Assessment of Tumour Budding in Colorectal Carcinoma and its Correlation with Pathological Staging among Patients undergoing Resection at a Tertiary Care Hospital in Kerala, India
Introduction: Colorectal Carcinoma (CRC) is one of the most commonly diagnosed carcinomas and a significant cause of cancer-related deaths worldwide. The prognosis and treatment decisions rely on the Tumour, Node, Metastasis (TNM) Staging system. However, some tumours are classified as low-risk...
Main Authors: | , , |
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Format: | Article |
Language: | English |
Published: |
JCDR Research and Publications Private Limited
2023-10-01
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Series: | Journal of Clinical and Diagnostic Research |
Subjects: | |
Online Access: | https://www.jcdr.net/articles/PDF/18546/63006_CE[Ra1]_F[SK]_QC(KK_RDW_SS)_PF1(AG_KM)_PFA(AG_KM)_PN(KM).pdf |
Summary: | Introduction: Colorectal Carcinoma (CRC) is one of the most
commonly diagnosed carcinomas and a significant cause of
cancer-related deaths worldwide. The prognosis and treatment
decisions rely on the Tumour, Node, Metastasis (TNM) Staging
system. However, some tumours are classified as low-risk
based on TNM stage exhibit adverse outcomes. Therefore, the
search for additional prognostic factors is necessary. Tumour
budding is an established independent prognostic factor, with
high-grade tumour budding consistently linked to lymph node
metastasis, local recurrence, and distant metastasis.
Aim: To assess and grade tumour budding in CRC cases and
examine its correlation with pathological staging.
Materials and Methods: A cross-sectional study was conducted
on 95 patients between December 2019 and December 2021
at Sree Gokulam Medical College and Research Foundation,
Venjaramood, Trivandrum, India. Resected specimens from
CRC patients were processed, and Haematoxylin and Eosin
(H&E) slides were examined for tumour budding assessment.
Ten individual fields were scanned under a 10x objective to
locate the hotspot area with the maximum number of tumour
buds. Tumour buds were then counted under a 40x objective in
the selected hotspot area. Tumour budding was categorised as
low (0-1 bud), intermediate (2-4 buds), or high (5 or more buds).
Immunohistochemistry (IHC) analysis with Pancytokeratin was
carried out when assessment with H&E slides alone was difficult.
The correlation between tumour budding and pathological
staging was evaluated, along with its association with various
histopathological parameters.
Results: The study included 95 patients, with a mean age of
68.22 years, comprising 58.95% males and 41.05% females.
Low-grade tumour budding was observed in 42 (44.21%) cases,
intermediate-grade budding in 34 (35.79%) cases, and highgrade tumour budding in 19 (20%) cases. There was a significant
correlation between tumour budding and pathological staging
(r-value=0.39) as well as the number of metastatic lymph nodes
(r-value=0.34). The presence of lymph node metastasis and
lymphovascular Invasion (LVI) showed a statistically significant
association (p-value<0.01).
Conclusion: Tumour budding grading is a valuable
histopathological finding, as it increases with higher T stage
and presence of nodal metastasis, aiding in the prediction of
nodal metastasis and recurrence. It is positively correlated
with pathological staging and the number of metastatic lymph
nodes. Including tumour budding grade in the histopathology
report can assist clinicians in assessing prognosis and making
treatment decisions. |
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ISSN: | 2249-782X 0973-709X |