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Venous invasion detection in colorectal cancer specimens: risk assessment of modifying the dissection method using a tangential approach
  1. Giacomo Puppa1,
  2. Gregoire Arnoux1,
  3. Aysegul Sari2,
  4. Richard Kirsch2
  1. 1 Department of Clinical Pathology, Geneva University Hospital, Genève, Switzerland
  2. 2 Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
  1. Correspondence to Dr Giacomo Puppa, Department of Clinical Pathology, Geneva University Hospital, Geneva 1211, Switzerland; Giacomo.Puppa{at}

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We read with interest the recent paper by Dirschmid et al.

The authors assessed the prevalence of extramural venous invasion (EMVI) and its association with metachronous visceral metastases in 27 pT2 and 12 pT1 colorectal carcinomas (CRCs) using a modified protocol that included tangential macroscopic dissection. None of the pT1 tumours showed EMVI or developed visceral metastasis. In contrast, EMVI was identified in 3/27 (11.1%) pT2 tumours, of which 2 developed metachronous visceral metastases. This work deserves special consideration for several reasons.

Venous invasion (VI) is a strong adverse prognostic factor and a powerful predictor of haematogenous metastases in CRC, accounting for most of cancer-related deaths.2 3 Despite its prognostic importance, VI is under-reported, with wide variation in published VI detection rates (10%–89%). Such variation may reflect differences in patient selection, macroscopic sampling techniques, number of tumour-containing blocks submitted, diagnostic criteria, use of special stains, and diligence and skill of the reporting pathologist.2 4–6 The diagnosis of VI in CRC specimens can be challenging on conventional H&E stains alone, and easily missed if morphological clues (eg, ‘orphaned artery’ and ‘protruding tongue’ signs) are not recognised.2 6 Elastin stains have been shown to enhance the detection of VI, increasing detection rates by twofold to threefold.5 7 As such, the CRC protocols of the College of American Pathologists (CAP) and Royal College of Pathologists (UK) …

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  • Handling editor Runjan Chetty.

  • Contributors GP drafted the MS. GA provided images and performed literature review. AS and RK revised the MS for important intellectual content.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.