Introduction There are different approaches for the proper management of T1 colorectal cancer
after local resection. The identification of lymph node metastasis usually requires
subsequent colorectal resection, and some histopathological factors can predict its
presence. The depth of invasion of the submucosal layer is no longer considered an
independent risk factor for predicting lymph node spread. Over the years, studies
have shown that other histopathological factors, such as angiolymphatic invasion,
are more relevant.
Objective To evaluate histopathological risk factors for lymph node metastasis in T1 colorectal
cancer, comparing methods using Hematoxylin and Eosin (HE) with immunohistochemistry.
Specifically, to evaluate angiolymphatic invasion, perineural invasion, and tumor
budding, determining higher detection rates of these factors.
Methods The study will investigate patients who underwent resection of lesions by endoscopic
methods and were histologically diagnosed with T1 colorectal cancer. These patients
are under follow-up with the Coloproctology team at Felício Rocho Hospital, Belo Horizonte
- MG. The slides that determined the diagnosis using hematoxylin and eosin were also
subjected to immunohistochemical analysis using antibodies such as D2-40, CD-34, Cytokeratins,
and S-100, and these results were compared.
Results During the period from January 2024 to June of the same year, 14 patients with T1
colorectal adenocarcinoma were identified from colonoscopy or TEO, under follow-up
with the team. Only 2 of these patients underwent surgery, and the others are being
followed with conservative treatment. The degree of differentiation found was either
well or moderately differentiated. Only 2 patients with angiolymphatic invasion were
detected by HE and were consistent with immunohistochemical methods. None showed positivity
for perineural invasion. The distinguishing factor was tumor budding, with two patients
showing moderate and high grades by immunohistochemistry, in contrast to the low grade
(Grade I) identified by HE for both.
Conclusion Although this is an ongoing study with preliminary results, immunohistochemistry
appears to be a more effective and easier method to detect poor prognostic factors
in T1 colorectal cancer, thus facilitating the management of these tumors, in which
only 10% actually present lymph node metastasis.
