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Lugli A, Kirsch R, Ajioka Y, Bosman F, Cathomas G, Dawson H, El Zimaity H, Fléjou JF, Hansen TP, Hartmann A, Kakar S, Langner C, Nagtegaal I, Puppa G, Riddell R, Ristimäki A, Sheahan K, Smyrk T, Sugihara K, Terris B, Ueno H, Vieth M, Zlobec I, Quirke P. Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference (ITBCC) 2016. Mod Pathol 2017; 30:1299-1311. [PMID: 28548122 DOI: 10.1038/modpathol.2017.46] [Citation(s) in RCA: 711] [Impact Index Per Article: 88.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 02/07/2023]
Abstract
Tumor budding is a well-established independent prognostic factor in colorectal cancer but a standardized method for its assessment has been lacking. The primary aim of the International Tumor Budding Consensus Conference (ITBCC) was to reach agreement on an international, evidence-based standardized scoring system for tumor budding in colorectal cancer. The ITBCC included nine sessions with presentations, a pre-meeting survey and an e-book covering the key publications on tumor budding in colorectal cancer. The 'Grading of Recommendation Assessment, Development and Evaluation' method was used to determine the strength of recommendations and quality of evidence. The following 10 statements achieved consensus: tumor budding is defined as a single tumor cell or a cell cluster consisting of four tumor cells or less (22/22, 100%). Tumor budding is an independent predictor of lymph node metastases in pT1 colorectal cancer (23/23, 100%). Tumor budding is an independent predictor of survival in stage II colorectal cancer (23/23, 100%). Tumor budding should be taken into account along with other clinicopathological features in a multidisciplinary setting (23/23, 100%). Tumor budding is counted on H&E (19/22, 86%). Intratumoral budding exists in colorectal cancer and has been shown to be related to lymph node metastasis (22/22, 100%). Tumor budding is assessed in one hotspot (in a field measuring 0.785 mm2) at the invasive front (22/22, 100%). A three-tier system should be used along with the budding count in order to facilitate risk stratification in colorectal cancer (23/23, 100%). Tumor budding and tumor grade are not the same (23/23, 100%). Tumor budding should be included in guidelines/protocols for colorectal cancer reporting (23/23, 100%). Members of the ITBCC were able to reach strong consensus on a single international, evidence-based method for tumor budding assessment and reporting. It is proposed that this method be incorporated into colorectal cancer guidelines/protocols and staging systems.
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Affiliation(s)
| | - Richard Kirsch
- Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Fred Bosman
- University Institute of Pathology, Lausanne University Medical Center, Lausanne, Switzerland
| | - Gieri Cathomas
- Institute of Pathology, Kantonsspital Liestal, Liestal, Switzerland
| | - Heather Dawson
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | - Jean-François Fléjou
- Pathology Department, Saint-Antoine Hospital, Pierre et Marie Curie University, Paris, France
| | - Tine Plato Hansen
- Department of Pathology, Copenhagen University Hospital, Herlev, Denmark
| | - Arndt Hartmann
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Sanjay Kakar
- Department of Anatomic Pathology, University of California, San Francisco, CA, USA
| | - Cord Langner
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Iris Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Giacomo Puppa
- Department of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Robert Riddell
- Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ari Ristimäki
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kieran Sheahan
- Department of Pathology, St Vincent's University Hospital, Dublin, Ireland
| | - Thomas Smyrk
- Divisions of Anatomic Pathology and Mayo Clinic, Rochester, MN, USA
| | - Kenichi Sugihara
- Department of Surgical Oncology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences, Bunkyo-ku, Tokyo, Japan
| | - Benoît Terris
- Pathology Department, Hôpital Cochin and Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Inti Zlobec
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Phil Quirke
- Pathology and Tumour Biology, University of Leeds, St James's University Hospital, Leeds, UK
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Liang F, Cao W, Wang Y, Li L, Zhang G, Wang Z. The prognostic value of tumor budding in invasive breast cancer. Pathol Res Pract 2013; 209:269-75. [PMID: 23561623 DOI: 10.1016/j.prp.2013.01.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/27/2012] [Accepted: 01/27/2013] [Indexed: 12/11/2022]
Abstract
We investigated the prognostic value of tumor budding in 160 cases of operable invasive ductal carcinoma, not otherwise specified (IDC-NOS). The number of buds was counted in H&E slides with a maximal invasive margin in a 0.950mm(2) field of vision (200×). According to a cut-off score selected by ROC analysis, the cohort was dichotomized into a low (0-7 budding foci, 107 cases, 66.9%) and a high-grade budding group (8 or more budding foci, 53 cases, 33.1%). The inter-observer test showed a good reproducibility with 0.717 as the К value. High-grade budding was significantly associated with the presence of lymphovascular invasion (LVI) (P=0.001), larger tumor size (P=0.014), and worse clinical outcome (P<0.001). By immunohistochemical staining, budded cells at the margin displayed epithelial mesenchymal transition (EMT)-like molecular phenotype and decreased proliferative activity. Survival analyses revealed that tumor budding (HR 4.275, P<0.001) together with tumor size (HR 2.468, P=0.002), node status (HR 2.362, P<0.001), and LVI status (HR 1.910, P=0.035) was the independent prognostic factor in IDC-NOS. In conclusion, tumor budding is a reproducible, significant, and independent histopathological prognostic factor in IDC-NOS.
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Affiliation(s)
- Fenli Liang
- Center for Cancer Research, First Affiliated Hospital of Xi'an Jiaotong University, 710061 Xi'an, China
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