Fig. 1: Tumor emboli and macrovascular infiltration detected during routine clinical autopsy in patients with various tumor types and premortem radiological evidence of vascular involvement.

a, The image shows inclusion and exclusion criteria to select patients with a cancer diagnosis who died of cancer-related complications at UTSW from January 2010 to December 2020 and underwent a clinical autopsy. b, The image shows a pie chart displaying the agreement among the ten medical professionals (indicated as ‘Reviewers’, left panel) who independently reviewed the patients in the UTSW retrospective cohort and determined their cause of death. c, The image shows representative H&E images of a tumor embolus (low and high magnification) with organized tumor cells adhering to the left ventricle wall taken from a patient with CRC. Scale bars = 1 mm (left) and 100 µm (right). d, The image shows H&E representative images of tumor emboli in medium (top images) and small (bottom images) caliber vessels for patients with colorectal (rPt.P32) and lung (rPt.P16) cancer, respectively, at low (L) and high (H) magnification. Scale bars = 500 µm (left) and 100 µm (right). e, The image shows box plots representing the quantification of tumor emboli detected in H&E images of patients from the UTSW retrospective cohort. Individual box plots show the counts of tumor emboli detected in vessels, small and medium/large calibers, for UTSW retrospective cohort patients (n = 92). Box plots indicate 25th, 50th and 75th percentiles and whiskers represent the range of values within 1.5 interquartile ranges of the 25th and 75th percentiles. Statistical annotations indicate the statistical significance of two-sided Wilcoxon signed-rank tests to compare groups shown on the x axis. Exact P values are 1.11 × 10⁻¹⁴, 0.96, 9.59 × 10⁻¹⁵ and 7.52 × 10⁻¹⁵ for medium/large arteries versus small veins, small arteries versus medium/large veins, small arteries versus small veins, and medium/large veins versus small veins, respectively. P values are not corrected for multiple comparisons. f, The image shows coronal (central image) and axial (lateral images) CT scans with a portion of the primary tumor infiltrating the superior vena cava from a patient with lung cancer (rPt.P107). Arrowheads demarcate tumor borders in the coronal image and point toward the tumor thrombus in the axial images. Axial images correspond to the planes demarcated by colored lines on the coronal image. Scale bar = 2 cm. g, The image shows representative H&E images from the clinical autopsy of a patient (rPt.P107) with lung cancer. The central image (low magnification) shows a segment of the superior vena cava with tumor cells infiltrating the vessel wall (left image, high magnification) and a blood clot containing several tumor cells highlighted by white arrows (right image, high magnification). Scale bars = 100 µm (left), 5 mm (middle) and 50 µm (right). Pts, patients; CNS, central nervous system; RN, registered nurse; SVC, superior vena cava; rPt, retrospective patients.