Normalization Overestimates Tumor Budding Counts in Colorectal Carcinoma Assessment

Validation of the international tumor budding consensus conference (itbcc) method for assessing tumor budding in colorectal cancer (CRC) revealed that normalization overcorrects tumor budding counts, resulting in the downgrading of many borderline cases. Despite this, tumor budding counts in a 0.95 mm2 field remained clinically predictive. These findings highlight the implications of normalization for risk stratification and adjuvant treatment decisions, suggesting the need to re-evaluate its role in tumor budding assessment.