologists diagnosed BLI using criteria familiar to them; all Japanese pathologists used a criterion of BLI from the Japanese Society for Cancer of the Colon and Rectum (JSCCR). In cohort 2, all pathologists used the JSCCR diagnostic criterion.

Results In cohort 1, diagnostic concordance was moderate in the US/Canadian and European pathologists. There were no differences in the consistency compared with results for Japanese pathologists, and no improvement in the diagnostic concordance was found for using the JSCCR criterion. However, in cohort 2, the JSCCR criterion decreased the consistency of BLI diagnosis in the US/Canadian and European pathologists. The level of decreased consistency in the assessment of BLI was different between the US/Canadian and European pathologists.

Conclusions A uniform criterion strongly influences the diagnostic consistency of BLI but may not always improve the concordance. Further study is required to achieve an objective diagnosis of BLI in colorectal cancer. The varying effects of diagnostic criterion on the pathologists from Japan, the USA/Canada and Europe might reflect varied interpretations of the criterion. Internationally accepted criterion should be developed by participants from around the world.


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