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Assessing venous invasion in stage II colon cancer: optimal elastin stains and survival analysis
  1. Soo Hyun Lee1,
  2. Omer Yilmaz2,
  3. Nandan Padmanabha3,
  4. Vikram Deshpande2,3,
  5. Osman Yilmaz2,3
  1. 1Pathology, Boston Medical Center, Boston, Massachusetts, USA
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Osman Yilmaz, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, USA; osmanhy{at}


Aims Venous invasion (VI) in colorectal carcinoma influences treatment strategies, especially in early stages. Despite elastin staining effectiveness in detecting VI, guidelines for its routine application, including the optimal number of slides for staining, are limited.

Methods Elastin staining was performed for VI assessment in patients with colorectal adenocarcinoma. Patients were categorised into two groups: single elastin stain group (SEG, n=248) and multiple elastin stain group (MEG, n=204).

Results The average number of elastin-stained blocks was 2±1.7, increasing to 3.3±1.9 in MEG. VI detection was significantly higher in patients in MEG (50.5%) compared with SEG (37.0%) (p=0.004). VI detection rate was higher in MEG (63.7%) than in SEG (46.0%) among patients with stage III–IV disease (p=0.011), but did not significantly differ among patients with stage I–II disease. Staining two blocks improved VI detection without additional gains from more stains. Compared with elastin performed on a single block, VI detected by elastin stain on two or more blocks did not significantly impact progression-free or disease-free survival with stage II patients.

Conclusions Employing two elastin stains on separate blocks significantly enhances VI detection in colorectal carcinoma without additional benefits from more extensive staining. This study suggests that while increasing sensitivity for VI detection, staining beyond two blocks may not benefit prognostication and could be counterproductive, warranting further research. We emphasise the need for strategic use of the elastin stain and cautious interpretation of the increased detection sensitivity of multiple elastin stains.

  • Colorectal Neoplasms
  • Staining and Labeling
  • Pathology, Surgical

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Handling editor Munita Bal.

  • VD and OY contributed equally.

  • Contributors SHL and OY analysed data and wrote the manuscript. VD designed the study and reviewed the manuscript. OmerY and NP reviewed the manuscript. OY is reponsible for the overall content and guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests One of the co-authors is an editor of this journal.

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