Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference (ITBCC) 2016

Alessandro Lugli, Richard Kirsch, Yoichi Ajioka, Fred Bosman, Gieri Cathomas, Heather Dawson, Hala El Zimaity, Jean François Fléjou, Tine Plato Hansen, Arndt Hartmann, Sanjay Kakar, Cord Langner, Iris Nagtegaal, Giacomo Puppa, Robert Riddell, Ari Ristimäki, Kieran Sheahan, Thomas Christopher Smyrk, Kenichi Sugihara, Benoît TerrisHideki Ueno, Michael Vieth, Inti Zlobec, Phil Quirke

Research output: Contribution to journalArticle

202 Scopus citations

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 mm 2) 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.

Original languageEnglish (US)
Pages (from-to)1299-1311
Number of pages13
JournalModern Pathology
Volume30
Issue number9
DOIs
StatePublished - Sep 1 2017

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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    Lugli, A., Kirsch, R., Ajioka, Y., Bosman, F., Cathomas, G., Dawson, H., El Zimaity, H., Fléjou, J. F., Hansen, T. P., Hartmann, A., Kakar, S., Langner, C., Nagtegaal, I., Puppa, G., Riddell, R., Ristimäki, A., Sheahan, K., Smyrk, T. C., Sugihara, K., ... Quirke, P. (2017). Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference (ITBCC) 2016. Modern Pathology, 30(9), 1299-1311. https://doi.org/10.1038/modpathol.2017.46