Use of an Elastic Connective Tissue Stain Significantly Increases the Detection of Venous Invasion in Esophageal Adenocarcinoma and Is Associated with Adverse Clinical Outcomes
MC Castonguay, DK Driman. University of Western Ontario and London Health Sciences Centre, London, ON, Canada
Background: The incidence of esophageal adenocarcinoma is increasing at 2.1% per year in the western world, faster than any other malignancy. Most (62%) patients present with regional or distant spread at diagnosis, resulting in only a 17% five-year survival. Detection of venous invasion (VI) may potentially lead to increased survival if it were to identify a subgroup of patients who would benefit from adjuvant therapy, as for some patients with colorectal carcinoma.
Design: Seventy surgical resection cases of esophageal adenocarcinomas, all reported as negative for VI, were selected sequentially from our departmental archives. The absence or presence of VI was confirmed upon review of H&E-stained tumor slides. All tumor blocks were subsequently stained with Movat pentachrome, and re-examined for venous invasion. Tumor stage (TNM 7), grade, and follow-up clinical data were collected. Statistical analysis was done using chi square, t tests, and logistic regression analysis.
Results: Nine cases were excluded, based on detection of VI with H&E stain alone. Of the remaining 61 cases, VI was detected in thirty-nine (64%) using Movat pentachrome. Twenty (51%) patients with VI developed visceral metastases during long-term follow-up, compared to 3 (14%) without VI (p=0.004). Patients with VI presented at higher T stage (p<0.001) and N stage (p<0.001), with a trend toward shortened survival (mean 26.6 vs 33.7 months, p=0.26), compared to VI-negative cases; with logistic regression, adjusting for T and N stages, patients with VI were more likely to develop visceral metastases (OR 2.6, p=0.277). Both groups showed equal sex and age distribution.
Conclusions: The use of an elastic stain significantly improves the detection of VI in cases of esophageal adenocarcinoma, compared to H&E staining. Our study confirms the adverse prognosis associated with VI, reflecting its relationship to increased T and N stages, and highlights the importance of documenting this histological parameter.
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 90, Monday Morning