Objective To systematically summarize the assessment methods, pathological and molecular mechanisms of tumor budding (TB) in colorectal cancer (CRC), and to explore its potential value in personalized therapy and future research directions. MethodsThrough a systematic analysis of the literature, it focuses on elucidating the pathological processes and molecular mechanisms underlying TB formation, highlighting its complex interplay with the tumor microenvironment. The review also summarizes methodologies for TB counting and grading, spanning from conventional histopathological evaluation to innovative approaches leveraging radiomics and artificial intelligence. ResultsTB plays an essential role in clinical decision-making for CRC patients, demonstrating how TB grade influences surgical strategy selection and the planning of neoadjuvant and adjuvant therapies. Additionally, TB is also a key prognostic indicator of CRC, high-grade TB being consistently associated with increased risk of recurrence and reduced survival rate. ConclusionsFuture research should further unravel the molecular mechanisms of TB, refine TB assessment methodologies, and validate the clinical utility of TB in personalized treatment strategies through multicenter trials. These efforts are expected to improve therapeutic outcomes and prognosis for CRC patients.