Venous invasion in oesophageal adenocarcinoma: enhanced detection using elastic stain and association with adverse histological features and clinical outcomes.

Aims: In oesophageal adenocarcinoma, detection rates of venous invasion using haematoxylin and eosin (H&E) and elastic stains have not been compared. The aims of this study were to investigate whether or not elastic stains facilitate the detection of venous invasion, and to determine the prognostic significance of venous invasion following review with elastic stains.

Methods And Results: One hundred and three resection specimens containing oesophageal adenocarcinoma, all reported originally as negative for venous invasion, were examined for the presence of venous invasion using H&E and subsequently Movat pentachrome stains. Venous invasion was detected in eight cases with H&E and an additional 66 cases using Movat pentachrome; overall, 72% of cases contained venous invasion. Venous invasion was associated with advanced stage, tumour size, lymphatic and perineural invasion and subsequent distant metastases. Venous invasion, stage, size, grade, lymphatic invasion and perineural invasion were prognostically significant on univariate analysis. Only tumour stage was independently prognostic. Two of eight patients with venous invasion but no other indication for adjuvant treatment died of recurrent disease.

Conclusions: Elastic stains improve detection of venous invasion significantly in oesophageal adenocarcinoma. Venous invasion is associated with multiple adverse clinicopathological features. Its identification may facilitate the stratification of patients at risk for visceral metastases and disease-related death.