Original Article
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World J Gastroenterol. Jun 28, 2013; 19(24): 3761-3769
Published online Jun 28, 2013. doi: 10.3748/wjg.v19.i24.3761
Assessment of vascular invasion in gastric cancer: A comparative study
Letícia Trivellato Gresta, Ismael Alves Rodrigues-Júnior, Lúcia Porto Fonseca de Castro, Geovanni Dantas Cassali, Mônica Maria Demas Álvares Cabral
Letícia Trivellato Gresta, Ismael Alves Rodrigues-Júnior, Lúcia Porto Fonseca de Castro, Mônica Maria Demas Álvares Cabral, Department of Anatomic Pathology and Medicine, University Federal of Minas Gerais, Belo Horizonte 30130-100, Brazil
Geovanni Dantas Cassali, Institute of Biological Sciences, University Federal of Minas Gerais, Belo Horizonte 31270-901, Brazil
Author contributions: Gresta LT conceived of the study, and participated in its design, acquisition of data, execution and drafted the manuscript; Rodrigues-Júnior IA performed the statistical analysis and interpretation of data, critical review and helped to edit the manuscript; de Castro LPF carried out the immunoassays and participated in the critical review of the results and discussion; Cassali GD provided for some reagents and revised the manuscript critically; Cabral MMDA conceived of the study, and participated in its design and coordination and helped to draft the manuscript; all authors read and approved the final manuscript.
Supported by Grants from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Correspondence to: Letícia Trivellato Gresta, MD, MSc, PhD, Department of Anatomic Pathology and Medicine, University Federal of Minas Gerais, Av. Antônio Carlos, Belo Horizonte 30130-100, Brazil. letrivellato@gmail.com
Telephone: +55-31-84548064 Fax: +55-31-38261792
Received: January 30, 2013
Revised: April 3, 2013
Accepted: April 13, 2013
Published online: June 28, 2013
Processing time: 149 Days and 2.6 Hours
Abstract

AIM: To evaluate and compare detection of lymphatic and blood vessel invasion (LVI and BVI) by hematoxylin-eosin (HE) and immunohistochemistry (IHC) in gastric cancer specimens, and to correlate with lymph node status.

METHODS: IHC using D2-40 (a lymphatic endothelial marker) and CD34 (a pan-endothelial marker) was performed to study LVI and BVI in surgical specimens from a consecutive series of 95 primary gastric cancer cases. The results of the IHC study were compared with the detection by HE using McNemar test and kappa index. The morphologic features of the tumors and the presence of LVI and BVI were related to the presence of lymph node metastasis. A χ2 test was performed to obtain associations between LVI and BVI and other prognostic factors for gastric cancer.

RESULTS: The detection rate of LVI was considerably higher than that of BVI. The IHC study identified eight false-positive cases and 13 false-negative cases for LVI, and 24 false-positive cases and 10 false-negative cases for BVI. The average Kappa value determined was moderate for LVI (κ = 0.50) and low for BVI (κ = 0.20). Both LVI and BVI were statistically associated with the presence of lymph node metastasis (HE: P = 0.001, P = 0.013, and IHC: P = 0.001, P = 0.019). The morphologic features associated with LVI were location of the tumor in the distal third of the stomach (P = 0.039), Borrmann’s macroscopic type (P = 0.001), organ invasion (P = 0.03) and the depth of tumor invasion (P = 0.001). The presence of BVI was related only to the depth of tumor invasion (P = 0.003).

CONCLUSION: The immunohistochemical identification of lymphatic and blood vessels is useful for increasing the accuracy of the diagnosis of vessel invasion and for predicting lymph node metastasis.

Keywords: Gastric cancer, Tumour-node-metastesis staging, Lymph node metastasis, Predictive factor, Lymphatic vessel invasion, Blood vessel invasion, Immunohistochemistry, CD34, D2-40

Core tip: The presence of lymphatic vessel invasion in gastric cancer is the strongest risk factor for lymph node metastasis and is known as an independent prognostic factor. The subjective evaluation of vessel invasion performed with conventional hematoxylin-eosin staining can lead to inaccurate false-positive and false-negative results. This study shows that the immunohistochemical identification of lymphatic and blood vessels is useful for increasing the accuracy of the diagnosis of lymphatic and blood vessel invasion and for predicting lymph node metastasis in gastric cancer.