Pattern and Significance of Tumour Budding in Colorectal Carcinomas Using ITBCC Guidelines: a Low Resource Setting Practice Observation

Purpose To determine the pattern and significance of tumour budding among colorectal carcinoma (CRC) Nigerian patients using the 2016 International Tumour Budding Consensus Conference (ITBCC) guidelines. Methods H&E-stained slides of resected CRC at the University College Hospital and a private laboratory, both in Ibadan, Nigeria, from January 2008 to December 2017 were reviewed. Patient age, gender, tumour size and location were obtained from the surgical pathology records. Tumours were graded and staged according to the 2010 WHO and the 2017 UICC protocols, respectively. Tumour budding was determined at × 20 objective lens magnification with a 20-mm eyepiece field number diameter. Descriptive, Mann-Whitney U and chi-square test statistics were applied using SPSS 20; p < 0.05 was considered significant. Results Ninety-six cases were included in this study. Fifty-one (53.1%) showed tumour budding. Tumour bud count was low (0–4) in 66 (68.8%), intermediate (5–9) in 12 (12.5%) and high (≥ 10) in 18 (18.8%) tumours. Four tumours had pT1 stage, 35 pT2, 37 pT3 and 20 pT4. Forty-three (44.8%) tumours were lymph node–positive, and 10 (10.4%) had metastasis. Patients’ age and tumour size distribution were similar in the tumour budding and non-budding groups (52.4 ± 17.1/58.5 ± 13.9 years and 6.6 ± 2.9/6.6 ± 2.8 cm, respectively). There was significant association between tumour budding and tumour grade ( p < 0.008), pT stage ( p < 0.000), lymphovascular permeation ( p < 0.000), perineural invasion ( p < 0.003) and nodal status ( p < 0.034), but not with gender ( p = 0.588), metastasis ( p = 0.327) and TNM group-stage ( p = 0.062). Conclusion Tumour budding frequency is high among our CRC patients and is associated with poorer prognostic factors.