Quantitation of the Regional Lymph Node Metastatic Burden and Prognosis in Malignant Mammary Tumors of Dogs

Araújo, Marina Rios de; Campos, Leonardo; Ferreira, Ênio; Cassali, Geovanni Dantas

doi:10.1111/jvim.13576

Cited by 35 publications

(35 citation statements)

References 41 publications

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“…Metastatic regional lymph nodes are an important negative prognostic factor in dogs with mammary tumors [18][19][20]. The association between an increase in the size of intraabdominal lymph nodes verified by ultrasonography and the presence of metastasis in superficial regional lymph nodes suggests that abdominal ultrasonography can help determine the metastatic potential of the mammary tumor prior to mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Abdominal ultrasonographic findings in dogs with mammary tumors: association with tumor characteristics and survival

Silva¹,

Juliani²,

Ribeiro³

et al. 2019

Turk J Vet Anim Sci

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Abdominal ultrasound is frequently performed as part of initial staging of canine mammary tumors. The aims of this study were to describe abdominal ultrasonographic findings present at diagnosis of mammary tumors in dogs and to assess their value for associations with histopathological results and treatment outcome. The medical records of 201 female dogs diagnosed with mammary tumors that had abdominal ultrasonography performed as part of their initial clinical evaluation were reviewed. Histopathological diagnosis of malignant mammary tumors was obtained in most cases (86%; 172 cases). One hundred and fifty-seven animals (78%) had some ultrasonographic abnormality. A total of 338 ultrasonographic changes were identified, and the spleen was the organ with the highest frequency of ultrasonographic changes (20%), followed by the uterus (18%) and the liver (16%). Abdominal ultrasonography abnormalities were not associated with mammary tumor malignancy (OR = 1.7; P = 0.27). Ultrasonographic evidence of enlarged intraabdominal lymph nodes was associated with metastases in surface regional lymph nodes (P < 0.05). Dogs with regional metastasis were more likely to present some abdominal ultrasonographic change (OR = 6.1; P = 0.04). Animals with ultrasonographic evidence of intraabdominal lymph node enlargement presented shorter survival after mastectomy. Abdominal ultrasonographic abnormalities are common in dogs with mammary tumors and are not associated with malignancy. However, the presence of intraabdominal lymph node enlargement identified by ultrasound may be associated with regional metastasis and shorter survival rates.

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Section: Discussionmentioning

confidence: 99%

Abdominal ultrasonographic findings in dogs with mammary tumors: association with tumor characteristics and survival

Silva¹,

Juliani²,

Ribeiro³

et al. 2019

Turk J Vet Anim Sci

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“…To our knowledge, this is the first study to utilize increased step‐sections and panCK immunohistochemistry to identify various occult carcinoma metastases in regional lymph nodes within a veterinary cohort. In veterinary medicine, very few studies have assessed for the presence of micrometastases and isolated tumour cells in regional lymph nodes, and thus, a standardized approach for histologic and immunohistochemical evaluation and identification of small volume metastases is lacking, as is information regarding the prognostic significance of these foci.…”

Section: Discussionmentioning

confidence: 99%

“…Several large‐scale prospective studies, however, have documented significant differences in disease‐free survival, and overall survival, disease‐free survival and distant‐disease‐free‐survival in women with micrometastatic or occult metastatic lymph nodes, respectively, as compared with node‐negative patients. To our knowledge, only two studies have been conducted to evaluate the prognostic significance of regional lymph node status in dogs, both of which focused on canine mammary carcinomas . The variability in prognostic significance among these studies supports the need for future larger scale and prospective studies in veterinary medicine to both identify the presence of occult metastases in various types of carcinomas and to determine their prognostic significance with respect to recurrence and survival.…”

Section: Discussionmentioning

confidence: 99%

“…Given the growing awareness of the prognostic and therapeutic implications of micrometastases and ITC, surgical removal of normal‐sized draining lymph nodes for histologic staging is being recommended with increasing frequency . Studies assessing the presence and prognostication of micrometastases, ITC and occult metastases within sentinel and regional lymph nodes of the canine population are lacking, although adoption of this methodology has begun to surface, predominantly within mammary carcinomas, as well as canine mast cell tumours . Additionally, a standardized methodology for pathologic evaluation of low volume tumour metastasis in lymph nodes is significantly lacking both in human and veterinary medicine .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Identification of occult micrometastases and isolated tumour cells within regional lymph nodes of previously diagnosed non‐metastatic (stage 0) canine carcinomas

Casey

Steffey

Affolter

2016

Vet Comparative Oncology

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Metastatic dissemination of carcinomas to lymph nodes impacts prognosis and treatment recommendations in human and veterinary medicine. Routine histopathologic evaluation of regional lymph nodes involves haematoxylin and eosin (H&E) staining to identify intra-nodal neoplastic cells; however, identification of small volume metastases (micrometastases and individual tumour cells) may be missed without the aid of immunohistochemistry or additional step-sections. The aim of this study was to identify occult carcinoma metastases in previously diagnosed non-metastatic lymph nodes using step-sections and pancytokeratin (panCK) immunohistochemistry. Samples from 20 regional lymph nodes diagnosed as non-metastatic were serially sectioned and evaluated with panCK. Of these, 25% (n = 5) contained micrometastases (n = 1) or isolated tumour cells (n = 4). This study demonstrates the increased efficacy of serial step-sections combined with panCK immunohistochemistry to identify small volume metastases in regional lymph nodes. The prognostic significance of micrometastases and isolated tumour cells in regional lymph nodes warrants further investigation in veterinary medicine.

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“…Another example is the Framingham Heart Study, which utilized 12‐year follow‐up of >8,400 individuals to predict future cardiovascular disease based on age, smoking status, cholesterol, presence or absence of diabetes, and blood pressure 60. Predictive data such as these are increasingly available in veterinary patients across a variety of disease conditions, including neoplasia,61, 62, 63 cardiovascular disease,64, 65 and various diseases in horses66, 67 and cows 68. Incorporation of baseline risk in RCTs potentially can help estimate treatment effects in heterogeneous patient populations with greater accuracy and help clinicians select individuals that are most likely to experience treatment benefit.…”

Section: Risk: Baseline Relative and Absolutementioning

confidence: 99%

Clinical Trials in Veterinary Medicine: A New Era Brings New Challenges

Oyama

Ellenberg

Shaw

2017

Veterinary Internal Medicne

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Randomized clinical trials (RCTs) are among the most rigorous ways to determine the causal relationship between an intervention and important clinical outcome. Their use in veterinary medicine has become increasingly common, and as is often the case, with progress comes new challenges. Randomized clinical trials yield important answers, but results from these studies can be unhelpful or even misleading unless the study design and reporting are carried out with care. Herein, we offer some perspective on several emerging challenges associated with RCTs, including use of composite endpoints, the reporting of different forms of risk, analysis in the presence of missing data, and issues of reporting and safety assessment. These topics are explored in the context of previously reported veterinary internal medicine studies as well as through illustrative examples with hypothetical data sets. Moreover, many insights germane to RCTs in veterinary internal medicine can be drawn from the wealth of experience with RCTs in the human medical field. A better understanding of the issues presented here can help improve the design, interpretation, and reporting of veterinary RCTs.

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Quantitation of the Regional Lymph Node Metastatic Burden and Prognosis in Malignant Mammary Tumors of Dogs

Cited by 35 publications

References 41 publications

Abdominal ultrasonographic findings in dogs with mammary tumors: association with tumor characteristics and survival

Abdominal ultrasonographic findings in dogs with mammary tumors: association with tumor characteristics and survival

Identification of occult micrometastases and isolated tumour cells within regional lymph nodes of previously diagnosed non‐metastatic (stage 0) canine carcinomas

Clinical Trials in Veterinary Medicine: A New Era Brings New Challenges

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