Routine Elastin Staining Improves Venous Invasion Detection Rates By 4.5 times in Colorectal Carcinoma
Abstract
Introduction and Objective. Colorectal carcinoma (CRC) is the second most common cause of cancer-related deaths in North America. Invasion of tumor cells into lymphatic and blood vessels is an imperative step in the metastatic progression of colorectal carcinoma. This is a before-and-after study conducted by the Department of Pathology of Mount Sinai Medical Center of Florida (MSMC) to assess the impact on venous invasion (VI) detection by implementing routine elastin staining on all tumor-containing blocks per case, where feasible, in CRC specimens. Methods. IRB approval from Mount Sinai Medical Center (MSMC) was obtained. Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines were followed for executing and reporting this study. We reviewed the pathological database of CRC specimens from patients who underwent colectomies during a two-year period, from January 1st, 2021, to December 31st, 2022. Official implementation of the intervention was started in January 2022: 93 cases pre-implementation and 61 post-implementation. Inclusion criteria: colectomy for CRC. Exclusion criteria: polypectomies (12 cases), endoscopic resections, local excisions, intramucosal carcinoma (2 cases), complete or near complete pathologic response, recurrent CRC, and synchronous primary CRC (2 cases). Statistical analyses were done using SPSS. Results. In January 2022, our department implemented a new protocol to include elastin staining on all tumor-containing blocks per case, where feasible. Elastin stains (Verhoeff-Van Gieson) were ordered on all blocks containing tumor at the time of specimen grossing. Lymphovascular invasion was identified in 55.7% post-implementation compared to 44.1% in the pre-implementation cohort. On univariate analysis, implementation of routine elastin stain was associated with increased VI detection rates (OR of 4.5, p-value) Conclusions-Implications. Routine use of elastin stain significantly improves the detection rates of VI in CRC resection specimens. It is particularly superior for detection of intramural invasion when vessels are distorted and/or obliterated by tumor cells.
Abstract Category
25. Pathology
Secondary Abstract Category
28. Surgery
Keywords
Elastin stain, colorectal carcinoma, venous invasion
Presentation Type
Poster Presentation
Routine Elastin Staining Improves Venous Invasion Detection Rates By 4.5 times in Colorectal Carcinoma
Introduction and Objective. Colorectal carcinoma (CRC) is the second most common cause of cancer-related deaths in North America. Invasion of tumor cells into lymphatic and blood vessels is an imperative step in the metastatic progression of colorectal carcinoma. This is a before-and-after study conducted by the Department of Pathology of Mount Sinai Medical Center of Florida (MSMC) to assess the impact on venous invasion (VI) detection by implementing routine elastin staining on all tumor-containing blocks per case, where feasible, in CRC specimens. Methods. IRB approval from Mount Sinai Medical Center (MSMC) was obtained. Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines were followed for executing and reporting this study. We reviewed the pathological database of CRC specimens from patients who underwent colectomies during a two-year period, from January 1st, 2021, to December 31st, 2022. Official implementation of the intervention was started in January 2022: 93 cases pre-implementation and 61 post-implementation. Inclusion criteria: colectomy for CRC. Exclusion criteria: polypectomies (12 cases), endoscopic resections, local excisions, intramucosal carcinoma (2 cases), complete or near complete pathologic response, recurrent CRC, and synchronous primary CRC (2 cases). Statistical analyses were done using SPSS. Results. In January 2022, our department implemented a new protocol to include elastin staining on all tumor-containing blocks per case, where feasible. Elastin stains (Verhoeff-Van Gieson) were ordered on all blocks containing tumor at the time of specimen grossing. Lymphovascular invasion was identified in 55.7% post-implementation compared to 44.1% in the pre-implementation cohort. On univariate analysis, implementation of routine elastin stain was associated with increased VI detection rates (OR of 4.5, p-value) Conclusions-Implications. Routine use of elastin stain significantly improves the detection rates of VI in CRC resection specimens. It is particularly superior for detection of intramural invasion when vessels are distorted and/or obliterated by tumor cells.