Refining the ITBCC tumor budding scoring system with a “zero-budding” category in colorectal cancer

Abstract

Tumor budding scoring guidelines from the International Tumor Budding Consensus Conference (ITBCC) for colorectal cancer propose three groups: BD1 (0–4 buds/0.785 mm2), BD2 (5–9 buds/0.785 mm2), and BD3 (10 or more buds/0.785 mm2). Here, we investigate whether a fourth scoring category, namely zero buds, may have additional clinical relevance. The number of tumor buds/0.785 mm2 was scored in 959 cases. Those with zero tumor buds were considered BD0, while a new BD1 category of 1–4 buds was proposed. Associations of both scoring approaches with clinicopathological features were analyzed. Conventional ITBCC scoring showed expected associations with unfavorable histopathological prognostic factors. In total, 111/959 (11.6%) were BD0. A significant difference was found when BD0 was compared statistically to BD1 (1–4 buds) for pT, TNM, tumor grade, and lymphatic, venous, and perineural invasion (p < 0.01, all). Tumors with BD0 occur relatively frequently and contribute additional information on tumor behavior. BD0 should be considered for subsequent ITBCC guidelines.

Should a fourth category be added to the international tumor budding consensus conference tumor budding scoring system in colorectal adenocarcinomas?

“…However, although most of these studies have the BD0 category, the cutoff values of low and high budding categories were used differently than the recommendations of the ITBCC. Only € Ozer et al [29] categorized budding as B0-BD1-BD2-BD3, similar to our study and Zlobec et al [10], but did not investigate the difference between BD0-BD1.…”

“…Most studies in the literature draw attention to the association of high tumor budding scores with aggressive tumor characteristics such as advanced pT, pN, AJCC stage, lymphovascular and perineural invasion, distant metastasis, and local tumor recurrence [10,18,[21][22][23][24][25][26]]. Budding's relationship with the histological grade of the tumor is still unclear.…”

“…The need to add a fourth category is a matter of debate. Zlobec et al [10] proposed adding the "zero budding (BD0)" category to the budding score categorization and stated that the tumors in this category had better differentiation and less vascular invasion. The BD0 category, i.e.…”

Tumor Budding beim kolorektalen Karzinom – Informationen zur klinischen Anwendung und Anleitung zur praktischen Bestimmung

“…Bereits bei der ITBCC 2016 war klar, dass der verfasste Konsens bei Erweiterung der Datenlage und adäquater Evidenz in der Literatur revidiert und verfeinert werden sollte. Beispielsweise wurde kürzlich eine zusätzliche Kategorie für vollständige Abwesenheit von Tumor Buds (Bd0; [ 26 ]) vorgeschlagen. In der publizierten Studie konnte gezeigt werden, dass CRC ohne Tumor Buds tendenziell niedrigere T‑Stadien und eine bessere Prognose zeigten, so dass möglicherweise die Bd0-Kategorie zusätzlich eingeführt werden könnte, um Karzinome mit günstigerem Verlauf besser charakterisieren zu können.…”

Tumor budding or tumor baloney?

“…"For every complex problem there is an answer that is clear, simple, and wrong" -H. L. Mencken Firstly, I would like to congratulate Zlobec et al [1] on their recent feat in colorectal cancer (CRC), refining the ITBCC tumor budding scoring system with the addition of a "zero-budding" category. Despite this advancement, tumor budding (TB) in itself may be better defined as tumor baloney, or tumor bologna, a sausage derived from Mortadella, informally defined as nonsense, and often used as a generalized expression of disagreement.…”