1
|
Chiti LE, Gariboldi EM, Ferrari R, Luconi E, Boracchi P, De Zani D, Zani D, Manfredi M, Spediacci C, Grieco V, Giudice C, Recordati C, Ferrari F, Stefanello D. Surgical complications following sentinel lymph node biopsy guided by γ-probe and methylene blue in 113 tumour-bearing dogs. Vet Comp Oncol 2023; 21:62-72. [PMID: 36178370 DOI: 10.1111/vco.12861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/22/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022]
Abstract
Sentinel lymph node biopsy (SLNB) is an accepted veterinary surgical procedure given the impact of early detection of nodal metastases on staging of several canine malignancies. This study aims at reporting the incidence and risk factors for surgical complications of SLNB in tumour-bearing dogs. A total of 113 client-owned dogs that underwent tumour excision and SLNB guided by γ-probing and blue dye were retrospectively enrolled. Recorded variables included: signalment, location and number of extirpated lymphocenters and nodes, time for SLNB, histopathological status of excised nodes. Incidence of SLNB complications was calculated. They were classified as minor and major based on severity and required treatment, and as short-term (0-30 days) and long-term (31-90 days). Univariate analysis with generalized linear model with binomial error estimated the association between variables and incidence of SLNB complications. Significance was set at 5%. Median overall time for SLNB was 25 min. Surgeons excised one node in 38% of dogs and multiple nodes in 62% of cases, belonging to one (62%) or multiple (38%) lymphocenters. Metastases were detected in 45% of nodes. No intraoperative complications occurred. The overall incidence of postoperative complications of SLNB was 21,24%, the majority of which (91.67%) were minor. Only increasing dogs' weight was associated with an increased incidence of SLNB complications (p = .00976). Sentinel lymphadenectomy was associated with a relatively low incidence of complications, most of which were self-limiting. The low morbidity and previously reported impact on staging of SLNB justify its implementation to collect data for prognostic studies.
Collapse
Affiliation(s)
- Lavinia Elena Chiti
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy.,Unit of Medical Statistics, Biometry and Epidemiology,Department of Biomedical and Clinical Sciences (DIBIC) "L. Sacco", LITA Vialba Campus, Università degli Studi di Milano, Milan, Italy
| | - Elisa Maria Gariboldi
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Roberta Ferrari
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Ester Luconi
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) "L. Sacco", LITA Vialba campus, Università degli Studi di Milano, Milan, Italy
| | - Patrizia Boracchi
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) "L. Sacco" & DSRC, LITA Vialba campus, Università degli Studi di Milano, Milan, Italy
| | - Donatella De Zani
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Davide Zani
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Martina Manfredi
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Carlotta Spediacci
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Valeria Grieco
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Chiara Giudice
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Camilla Recordati
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Francesco Ferrari
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Damiano Stefanello
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| |
Collapse
|
2
|
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.
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Manfredi M, De Zani D, Chiti LE, Ferrari R, Stefanello D, Giudice C, Pettinato V, Longo M, Di Giancamillo M, Zani DD. Preoperative planar lymphoscintigraphy allows for sentinel lymph node detection in 51 dogs improving staging accuracy: Feasibility and pitfalls. Vet Radiol Ultrasound 2021; 62:602-609. [PMID: 34131982 PMCID: PMC8518895 DOI: 10.1111/vru.12995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 01/01/2023] Open
Abstract
Sentinel lymph node (SLN) mapping is the current gold standard for the oncological staging of solid malignancies in humans. This prospective observational study describes the feasibility and the limits of preoperative lymphoscintigraphy for SLN detection in dogs with spontaneous malignancies and the improvements in staging accuracy. Client‐owned dogs with confirmed malignant neoplasia and absence of distant metastasis were prospectively enrolled. Lymphoscintigraphy was performed after the peritumoral injection of Technetium‐99m labeled nanocolloids. Regional dynamic and static images were acquired, with and without masking of the injection site with a lead shield. The dogs were then subjected to surgery for tumor excision and SLN extirpation. Intraoperative SLN detection was performed by combining methylene blue dye and a dedicated gamma probe. Overall, 51 dogs with a total of 60 solid malignant tumors were enrolled. Lymphoscintigraphy identified at least one SLN in 57 of 60 cases (95%). The SLN did not always correspond to the regional lymph node (35/57, 61.4%). The use of a lead shield, masking the injection site, markedly improved the SLN visibility. The median time of SLN appearance was 11.4 ± 9.3 min. No side effects were observed. Preoperative lymphoscintigraphy allows for SLN detection in dogs and can improve staging accuracy by either identifying the SLN in a different lymphosome than clinically expected or discriminating the draining node in uncertain cases. The combined use of preoperative and intraoperative techniques is recommended to increase the SLN detection rate.
Collapse
Affiliation(s)
- Martina Manfredi
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Donatella De Zani
- Centro Clinico-Veterinario e Zootecnico-Sperimentale, Università degli Studi di Milano, Lodi, Italy
| | - Lavinia Elena Chiti
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Roberta Ferrari
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Damiano Stefanello
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Chiara Giudice
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Vincenzina Pettinato
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Maurizio Longo
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Mauro Di Giancamillo
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Davide Danilo Zani
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| |
Collapse
|