Assessing the Risk of Nodal Metastases in Canine Integumentary Mast Cell Tumors: Is Sentinel Lymph Node Biopsy Always Necessary?

Ferrari, Roberta; Boracchi, P.; Chiti, Lavinia Elena; Manfredi, M.; Giudice, Chiara; Zani, D. De; Spediacci, Carlotta; Recordati, Camilla; Grieco, Valeria; Gariboldi, Elisa Maria; Stefanello, Damiano

doi:10.3390/ani11082373

Cited by 22 publications

(61 citation statements)

References 35 publications

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“…For age and weight, the median was used as the cut‐off value. For tumour diameter, a cut‐off value of 3 cm was selected based on previous studies 2,13 …”

Section: Discussionmentioning

confidence: 99%

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Histologic grade has a higher‐weighted value than nodal status as predictor of outcome in dogs with cutaneous mast cell tumours and overtly metastatic sentinel lymph nodes

Guerra

Faroni

Sabattini

et al. 2022

Vet Comparative Oncology

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In canine cutaneous mast cell tumours (cMCTs), histologic grade and clinical stage are the most important prognostic factors, with high‐grade tumours and metastatic lymph nodes (LNs) significantly influencing the evolution of disease. However, it is uncertain whether histologic grade and clinical stage should be given equal weighting value in patient prognostication and management. Dogs with low‐ and high‐grade cMCTs and at least one overtly metastatic sentinel LN undergoing standardized treatment, consisting of surgical excision of the cMCT, lymphadenectomy and chemotherapy, were retrospectively included. The aim was to determine whether, at the same clinical stage, histologic grade retained prognostic relevance. Sixty dogs were included: 26 had a high‐grade cMCT tumour and 34 had a low‐grade cMCT. Median follow‐up was 367 days (range, 187–748) in the high‐grade group, and 1208 days (range, 180–2576) in the low‐grade group. Median time to progression was significantly shorter in the high‐grade group than in the low‐grade group (214 days versus not reached; p < .001), as well as tumour‐specific survival (545 days versus not reached; p < .001). On multivariable analysis, a high histologic grade and incomplete margins retained prognostic significance for both tumour progression and tumour‐specific death. In dogs with cMCT and at least one overtly metastatic LN undergoing multimodal treatment, histologic grade significantly correlated with outcome. Overall prognosis was not unfavourable, even in the high‐grade group, further supporting that a multimodal therapeutic approach, addressing primary tumour and sentinel LN, should be offered. Whether chemotherapy should be incorporated in the therapeutic planning of low‐grade cMCTs remains to be defined.

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“…For age and weight, the median was used as the cut‐off value. For tumour diameter, a cut‐off value of 3 cm was selected based on previous studies 2,13 …”

Section: Discussionmentioning

confidence: 99%

“…For tumour diameter, a cut-off value of 3 cm was selected based on previous studies. 2,13 Data were analysed by use of commercial software programs (SPSS Statistics v. 26, IBM, Somers, NY, and Prism v. 5.0, GraphPad, San Diego, CA). p Values ≤ .05 were considered significant.…”

Section: Methodsmentioning

confidence: 99%

Histologic grade has a higher‐weighted value than nodal status as predictor of outcome in dogs with cutaneous mast cell tumours and overtly metastatic sentinel lymph nodes

Guerra

Faroni

Sabattini

et al. 2022

Vet Comparative Oncology

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“…For example, Lapsley et al demonstrated in their study with cMCT and scMCT patients using ICTL to determine SLN that the SLN differed from RLN in 25% of the cases and the histopathology of the SLN altered the treatment recommendation in 50% of the examined cases, however, this pre-post study only included 17 MCT patients (96). Another study found a correlation between the size of cMCT or scMCT and a significantly higher risk to develop LN metastasis using lymphoscintigraphy SLN mapping (97). However, SLN mapping and biopsy of these LNs requires additional diagnostic and invasive procedures that are expensive and not always available, and therefore not widely used in veterinary practice.…”

Section: Lymph Node Assessmentmentioning

confidence: 99%

“…Also, the regional LN (RLN), which is the anatomically closest LN, may not be the draining sentinel LN (SLN) (91). More recently, a number of studies examined different techniques to identify SLN, including methylene blue dye, lymphoscintigraphy, indirect computed tomography lymphangiography (ICTL) and contrast enhanced ultrasound (CEUS) (91)(92)(93)(94)(95)(96)(97). For example, Lapsley et al demonstrated in their study with cMCT and scMCT patients using ICTL to determine SLN that the SLN differed from RLN in 25% of the cases and the histopathology of the SLN altered the treatment recommendation in 50% of the examined cases, however, this pre-post study only included 17 MCT patients (96).…”

Section: Lymph Node Assessmentmentioning

confidence: 99%

Proposed Diagnostic Criteria and Classification of Canine Mast Cell Neoplasms: A Consensus Proposal

et al. 2021

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Mast cell neoplasms are one of the most frequently diagnosed malignancies in dogs. The clinical picture, course, and prognosis vary substantially among patients, depending on the anatomic site, grade and stage of the disease. The most frequently involved organ is the skin, followed by hematopoietic organs (lymph nodes, spleen, liver, and bone marrow) and mucosal sites of the oral cavity and the gastrointestinal tract. In cutaneous mast cell tumors, several grading and staging systems have been introduced. However, no comprehensive classification and no widely accepted diagnostic criteria have been proposed to date. To address these open issues and points we organized a Working Conference on canine mast cell neoplasms in Vienna in 2019. The outcomes of this meeting are summarized in this article. The proposed classification includes cutaneous mast cell tumors and their sub-variants defined by grading- and staging results, mucosal mast cell tumors, extracutaneous/extramucosal mast cell tumors without skin involvement, and mast cell leukemia (MCL). For each of these entities, diagnostic criteria are proposed. Moreover, we have refined grading and staging criteria for mast cell neoplasms in dogs based on consensus discussion. The criteria and classification proposed in this article should greatly facilitate diagnostic evaluation and prognostication in dogs with mast cell neoplasms and should thereby support management of these patients in daily practice and the conduct of clinical trials.

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“…But the question of which node to sample was emphasised as clinicians predicted the lymphatic drainage incorrectly in 45.8% of MCT patients (Fournier et al 2021). Number and localisation of the first draining lymph node of a tumour, the so-called sentinel lymph node (SLN) was shown to be inconsistent and different from the expected locoregional lymph nodes in up to 60% of cases (Worley 2014, Ferrari et al 2021, Fournier et al 2021.…”

Section: Introductionmentioning

confidence: 99%

Near‐infrared fluorescent image‐guided lymph node dissection compared with locoregional lymphadenectomies in dogs with mast cell tumours

Beer

Rohrer-Bley

Nolff

2022

J of Small Animal Practice

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Objectives Near‐infrared fluorescent imaging has been described for intraoperative mapping of the draining lymph nodes in human cancer and canine oral tumours. The aim of this study was to retrospectively describe the results of lymphadenectomies in dogs with mast cell tumours treated either by standard unguided locoregional lymph node dissection or near‐infrared fluorescent image‐guided lymph node dissection. Methods Medical records between 2012 and 2020 were reviewed for dogs that were presented for surgical resection of mast cell tumours with concurrent lymphadenectomy either with (near‐infrared fluorescent image‐guided lymph node dissection) or without near‐infrared fluorescence image guidance (lymph node dissection). The number and location of lymph nodes planned for surgical dissection and actually dissected nodes, presence of metastases and perioperative complications were recorded. Results Thirty‐five patients underwent near‐infrared fluorescent image‐guided lymph node dissection, and 43 lymph node dissections. The number of nodes preoperatively planned for resection were 70 and 68, respectively. Fifty‐eight of those (83%) were identified during near‐infrared fluorescent image‐guided lymph node dissection procedures, compared with 50 (74%) during lymph node dissection. near‐infrared fluorescent image‐guided lymph node dissection resulted in resection of additional fluorescent nodes not corresponding to locoregional nodes in 15 of 35 dogs. Using near‐infrared fluorescent image‐guided lymph node dissection, we identified at least one metastatic node in 68% of dogs (24 of 35) compared with 33% (14 of 43) when lymph node dissection was used without imaging. No complications related to near‐infrared fluorescent imaging were reported. Clinical Significance The present study suggests that near‐infrared imaging is a promising technique for intraoperative detection of the draining lymph nodes in dogs with mast cell tumours. Further validation of the technique is required to assess if near‐infrared fluorescent imaging can detect the true sentinel lymph node.

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Assessing the Risk of Nodal Metastases in Canine Integumentary Mast Cell Tumors: Is Sentinel Lymph Node Biopsy Always Necessary?

Cited by 22 publications

References 35 publications

Histologic grade has a higher‐weighted value than nodal status as predictor of outcome in dogs with cutaneous mast cell tumours and overtly metastatic sentinel lymph nodes

Histologic grade has a higher‐weighted value than nodal status as predictor of outcome in dogs with cutaneous mast cell tumours and overtly metastatic sentinel lymph nodes

Proposed Diagnostic Criteria and Classification of Canine Mast Cell Neoplasms: A Consensus Proposal

Near‐infrared fluorescent image‐guided lymph node dissection compared with locoregional lymphadenectomies in dogs with mast cell tumours

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