Venous invasion (VI) is a powerful yet underreported prognostic factor in colorectal cancer (CRC). Its detection can be improved with an elastin stain. We evaluated the impact of routine elastin staining on VI detection in resected CRC and its relationship with oncologic outcomes. Pathology reports from the year before (n=145) and the year following (n=128) the implementation of routine elastin staining at our institution were reviewed for established prognostic factors, including VI. A second review, using elastin stains, documented the presence/absence, location, number, and size of VI foci. The relationship between VI and oncologic outcomes was evaluated for original and review assessments. VI detection rates increased from 21% to 45% following implementation of routine elastin staining (odds ratio [OR]=3.1; 95% confidence interval [CI]: 1.8-5.3; P<0.0001). The second review revealed a lower VI miss rate postimplementation than preimplementation (22% vs. 48%, respectively; P=0.007); this difference was even greater for extramural VI–positive cases (9% vs. 38%, respectively; P=0.0003). Missed VI cases postimplementation had fewer VI foci per missed case (P=0.02) and a trend towards less extramural VI than those missed preimplementation. VI assessed with an elastin stain was significantly associated with recurrence-free survival (P=0.003), and cancer-specific survival (P=0.01) in contrast to VI assessed on hematoxylin and eosin alone (P=0.053 and 0.1, respectively). The association between VI and hematogenous metastasis was far stronger for elastin-detected VI (OR=11.5; 95% CI: 3.4-37.1; P<0.0001) than for hematoxylin and eosin–detected VI (OR=3.7; 95% CI: 1.4-9.9; P=0.01). Routine elastin staining enhances VI detection and its ability to stratify risk in CRC and should be considered for evaluation of CRC resection specimens.

静脉侵犯 (VI) 是结直肠癌 (CRC) 中一个强大但未被充分报道的预后因素。可以通过弹性蛋白染色来改进其检测。我们评估了常规弹性蛋白染色对切除的 CRC 中 VI 检测的影响及其与肿瘤学结果的关系。我们对我们机构实施常规弹性蛋白染色前一年 (n=145) 和后一年 (n=128) 的病理报告进行了审查，以确定已确定的预后因素，包括 VI。第二次检查使用弹性蛋白染色，记录了 VI 病灶的存在/不存在、位置、数量和大小。VI 和肿瘤学结果之间的关系针对原始评估和审查评估进行了评估。实施常规弹性蛋白染色后，VI 检出率从 21% 增加至 45%（比值比 [OR]=3.1；95% 置信区间 [CI]：1.8-5.3；P <0.0001）。第二次审查显示，实施后的 VI 缺失率低于实施前（分别为 22% 和 48%；P = 0.007）；对于壁外 VI 阳性病例，这种差异甚至更大（分别为 9% 和 38%；P =0.0003）。与实施前错过的病例相比，实施后错过的 VI 病例的 VI 病灶较少（P = 0.02），并且有减少壁外 VI 的趋势。与仅用苏木精和伊红评估的 VI（分别为P = 0.053 和 0.1 ）相比，用弹性蛋白染色评估的 VI 与无复发生存期（P = 0.003）和癌症特异性生存期（ P = 0.01 ）显着相关。弹性蛋白检测到的 VI（OR=11.5；95% CI：3.4-37.1；P < 0.0001）与苏木精和伊红检测到的 VI（OR=3.7；95% CI：1.4）相比，VI 与血行转移之间的关联性要强得多。 -9.9；P =0.01）。常规弹性蛋白染色可增强 VI 检测及其对 CRC 风险进行分层的能力，应考虑用于评估 CRC 切除标本。