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Thomson C. Augmenting Laparoscopic Surgery with Fluorescence Imaging. Vet Clin North Am Small Anim Pract 2024; 54:671-683. [PMID: 38508967 DOI: 10.1016/j.cvsm.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Minimally invasive endoscopic surgery is growing in veterinary medicine, in large part, due to the advantages associated with reduced pain, potential for decreased complications, and increased visualization of structures through magnification and illumination. With advancing technologies, we can now improve upon natural "white light" endoscopy with fluorescence-guided imaging. Near-infrared (NIR) cameras allow for real-time, high-definition visualization of vessels, anatomic structures, and perfusion. New uses of NIR technologies during laparoscopy are continuing to grow for vascular, lymphatic, and oncologic-related techniques. Limitations exist, and future efforts need to determine optimal dosing, tissue-specific fluorophores, and veterinary-specific techniques.
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Affiliation(s)
- Chris Thomson
- Surgical Oncology, Veterinary Specialty Hospital - North County, by Ethos Veterinary Health, 2055 Montiel Road #104, San Marcos, CA 92069, USA.
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2
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Zhang Y, Han X, Luo J, Zhang Q, He X. Viscoelasticity quantification of cancerous tongue using intraoral optical coherence elastography: a preliminary study. BIOMEDICAL OPTICS EXPRESS 2024; 15:3480-3491. [PMID: 38855658 PMCID: PMC11161336 DOI: 10.1364/boe.519078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 06/11/2024]
Abstract
Quantifying the biomechanical properties of the tongue is significant for early diagnosis of tongue carcinoma. Therefore, an intraoral optical coherence elastography system based on a miniature probe was proposed here to evaluate the viscoelasticity of in vivo tongue for the first time. Results of experiments with Sprague-Dawley rats indicate that considerable elasticity diversity occurred between cancerous and normal tongues, and the corresponding ratio of their Young's modulus was evaluated to be 3.74. It is also found that, viscosity in diseased tissue is smaller than that in normal tissue. Additionally, healthy, transitional and cancerous regions in the cancerous tongue can be distinguished easily by calculating viscoelasticity characteristics. Based on this preliminary attempt, our method with advantages of noninvasive, high-resolution, high-sensitivity and real-time detection and convenient operation may have good potential to become a useful tool for tongue carcinoma assessment after further optimization.
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Affiliation(s)
- Yubao Zhang
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R., China
| | - Xiao Han
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R., China
- School of Instrument Science and Opto-Electronics Engineering, Beihang University, Beijing, P. R., China
| | - Jiahui Luo
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R., China
| | - Qin Zhang
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R., China
| | - Xingdao He
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R., China
- School of Instrument Science and Opto-Electronics Engineering, Beihang University, Beijing, P. R., China
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3
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Oblak ML, Lu HY, Ram AS, McKenna C. Comparative aspects of targeted sentinel lymph node mapping in veterinary and human medicine: opportunities for future research. Front Med (Lausanne) 2024; 11:1342456. [PMID: 38633313 PMCID: PMC11021648 DOI: 10.3389/fmed.2024.1342456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/29/2024] [Indexed: 04/19/2024] Open
Abstract
There is a significant overlap in the genetic, metabolic and epigenetic alterations between human and companion animal cancers, including those of the oral cavity, breast, bladder, skin, lungs and pancreas. In many cancer types, the identification and removal of affected lymph nodes are essential for accurate cancer management, including treatment and prognosis. Historically, lymphadenectomy and subsequent radical resection based on regional anatomy, palpation and lymph node aspirates were considered sufficient; however, modern approaches with sentinel lymph node mapping (SLN) mapping have increased the accuracy of surgical decision-making. Preoperative and intraoperative SLN mapping techniques in veterinary patients parallel those used in human medicine. While many of these techniques are highly successful, the main challenges with current methodologies are their sensitivity and specificity for the presence of cancer, which can be overcome via precision medicine and targeted SLN mapping agents. Given the large population of dogs and cats with cancer, the crossover of knowledge between species can help to deepen our understanding of many of these cancers and can be useful in evaluating new drugs and/or therapies. In this review, we discuss SLN mapping techniques in veterinary medicine and the concept of precision medicine as it relates to targeted SLN mapping imaging agents. The large number of companion animals affected by cancer is an underutilized resource to bridge the translational gap and we aim to provide a reference for the use of dogs and cats as a comparative model for human SLN mapping.
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Affiliation(s)
- Michelle L. Oblak
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Hui Yu Lu
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Ann S. Ram
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Charly McKenna
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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4
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Pimentel PAB, da Silva PHS, de Sena BV, Flecher MC, Cassali GD, Horta RDS. The role of lymph nodes and their drainage in canine mammary gland tumours: Systematic review. Res Vet Sci 2024; 168:105139. [PMID: 38194890 DOI: 10.1016/j.rvsc.2024.105139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/30/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
Mammary gland tumours are the most common neoplasms in intact bitches. Over the last decades, veterinary oncology has evolved in detecting and determining the lymph nodes to be removed in these patients for an accurate staging and prognosis, as well as to achieve better disease control and higher overall survival time. Our objective was to describe recent advances related to lymphatic drainage in bitches with mammary gland tumours, focusing on surgery, diagnosis, and prognosis. Through a systematic review using PubMed as the database, a thorough multi-step search reduced 316 studies to 30 for analysis. Vital dyes appear to be crucial in reducing the overall surgery time through transoperative staining of the lymph nodes. Imaging contrasts provide information regarding specific tumour drainage; however, there is still little evidence for their use. The axillary and superficial inguinal lymph nodes are well-established as regional lymph nodes of the cranial and caudal mammary glands. In sequence, accessory axillary, medial iliac, popliteal, and sternal lymph nodes should receive attention if they demonstrate contrast drainage, even considering that the literature has not shown a relationship between drainage and metastasis in these cases. In conclusion, recent studies have provided us with more support in regional lymph node excision regarding the TNM staging system. Studies are highly heterogeneous and method comparisons do not fit due to the non-uniformity of samples, materials, and procedures. We suggest further studies with a larger sample size, complete follow-up of patients, contrast use, and lymph node morphological and immunohistochemical analysis.
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Affiliation(s)
| | | | - Bruna Voltolin de Sena
- Department of Veterinary Clinic and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Brazil
| | - Mayra Cunha Flecher
- Department of Pathology, Institute of Biology, Universidade Federal de Minas Gerais, Brazil
| | | | - Rodrigo Dos Santos Horta
- Department of Veterinary Clinic and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Brazil.
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5
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Wang T, Li H, Pu T, Yang L. Microsurgery Robots: Applications, Design, and Development. SENSORS (BASEL, SWITZERLAND) 2023; 23:8503. [PMID: 37896597 PMCID: PMC10611418 DOI: 10.3390/s23208503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Microsurgical techniques have been widely utilized in various surgical specialties, such as ophthalmology, neurosurgery, and otolaryngology, which require intricate and precise surgical tool manipulation on a small scale. In microsurgery, operations on delicate vessels or tissues require high standards in surgeons' skills. This exceptionally high requirement in skills leads to a steep learning curve and lengthy training before the surgeons can perform microsurgical procedures with quality outcomes. The microsurgery robot (MSR), which can improve surgeons' operation skills through various functions, has received extensive research attention in the past three decades. There have been many review papers summarizing the research on MSR for specific surgical specialties. However, an in-depth review of the relevant technologies used in MSR systems is limited in the literature. This review details the technical challenges in microsurgery, and systematically summarizes the key technologies in MSR with a developmental perspective from the basic structural mechanism design, to the perception and human-machine interaction methods, and further to the ability in achieving a certain level of autonomy. By presenting and comparing the methods and technologies in this cutting-edge research, this paper aims to provide readers with a comprehensive understanding of the current state of MSR research and identify potential directions for future development in MSR.
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Affiliation(s)
- Tiexin Wang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
| | - Haoyu Li
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Tanhong Pu
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Liangjing Yang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
- Department of Mechanical Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
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Annoni M, Borgonovo S, Aralla M. Sentinel lymph node mapping in canine mast cell tumours using a preoperative radiographic indirect lymphography: Technique description and results in 138 cases. Vet Comp Oncol 2023; 21:469-481. [PMID: 37191042 DOI: 10.1111/vco.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
Several sentinel lymph node (SLN) mapping techniques, to detect nodal metastasis in canine tumours have been investigated in the last 10 years in veterinary oncology. The purpose of this prospective study was to describe a reliable, quick, and inexpensive technique for SLN mapping in canine patients affected by cutaneous and subcutaneous mast cell tumours (MCT). Eighty dogs were enrolled in this study for a total of 138 cytologically diagnosed MCTs. Sentinel lymph node mapping was performed by injecting iomeprole peritumorally followed by serial radiographs at 1, 3, 6 and 9-min post injection. A total of 168 SLNs were detected, 90% at first radiograph, 1 min after the peritumoral iomeprole injection, while in the rest of the cases SLN was identified at 3 min. Sentinel lymph nodes detected by the preoperative radiographic indirect lymphography with iomeprole (PRILI) differed from regional lymph nodes in 57% of cases. The PRILI technique detected simultaneously multiple SLNs in the 26% of cases and multiple lymph centers in the 31% of MCTs. To allow the surgical identification of the SLNs, a peritumoral injection of methylene blue was performed at the time of surgery. This study reports a widely available technique for SLN mapping using digital radiographs in combination with a water-soluble medium, representing a cost-effective alternative to other SLN mapping procedures. Based on our results, this technique can be effective for SLNs mapping in dogs with MCTs but further comparative studies are needed to assess its reliability and efficacy in different tumours.
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Affiliation(s)
- Maurizio Annoni
- Department of Soft Tissue and Oncologic Surgery, AniCura Clinica Veterinaria Tibaldi, Milan, Italy
| | - Simone Borgonovo
- Department of Diagnostic Imaging, AniCura Clinica Veterinaria Tibaldi, Milan, Italy
| | - Marina Aralla
- Department of Oncology, Pronto Soccorso Veterinario Laudense, Lodi, Milan, Italy
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7
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Griffin LR, Frank C, Rao S, Seguin B. Lymphotropic nanoparticle magnetic resonance imaging for diagnosing metastatic lymph nodes in dogs with malignant head and neck tumours. Vet Comp Oncol 2023; 21:427-436. [PMID: 37186437 DOI: 10.1111/vco.12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
Lymphotropic nanoparticle magnetic resonance imaging (LNMRI) utilises ultrasmall paramagnetic iron nanoparticles (USPIOs) for imaging of metastatic lymph nodes in patients afflicted with cancer. LNMRI has been shown to be a highly effective and accurate way to diagnose metastasis in humans but has not been commonly reported on in veterinary medicine. USPIOs are phagocytised by macrophages and then localised to lymph nodes where they create a susceptibility artefact on gradient echo MRI sequences. In this study dogs (n = 24) with naturally occurring head and neck tumours were imaged with LNMRI then had mandibular and retropharyngeal lymph nodes extirpated for histological analysis. Subjective and objective analysis of the LNMRI images was performed and imaging results compared to histology as the gold standard. A total of 149 lymph nodes were included in this study. The overall sensitivity, specificity and accuracy was 64%, 94.4% and 89.3% respectively. However, if dogs with mast cell tumours were excluded from analysis the sensitivity, specificity and accuracy rose to 85.7%, 95.7% and 94.6%. LNMRI is potentially an accurate way to determine the presence of lymph node metastasis in dogs with some types of head and neck tumours. However, LNMRI has only moderate accuracy in dogs with oral or mucocutaneous mast cell tumours in this region.
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Affiliation(s)
- Lynn R Griffin
- Environmental and Radiological Health Science Department, Colorado State Univeristy, Fort Collins, Colorado, USA
| | - Chad Frank
- Microbiology, Immunology and Pathology Department, Colorado State University, Fort Collins, Colorado, USA
| | - Sangeeta Rao
- Animal Population Health Institute and Clinical Sciences Department, Colorado State University, Veterinary Teaching Hospital, Fort Collins, Colorado, USA
| | - Bernard Seguin
- Clinical Sciences Department and Flint Animal Cancer Center, Colorado State University, Veterinary Teaching Hospital, Fort Collins, Colorado, USA
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8
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Kuvaldina AB, Buote N, Campoy L, Porter I, Hayes GM. Development of a minimally invasive endoscopic technique for excisional biopsy of the axillary lymph nodes in dogs. Vet Surg 2023; 52:888-896. [PMID: 36281637 DOI: 10.1111/vsu.13901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/31/2022] [Accepted: 09/01/2022] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To develop and describe a minimally invasive technique for excisional biopsy of the axillary lymph nodes in dogs. STUDY DESIGN Descriptive cadaver and clinical case series. ANIMALS Four canine cadavers and three clinical patients. METHODS A 3D computed tomographic reconstruction of the canine axilla was used to identify an optimal avenue of approach to the lymph nodes. This approach was refined using endoscopic techniques in four cadavers (six procedures) and potential surgical hazards, landmarks, and the surgical time required for excisional biopsy of the nodes was recorded. The procedure was then performed in three clinical cases. RESULTS Axillary lymph node removal was achieved using an endoscopic technique with surgical times of 58 and 35 minutes in two of three clinical cases. The third case required conversion to an open approach after endoscopic identification of the node. No major complications were encountered. CONCLUSION Excisional biopsy of the axillary lymph nodes can be performed successfully using a minimally invasive technique in the dog. Further investigation in clinical cases is needed to determine the risks and complications of this procedure. CLINICAL SIGNIFICANCE Minimally invasive excisional biopsy of the axillary lymph nodes in dogs can be performed and may have a role in assisting with staging and local disease control in oncologic cases.
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Affiliation(s)
| | - Nicole Buote
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Luis Campoy
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Ian Porter
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Galina M Hayes
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
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Gariboldi EM, Ubiali A, Chiti LE, Ferrari R, De Zani D, Zani DD, Grieco V, Giudice C, Recordati C, Stefanello D, Auletta L. Evaluation of Surgical Aid of Methylene Blue in Addition to Intraoperative Gamma Probe for Sentinel Lymph Node Extirpation in 116 Canine Mast Cell Tumors (2017-2022). Animals (Basel) 2023; 13:1854. [PMID: 37889797 PMCID: PMC10251889 DOI: 10.3390/ani13111854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 10/29/2023] Open
Abstract
Methylene Blue (MB) is combined with radiopharmaceutical for intraoperative sentinel lymph node (SLN) mapping, but its role during SLN extirpation has not been investigated yet in veterinary medicine. The aim of this study was to assess whether MB increased surgical detection of SLN beyond the use of intraoperative gamma-probe (IGP) alone in clinically node-negative dogs with mast cell tumors (MCTs) following the detection of sentinel lymphocentrums (SLCs) via preoperative planar lymphoscintigraphy. Dogs enrolled underwent MCT excision and SLC exploration guided by both MB and IGP. Data recorded for each SLN were staining (blue/non-blue), radioactivity (hot/non-hot), and histopathological status (HN0-1 vs. HN2-3). A total of 103 dogs bearing 80 cutaneous, 35 subcutaneous, and 1 mucocutaneous MCTs were included; 140 SLCs were explored, for a total of 196 SLNs removed. Associating MB with IGP raised the SLNs detection rate from 90% to 95%. A total of 44% of SLNs were metastatic: 86% were blue/hot, 7% were only blue, 5% were only hot, and 2% were non-blue/non-hot. All HN3 SLNs were hot. Combining MB with IGP can increase the rate of SLN detection in dogs with MCTs; nonetheless, all lymph nodes identified during dissection should be removed, as they might be unstained but metastatic.
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Affiliation(s)
- Elisa Maria Gariboldi
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Alessandra Ubiali
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Lavinia Elena Chiti
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
- Clinic for Small Animals Surgery, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
| | - Roberta Ferrari
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Donatella De Zani
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Davide Danilo Zani
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Valeria Grieco
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Chiara Giudice
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Camilla Recordati
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Damiano Stefanello
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Luigi Auletta
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
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Alvarez-Sanchez A, Townsend KL, Newsom L, Milovancev M, Gorman E, Russell DS. Comparison of indirect computed tomographic lymphography and near-infrared fluorescence sentinel lymph node mapping for integumentary canine mast cell tumors. Vet Surg 2023; 52:416-427. [PMID: 36574349 DOI: 10.1111/vsu.13929] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 11/18/2022] [Accepted: 12/03/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare the independent and combined use of indirect computed tomographic lymphography (ICTL) and near-infrared fluorescence (NIRF) for sentinel lymph node (SLN) mapping in dogs with integumentary mast cell tumors (MCT) and report the metastatic LN rate. STUDY DESIGN Prospective clinical study. ANIMALS Twenty client-owned dogs. METHODS Dogs underwent preoperative ICTL, then intraoperative NIRF SLN mapping and excision of the anatomic lymph node (ALN) and/or SLN, and primary MCT. Technique agreement was complete if the same SLN was detected, and partial if the same SLN was detected along with additional SLN. No agreement occurred if the techniques detected different or no SLN. MCT were graded using two- and three-tier schemes, and LN were graded from HN0-3; HN2-3 were considered metastatic. RESULTS Complete, partial, and no agreement between ICTL and NIRF was seen in 8/20 (40%), 8/20 (40%), and 4/20 (20%) dogs, respectively. Detection of ICTL-SLN and NIRF-SLN failed in 1/20 (5%) and 4/20 (20%), respectively. Tumors were grade II/low-grade in 19/20 (95%) and grade III/high-grade in 1/20 (5%) dogs. Nineteen out of 20 (95%) dogs had HN2-3 LN. CONCLUSIONS Technique agreement of at least one SLN was seen in 16/20 (80%) dogs. Although most MCT were classified as intermediate to low grade, LN metastases were commonly detected. CLINICAL SIGNIFICANCE Combining ICTL and NIRF for MCT SLN mapping yields high SLN detection rates. Lymph node metastasis may be more common than previously reported for intermediate to low grade MCT.
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Affiliation(s)
- Alejandro Alvarez-Sanchez
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| | - Katy L Townsend
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| | - Lauren Newsom
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| | - Milan Milovancev
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
- Summit Veterinary Referral Center, Tacoma, Washington, USA
| | - Elena Gorman
- Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| | - Duncan S Russell
- Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
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11
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Goldschmidt S, Stewart N, Ober C, Bell C, Wolf-Ringwall A, Kent M, Lawrence J. Contrast-enhanced and indirect computed tomography lymphangiography accurately identifies the cervical lymphocenter at risk for metastasis in pet dogs with spontaneously occurring oral neoplasia. PLoS One 2023; 18:e0282500. [PMID: 36862650 PMCID: PMC9980747 DOI: 10.1371/journal.pone.0282500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
For dogs with oral tumors, cervical lymph node (LN) metastasis alters treatment and prognosis. It is therefore prudent to make an accurate determination of the clinical presence (cN+ neck) or absence (cN0 neck) of metastasis prior to treatment. Currently, surgical LN extirpation with histopathology is the gold standard for a diagnosis of metastasis. Yet, recommendations to perform elective neck dissection (END) for staging are rare due to morbidity. Sentinel lymph node (SLN) mapping with indirect computed tomography lymphangiography (ICTL) followed by targeted biopsy (SLNB) is an alternative option to END. In this prospective study, SLN mapping followed by bilateral END of all mandibular LNs (MLNs) and medial retropharyngeal LNs (MRLNs) was performed in 39 dogs with spontaneously occurring oral neoplasia. A SLN was identified by ICTL in 38 (97%) dogs. Lymphatic drainage patterns were variable although most often the SLN was identified as a single ipsilateral MLN. In the 13 dogs (33%) with histopathologically confirmed LN metastasis, ICTL correctly identified the draining lymphocentrum in all (100%). Metastasis was confined to the SLN in 11 dogs (85%); 2 dogs (15%) had metastasis beyond the SLN ipsilaterally. Contrast enhanced CT features had good accuracy in predicting metastasis, with short axis measurements less than 10.5 mm most predictive. ICTL imaging features alone were unable to predict metastasis. Cytologic or histopathologic SLN sampling is recommended prior to treatment to inform clinical decision-making. This is the largest study to show potential clinical utility of minimally invasive ICTL for cervical LN evaluation in canine oral tumors.
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Affiliation(s)
- Stephanie Goldschmidt
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, United States of America
- * E-mail:
| | | | - Christopher Ober
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, United States of America
| | - Cynthia Bell
- Specialty Oral pathology for Animals, Geneseo, Illinois, United States of America
| | - Amber Wolf-Ringwall
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, United States of America
| | - Michael Kent
- Department of Surgical and Radiologic Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America
| | - Jessica Lawrence
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, United States of America
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12
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Treggiari E, Pellin MA, Romanelli G, Maresca G, Gramer I, Yale AD, Pecceu E, Pignanelli M, Borrego J, Purzycka K, Berlato D. Tonsillar carcinoma in dogs: Treatment outcome and potential prognostic factors in 123 cases. J Vet Intern Med 2023; 37:247-257. [PMID: 36705533 PMCID: PMC9889721 DOI: 10.1111/jvim.16623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 12/16/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Tonsillar carcinomas are rarely reported in dogs. Information on outcome after treatment is sparse and prognosis is guarded to poor. HYPOTHESIS/OBJECTIVES Assess treatment outcome and potential prognostic factors in a population of dogs with cytological or histopathological diagnosis of tonsillar carcinoma. ANIMALS A total of 123 client-owned dogs with diagnosis of tonsillar carcinoma confirmed by cytology or histopathology. METHODS Retrospective, multi-institutional study. Medical records of 12 institutions were reviewed from 2012 to 2021. RESULTS Treatment included surgery, chemotherapy (conventional, tyrosine kinase inhibitors or metronomic chemotherapy), radiotherapy, nonsteroidal anti-inflammatory drugs (NSAIDs) or a combination of these. Surgery was performed in 68 cases, chemotherapy was administered in association with NSAIDs in 64 cases, NSAIDs were used alone in 14 cases and in association with surgery in 21 cases, whereas radiotherapy was used alone or in combination with surgery or chemotherapy in 20 cases. Overall survival time (OST) was 126 days (95% confidence interval [CI], 88-164). Significantly longer survival (P < .001) was seen in dogs without evidence of metastatic disease (median survival time, 381 days; 95% CI, 116-646). Other significant positive prognostic factors included absence of clinicals signs at presentation, surgery (tonsillectomy), use of adjuvant chemotherapy and use of NSAIDs. CONCLUSION AND CLINICAL IMPORTANCE Asymptomatic dogs, those treated with surgery, those that received adjuvant chemotherapy, and those that received NSAIDs may have a better prognosis than previously expected, but overall survival remains short for dogs with tonsillar carcinoma.
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Affiliation(s)
| | | | | | | | - Irina Gramer
- Queen Mother Hospital for AnimalsRoyal Veterinary CollegeHertfordshireUK,Davies Veterinary SpecialistsHigham GobionHitchinUK
| | - Andrew D. Yale
- Queen Mother Hospital for AnimalsRoyal Veterinary CollegeHertfordshireUK
| | - Evi Pecceu
- Royal Dick School, Swann Cancer CenterUniversity of EdinburghEdinburghUK,Present address:
Dierenartsencentrum Hond en KatDeinzeBelgium
| | | | - Juan Borrego
- Aùna Especialidades VeterinariasPaternaValenciaSpain
| | - Katarzyna Purzycka
- Anderson and Moores Veterinary SpecialistsWinchesterUK,Present address:
Lumbry Park Veterinary SpecialistsHampshireUK
| | - Davide Berlato
- Dick White Specialists ReferralsSix Mile BottomCambridgeshireUK,Present address:
Animal Oncology and Imaging CenterHunenbergCHSwitzerland
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13
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Ferraris EI, Olimpo M, Giacobino D, Manassero L, Iussich S, Lardone E, Camerino M, Buracco P, Morello EM. Sentinel lymph node mapping with computed tomography lymphography for mast cell tumours and a comparison between regional and sentinel lymph node histological status: Sixty-two cases. Vet Comp Oncol 2023; 21:208-220. [PMID: 36635868 DOI: 10.1111/vco.12878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/14/2023]
Abstract
It is known that the regional lymph node (RLN) may not correspond to the sentinel lymph node (SLN) (the first lymph node draining the tumour), and many diagnostic techniques have recently been aimed at its detection. Although lymphoscintigraphy is the gold standard in both human and veterinary medicine for SLN mapping, it is relatively unavailable in veterinary medicine due to costs and difficult management of the radiotracer. This prospective study evaluated, as a first aim, the feasibility and sensitivity of the computed tomography lymphography (CTL) in detecting the SLN in 62 mast cell tumours (MCTs). The second aim was to evaluate the accuracy of the CTL in identifying the most representative lymph node of the patient's lymphatic status; the histological status of the SNL was compared with that of the RLN, to see in how many cases the patient's stage would have changed according to the RLN. When the RLN turned out to be also the SLN it was decided to excise, as a control LN, the one localised in the neighbourhood of the MCT (neighbouring lymph node; NLN). The detection rate was 90%, with failure of SLN identification in six cases. In 18 (32%) of 56 MCTs with a diagnostic CTL, the SLN did not correspond to the RLN. Forty-five MCTs were surgically removed, together with their corresponding SLN and RLN/NLN. Since the clinical stage of the patient would have changed in only 7% of cases, CTL is a reliable method of detecting the SLN and, for staging purposes, there is no need to remove other LNs.
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Affiliation(s)
| | - Matteo Olimpo
- Department of Veterinary Sciences, University of Torino, Turin, Italy
| | - Davide Giacobino
- Department of Veterinary Sciences, University of Torino, Turin, Italy
| | - Luca Manassero
- Department of Veterinary Sciences, University of Torino, Turin, Italy
| | - Selina Iussich
- Department of Veterinary Sciences, University of Torino, Turin, Italy
| | - Elena Lardone
- Department of Veterinary Sciences, University of Torino, Turin, Italy
| | | | - Paolo Buracco
- Department of Veterinary Sciences, University of Torino, Turin, Italy
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14
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Chiti LE, Husi B, Park B, Beer P, D'Orchymont F, Holland JP, Nolff MC. Performance of two clinical fluorescence imaging systems with different targeted and non-targeted near-infrared fluorophores: a cadaveric explorative study. Front Vet Sci 2023; 10:1091842. [PMID: 37138917 PMCID: PMC10149874 DOI: 10.3389/fvets.2023.1091842] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Near-infrared (NIR) fluorescence-guided surgery is increasingly utilized in humans and pets. As clinical imaging systems are optimized for Indocyanine green (ICG) detection, the usage of targeted dyes necessitates the validation of these systems for each dye. We investigated the impact of skin pigmentation and tissue overlay on the sensitivity of two NIR cameras (IC-FlowTM, VisionsenseTM VS3 Iridum) for the detection of non-targeted (ICG, IRDye800) and targeted (AngiostampTM, FAP-Cyan) NIR fluorophores in an ex vivo big animal model. Methods We quantitatively measured the limit of detection (LOD) and signal-to-background ratio (SBR) and implemented a semi-quantitative visual score to account for subjective interpretation of images by the surgeon. Results VisionsenseTM VS3 Iridum outperformed IC-FlowTM in terms of LOD and SBR for the detection of all dyes except FAP-Cyan. Median SBR was negatively affected by skin pigmentation and tissue overlay with both camera systems. Level of agreement between quantitative and semi-quantitative visual score and interobserver agreement were better with VisionsenseTM VS3 Iridum. Conclusion The overlay of different tissue types and skin pigmentation may negatively affect the ability of the two tested camera systems to identify nanomolar concentrations of targeted-fluorescent dyes and should be considered when planning surgical applications.
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Affiliation(s)
- Lavinia E. Chiti
- Klinik für Kleintierchirurgie, Vetsuisse-Fakultät, University of Zurich, Zurich, Switzerland
- *Correspondence: Lavinia E. Chiti
| | - Benjamin Husi
- Klinik für Kleintierchirurgie, Vetsuisse-Fakultät, University of Zurich, Zurich, Switzerland
| | - Brian Park
- Klinik für Kleintierchirurgie, Vetsuisse-Fakultät, University of Zurich, Zurich, Switzerland
| | - Patricia Beer
- Klinik für Kleintierchirurgie, Vetsuisse-Fakultät, University of Zurich, Zurich, Switzerland
| | | | - Jason P. Holland
- Department of Chemistry, University of Zurich, Zurich, Switzerland
| | - Mirja C. Nolff
- Klinik für Kleintierchirurgie, Vetsuisse-Fakultät, University of Zurich, Zurich, Switzerland
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15
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Chiti LE, Gariboldi EM, Stefanello D, De Zani D, Grieco V, Nolff MC. Sentinel Lymph Node Mapping and Biopsy in Cats with Solid Malignancies: An Explorative Study. Animals (Basel) 2022; 12:3116. [PMID: 36428344 PMCID: PMC9686746 DOI: 10.3390/ani12223116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
There is increasing evidence on the utility of sentinel lymph node (SLN) biopsy (SLNB) for the staging of dogs with various malignancies; however, comparable information is missing in cats. This multi-institutional study aims at reporting the feasibility and detection rate of SLNB guided by lymphoscintigraphy and the blue dye or near-infrared fluorescent lymphography (NIRF-L) in cats with solid tumors. In total, 12 cats presented with 14 solid malignancies that underwent curative-intent surgical excision of the primary tumor and SLNB were retrospectively enrolled. The mapping technique used, location and number of SLN, correspondence with the regional lymph node (RLN), and histological status of the SLN were retrieved. The detection rate and complications of SLNB were also recorded. NIRF-L was performed in 64.3% of tumors and lymphoscintigraphy in 35.7%. The detection rate was 100% for both techniques. The SLN did not correspond (fully or partially) to the RLN in 71.4% of cases, with multiple SLN being excised in 9/14 tumors. No complications related to SLNB were recorded. At histopathology, metastases were identified in 41.7% of cats, all with mast cell tumors (MCT). SLNB guided by NIRF-L or lymphoscintigraphy is feasible and safe in cats with solid tumors and should be suggested for correct tumor staging in cats, especially with MCT.
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Affiliation(s)
- Lavinia Elena Chiti
- Clinic for Smal Animals Surgery, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
| | - Elisa Maria Gariboldi
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Damiano Stefanello
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Donatella De Zani
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Valeria Grieco
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Mirja Christine Nolff
- Clinic for Smal Animals Surgery, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
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16
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Sentinel Lymph Node Biopsy Is Feasible in Dogs with Scars from Prior Local Excision of Solid Malignancies. Animals (Basel) 2022; 12:ani12172195. [PMID: 36077914 PMCID: PMC9454906 DOI: 10.3390/ani12172195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Sentinel lymph node (SLN) excision is gaining relevance in the management of various canine malignancies due to its recognized impact on staging and treatment choices. However, the technologies to perform SLN mapping are only available to a few referral centers, and there is increasing demand for secondary nodal staging after prior tumor excision at the primary care institution. This retrospective study investigated the feasibility and usefulness of SLN biopsy in dogs with surgical scars resulting from the removal of various solid tumors referred for further staging and/or adjuvant treatment options. Thirty-three dogs with 34 scars underwent SLN biopsy at a median of 50 days after primary tumor excision. An SLN was identified for 31/34 scars, translating to a detection rate of 91.2%. Metastases were identified with histopathology in 13/31 dogs (41.9%) and they all had an excision of a mast cell tumor. SLN biopsy should be suggested in dogs presenting with scars from prior solid tumor excision, considering the observed detection rate and the importance of knowing the metastatic status of the SLN in oncological diseases. Abstract Sentinel lymph node (SLN) biopsy is a well-established staging tool in canine oncology. This study aims to explore the feasibility of SLN biopsy in dogs with scars from prior excised solid malignancies that were referred for further tumor staging and/or adjuvant treatment options. Mapping was either performed using radiopharmaceutical, methylene blue, and/or near-infrared fluorescent (NIRF) imaging. Thirty-three dogs with 34 scars from prior excision of the mast cell tumor (MCT) (n = 29), soft tissue sarcoma (n = 2), oral melanoma (n = 1), subungual melanoma (n = 1), and mammary adenocarcinoma (n = 1) were retrospectively enrolled. Primary treatment consisted of curative intent/wide tumor excisions in 50.0% of dogs and marginal excision in the remaining 50.0%. The median time between tumor excision and SLN biopsy was 50 days (range 17–110 days). The procedure was successful in 31/34 scars, translating to a detection rate of 91.2%. The SLN did not correspond to the regional lymph node in 19/31 scars (61.3%). SLN metastases were histologically identified in 13/31 (41.9%) dogs, all of them affected by MCT. Based on our results, SLN biopsy using lymphoscintigraphy/methylene blue and/or NIRF is feasible in dogs presenting with scars from the prior surgical excision of solid tumors, and should be suggested for accurate nodal staging.
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17
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Beer P, Rohrer-Bley C, Nolff MC. Near-infrared fluorescent image-guided lymph node dissection compared with locoregional lymphadenectomies in dogs with mast cell tumours. J Small Anim Pract 2022; 63:670-678. [PMID: 35815663 PMCID: PMC9542114 DOI: 10.1111/jsap.13529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 03/03/2022] [Accepted: 05/25/2022] [Indexed: 12/21/2022]
Abstract
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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Affiliation(s)
- P Beer
- Vetsuisse Faculty, Clinic for Small Animal Surgery, University of Zurich, Zurich, 8057, Switzerland
| | - C Rohrer-Bley
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, 8057, Switzerland
| | - M C Nolff
- Vetsuisse Faculty, Clinic for Small Animal Surgery, University of Zurich, Zurich, 8057, Switzerland
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18
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Cervical lymph node staging in head and neck tumors: bridging the gap between humans and companion animals. Eur J Nucl Med Mol Imaging 2022; 49:3306-3308. [PMID: 35511279 DOI: 10.1007/s00259-022-05829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Bertran J, Thomson AC. Current Concepts in Head and Neck Surgery. Vet Clin North Am Small Anim Pract 2022; 52:489-512. [DOI: 10.1016/j.cvsm.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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Arz R, Seehusen F, Meier VS, Nolff MC. Indocyanine-based near-infrared lymphography for real-time detection of lymphatics in a cat with multiple mast cell tumours. JFMS Open Rep 2022; 8:20551169221074961. [PMID: 35251677 PMCID: PMC8891856 DOI: 10.1177/20551169221074961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Case summary An 11-year-old female domestic shorthair cat was presented with cutaneous mast cell tumours (MCTs) localised at the right temporal region, the left buccal region and on the third digit of the right thoracic limb. Staging was negative and locoregional lymph nodes appeared normal, based on clinical findings. During surgery, real-time indocyanine green (ICG)-based lymphography was performed to detect the cutaneous draining pattern of all the primary MCTs. ICG was injected intracutaneously in four quadrants around each tumour, and a clear lymphogram was visible shortly after injection. Using near-infrared lymphography (NIR-L) for guidance, all lymphadenectomies were performed in 12 mins or less, with a maximal incision length of 3.5 cm. The smallest resected node was 0.9 cm in diameter. All MCTs were classified as low-grade cutaneous MCT. All four ICG-positive lymph nodes were considered premetastatic or metastatic. The only ICG-negative resected node was also negative for tumour cells. No complications related to NIR-L were recorded. Relevance and novel information This is the first description of NIR-L in a cat with MCT. Application was straightforward and ICG enrichment only occurred in the metastatic nodes, suggesting correct identification of lymphatic draining patterns. Of note, as previously described in dogs, we did detect nodal metastasis, despite low-grade primary tumours. The clinical relevance should be evaluated in future studies.
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Affiliation(s)
- Raphael Arz
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Frauke Seehusen
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Valeria S Meier
- Clinic for Oncology and Radiation Oncology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Switzerland
- Department of Physics, University of Zurich, Switzerland
| | - Mirja C Nolff
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Switzerland
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21
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Guerra D, Faroni E, Sabattini S, Agnoli C, Chalfon C, Stefanello D, Del Magno S, Cola V, Grieco V, Marconato L. Histologic grade has a higher-weighted value than nodal status as predictor of outcome in dogs with cutaneous mast cell tumors and overtly metastatic sentinel lymph nodes. Vet Comp Oncol 2022; 20:551-558. [PMID: 35195937 DOI: 10.1111/vco.12806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
Abstract
In canine cutaneous mast cell tumors (cMCTs), histologic grade and clinical stage are the most important prognostic factors, with high-grade tumors 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 tumor 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<0.001), as well as tumor-specific survival (545 days versus not reached; P<0.001). On multivariable analysis, a high histologic grade and incomplete margins retained prognostic significance for both tumor progression and tumor-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 unfavorable, even in the high-grade group, further supporting that a multimodal therapeutic approach, addressing primary tumor and sentinel LN, should be offered. Whether chemotherapy should be incorporated in the therapeutic planning of low-grade cMCTs remains to be defined. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dina Guerra
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Eugenio Faroni
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Silvia Sabattini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Chiara Agnoli
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Carmit Chalfon
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Damiano Stefanello
- Dipartimento di Medicina Veterinaria Università degli Studi di Milano, Lodi, Italy
| | - Sara Del Magno
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Veronica Cola
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Valeria Grieco
- Dipartimento di Medicina Veterinaria Università degli Studi di Milano, Lodi, Italy
| | - Laura Marconato
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
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22
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Castejón-González AC, Reiter AM. Oral and Maxillofacial Tumor Management - From Biopsy to Surgical Removal. Vet Clin North Am Small Anim Pract 2021; 52:235-270. [PMID: 34838252 DOI: 10.1016/j.cvsm.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The main objective of oral and maxillofacial (OMF) tumor resection is to get local control of the disease. Many OMF tumors can be cured with wide or radical surgery, whereas others might only achieve temporary local control of the disease by removing infection and the source of pain, thereby improving the quality of life of the patient while keeping masticatory function. The standard of care on managing OMF tumors includes the diagnosis and identification of the local and distant extension of the disease to establish an appropriate treatment plan tailored for each patient. In this article, we provide a practical review of the current information related to staging, biopsy, and main surgical techniques for OMF tumor removal.
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Affiliation(s)
- Ana C Castejón-González
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104, USA
| | - Alexander M Reiter
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104, USA.
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23
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Ram AS, Matuszewska K, Petrik J, Singh A, Oblak ML. Quantitative and Semi-quantitative Methods for Assessing the Degree of Methylene Blue Staining in Sentinel Lymph Nodes in Dogs. Front Vet Sci 2021; 8:758295. [PMID: 34746290 PMCID: PMC8567073 DOI: 10.3389/fvets.2021.758295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/22/2021] [Indexed: 11/27/2022] Open
Abstract
Background: To develop a digital algorithm for quantitative assessment of surface methylene blue staining in whole lymph nodes and validate a semi-quantitative visual scoring method for patient-side use. Methods: Lymph nodes from canine patients with spontaneous tumors undergoing sentinel lymph node mapping were prospectively assessed ex vivo and photographed. Using an open-source computer-based imaging software, an algorithm was developed for quantification of staining based on a signal-to-background ratio. Next, two blinded observers evaluated images and assigned a semi-quantitative visual score based on surface staining (0—no blue stain, 1−1–50% stained, and 2−51–100% stained) and those results were compared to the established quantitative standard. Results: Forty-three lymph nodes were included. Image analysis successfully quantified blue staining and differentiated from normal lymph node tissue in all cases. Agreement between observers using the Kappa coefficient demonstrated strong agreement (k = 0.8581, p < 0.0001) between semi-quantitative visual scoring and image analysis. There was substantial interobserver and intraobserver agreement for the scoring system (k = 0.7340, p < 0.0001 and k = 0.8983, p < 0.0001, respectively). Conclusion: A digital algorithm using an open-source software was simple and straightforward to use for quantification of blue staining. The use of a semi-quantitative visual scoring system shows promise for a simple, objective, repeatable assessment of methylene blue staining at the time of surgery. This study demonstrates reliable and repeatable methods for blue staining quantification thereby providing a novel and objective reporting mechanism in scientific research involving sentinel lymph node mapping.
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Affiliation(s)
- Ann S Ram
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.,Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Kathy Matuszewska
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Jim Petrik
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Michelle L Oblak
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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24
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Bae S, Townsend KL, Milovancev M. Location of the targeted lymph node in a mandibular lymphocentrum: A needle aspiration model in canine cadavers. Vet Comp Oncol 2021; 19:671-677. [PMID: 34240790 DOI: 10.1111/vco.12750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 01/03/2023]
Abstract
Accurate tumour staging has a profound impact on the care and prognosis of oncologic patients. Due to the presence of multiple lymph nodes (LNs) in the mandibular lymphocentrum, clinicians may not know which specific LN they are sampling during routine fine needle aspirations, which introduces a source of uncertainty in accurately determining patient clinical stage. The objective of this cadaveric study was to determine the success of targeting specific mandibular LNs by palpation alone, verified by computed tomography (CT). A 1.5-inch, 22-gauge needle was inserted into the targeted LN (selected by drawing with the equal sample sizes of the left/right mandibular lymphocentrum and the lateral/medial node) and success was evaluated by CT images in transverse, sagittal and dorsal views. The overall success rate of inserting the needle into the targeted LN was 55.9%. One variable was significantly associated with successful needle insertion: lateral (vs. medial) LN location (p = .019). In addition, the distance from the LN to the ventral skin surface in the successful group appeared to be shorter compared to the unsuccessful group (3.37 mm [1.55-6.46] vs. 4.9 mm [1.57-17.79], p = .066). These findings suggest that physical accessibility of the LN is the most important factor for successful needle insertion using palpation. Palpation-based sampling of specific mandibular LNs is often inaccurate and if targeted sampling of a particular LN is required, additional methods should be used to guide accurate sample acquisition.
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Affiliation(s)
- Sohee Bae
- Carlson College of Veterinary Medicine, Department of Clinical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Katy L Townsend
- Carlson College of Veterinary Medicine, Department of Clinical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Milan Milovancev
- Carlson College of Veterinary Medicine, Department of Clinical Sciences, Oregon State University, Corvallis, Oregon, USA
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