Brotamento tumoral no adenocarcinoma colorretal: valor prognóstico e implicações para o laudo anatomopatológico

Abstract

Objective: To critically synthesize recent evidence on tumour budding in colorectal adenocarcinoma, focusing on standardized assessment, its association with lymph node metastasis and recurrence, reproducibility limitations, and implications for pathology reporting. Method: A structured narrative review was conducted using a reproducible PubMed/MEDLINE search on September 15, 2026. Sources published between September 15, 2021, and September 15, 2026, were included, prioritizing guidelines, systematic reviews, meta-analyses, and cohorts with histopathological assessment. The scope was limited to peritumoural budding in conventional, primary colorectal adenocarcinoma without neoadjuvant treatment. Results: The College of American Pathologists protocol recommends haematoxylin-eosin counting in the highest-density area of the invasive front, standardized to 0.785 mm², and grading as Bd1 (0–4), Bd2 (5–9), or Bd3 (≥10) buds. In a meta-analysis of 57 studies including 24,956 pT1 patients, high-grade budding was associated with lymph node metastasis (relative risk 4.04; 95% confidence interval 3.52–4.64) and local recurrence (relative risk 2.35; 95% confidence interval 1.21–4.54). In stage III colon cancer, associations with worse disease-free and overall survival persisted after adjustment for clinicopathological factors. Evidence is limited by methodological heterogeneity, interobserver variability, uncertainty around threshold cases, and applicability restricted to specific histological subtypes. Conclusion: Tumour budding adds prognostic information to pTNM staging and other risk factors, but does not replace them or independently determine therapeutic management. Structured reporting of count, grade, method, and reasons for non-applicability supports multidisciplinary communication and cautious interpretation.