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Br J Cancer. 2014 Feb 18;110(4):1008-13. doi: 10.1038/bjc.2013.797. Epub 2013 Dec 24.

Intratumoural budding (ITB) in preoperative biopsies predicts the presence of lymph node and distant metastases in colon and rectal cancer patients.

Author information

1
Translational Research Unit (TRU), Institute of Pathology, University of Bern, Bern, Switzerland.
2
Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
3
1] Translational Research Unit (TRU), Institute of Pathology, University of Bern, Bern, Switzerland [2] Division of Clinical Pathology, Institute of Pathology, University of Bern, Bern, Switzerland.
4
Department of Oncology, Hospital Centre Biel, Biel, Switzerland.
5
1] Translational Research Unit (TRU), Institute of Pathology, University of Bern, Bern, Switzerland [2] Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.

Abstract

BACKGROUND:

In colorectal cancer (CRC), tumour budding at the invasion front is associated with lymph node (LN) and distant metastasis. Interestingly, tumour budding can also be detected in biopsies (intratumoural budding; ITB) and may have similar clinical importance. Here we investigate whether ITB in preoperative CRC biopsies can be translated into daily diagnostic practice.

METHODS:

Preoperative biopsies from 133 CRC patients (no neoadjuvant therapy) underwent immunohistochemistry for pan-cytokeratin marker AE1/AE3. Across all biopsies for each patient, the densest region of buds at × 40 (high-power field; HPF) was identified and buds were counted.

RESULTS:

A greater number of tumour buds in the biopsy was associated with pT stage (P=0.0143), LN metastasis (P=0.0007), lymphatic (P=0.0065) and venous vessel invasion (P=0.0318) and distant metastasis (cM1) (P=0.0013). Using logistic regression, a 'scale' was developed to estimate the probability of LN and distant metastasis using the number of tumour buds (e.g. 10 buds per HPF: 64% chance of LN metastasis; 30 buds per HPF: 86% chance). Inter-observer agreement for ITB was excellent (intraclass correlation coefficient: 0.813).

CONCLUSION:

Tumour budding can be assessed in the preoperative biopsy of CRC patients. It is practical, reproducible and predictive of LN and distant metastasis. Intratumoural budding qualifies for further investigation in the prospective setting.

PMID:
24366305
PMCID:
PMC3929877
DOI:
10.1038/bjc.2013.797
[Indexed for MEDLINE]
Free PMC Article

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