A Study on Efficacy of Verhoeff Van Gieson Elastic Stain and CD34 Immunohistochemistry in Identification of Extramural Vascular Invasion in Colorectal Cancers

Background: Colorectal cancer (CRC) is the third most common malignancy worldwide and the second leading cause of cancer-related deaths, mainly due to late-stage diagnosis and recurrence. Lymphovascular invasion (LVI), particularly extramural vascular invasion (EMVI), is a strong prognostic marker linked to metastasis and poorer survival outcomes. However, EMVI detection is often underreported due to variability in diagnostic techniques, making accurate identification crucial for guiding adjuvant therapy decisions. This study aims to compare the efficacy of hematoxylin and eosin (H&E) staining, Verhoeff Van Gieson (VVG) elastic staining, and CD34 immunohistochemistry (IHC) in detecting EMVI in colorectal cancer specimens.Methods: This is a cross-sectional study of 72 colorectal cancer patients conducted at a tertiary referral center in Kerala, South India, over a period of 18 months. EMVI was assessed using H&E, VVG, and CD34 stains, and detection rates were compared using SPSS 23.0 version. Result: H&E staining identified EMVI in 10 cases (14%), VVG in 15 cases (21%), and CD34 IHC in 7 cases (9.7%), with significant differences between methods. VVG staining had the highest detection rate and was significantly associated with lymph node metastasis (p=0.024) and advanced AJCC stages (p=0.017).Conclusion: VVG elastic staining enhances EMVI detection in colorectal cancer compared to H&E. The use of CD34 IHC, while less effective and more resource-intensive, is not recommended for routine EMVI detection due to its lower sensitivity and technical complexity.