Wajahat Ahmed Khan, Bushra Parveen, Muhammad Asif, Muhammad Usman Rathore, Farhat Rashid, Hassan Tariq, Naveed Khan.
Association of Tumour Budding with Histological Type and Grade, Pathological Stage and Lymph Node Metastasis in Colorectal Carcinoma.
Pak Armed Forces Med J Jan ;74(1):206-10.

Objective: To investigate the association between the tumour budding of colorectal carcinoma and its histological type, grade, lymph node metastasis, and pathological stage. Study Design: Cross-sectional study Place and Duration of Study: Histopathology Department, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Dec 2021 to Mar 2023. Methodology: One hundred and twenty colorectal carcinoma patients were examined for existence and severity using Hematoxylin and Eosin-stained sections. According to the number of tumour buds, cases were categorised as low grade (<10/200X), intermediate grade (10-19/200X), and high grade (>20/200X). These categories were related to lymph node involvement, histological type and grade, and pathological staging. In challenging cases, pan-cytokeratin immunohistochemistry labelling was conducted to confirm tumour budding. Results: The mean age of presentation was 55.78±12.47 years. The most common site of involvement was the ascending colon 66(55%), followed by the recto-sigmoid colon 29(24.2%). Most cases were conventional adenocarcinoma 80(67%), followed by mucinous carcinoma 31(26%). Most cases were moderately differentiated 62(52%) and were stage III 79(66%). Forty-two (35%) had low-grade, and thirty-four (28.3%) had intermediate-grade and high-grade tumour budding. Tumour budding significantly correlates with tumour size, histological grade, invasion extent, and lympho-vascular invasion (p-value <0.05). Conclusion: Tumour budding is strongly associated with nodal metastasis and a high grade of colorectal carcinoma; thus, it must be considered an important independent adverse prognostic indicator for colorectal carcinoma.

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