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The presence of tumor cells in blood vessels, particularly extramural venous invasion (EMVI), is an independent poor prognostic factor in colorectal cancer (CRC). The Association of Directors of Anatomic and Surgical Pathology and the College of American Pathologists define EMVI as the microscopic presence of tumor cells in venous vessels beyond the muscularis propria., 4 The prevalence and significance of EMVI in esophageal cancer (EC) is still unclear. Most studies focused on differentiating venous invasion from lymphatic vascular invasion (LVI), as expressed in the current TNM classification, without assessing where the venous invasion was located. Problems addressed included the prevalence and prognostic significance of EMVI in EC resection specimens, and how to overcome difficulties among pathologists in identifying EMVI by using Elastica van Gieson (EVG) staining. We investigated archival specimens with pathological T3 or higher from patients operated by surgery alone, and those after neoadjuvant chemoradiotherapy (nCRT). The key question was whether EMVI can be used as a predictive factor in the response evaluation of nCRT. PRESENT

ASO Author Reflections: Diagnostic Significance of Extramural Venous Invasion in Patients with Locally Advanced Esophageal Cancer