Treating the locoregional lymph nodes with radiation and/or surgery significantly improves outcome in dogs with high‐grade mast cell tumours

Mendez, Susan E.; Drobatz, Kenneth J.; Duda, Lili; White, Pamela; Kubicek, Lyndsay; Sørenmo, Karin U.

doi:10.1111/vco.12541

Cited by 31 publications

(48 citation statements)

References 17 publications

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“…27,28,[44][45][46][47][48][49][50][51][52]55,60,61 Seven dogs lacked diagnostic liver cytology, therefore additional analysis was performed to exclude these dogs, which did not alter our 56 However we were consistent with current literature in the standards set forth at the start of the study. 53,56,72 Labradors were overrepresented at 45% of the canine population in this study. This is markedly higher than multiple previous reports that included 11%-27% Labradors.…”

Section: Discussionmentioning

confidence: 60%

“…Whether LN metastasis is always a negative prognostic indicator is controversial as multiple studies show a negative impact on outcome 11,12,18,39 ; however, other publications show that if treated appropriately a metastatic LN does not necessarily implicate a worse prognosis. 36,43,69 69,72 Sentinel LN mapping may therefore play a prominent role in determining more locally invasive procedures to remove additional tissue. 73 Visceral metastasis without a detectable metastasis to LNs has been reported in previous literature; therefore, not having a metastatic LN does not completely remove the need to assess liver/spleen for metastasis.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound is a poor predictor of early or overt liver or spleen metastasis in dogs with high‐risk mast cell tumours

Pecceu

Varela

Handel

et al. 2020

Vet Comparative Oncology

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Conflicting evidence exists regarding the importance of routine abdominal ultrasound (US) with hepatic and splenic fine needle aspiration (FNA) cytology during staging of canine mast cell tumours (MCT). The objective of this study was to correlate ultrasonographic and cytologic findings in dogs with strictly defined high-risk MCTs and to determine the influence on outcome. Our hypothesis was that US poorly predicts visceral metastasis in high-risk MCTs and that early metastasis is associated with improved outcome when compared to overt metastasis. US of liver and spleen correlated to cytologic results, categorized as no metastasis, early metastasis or overt metastasis. Of 82 dogs prospectively enrolled, 18% had early visceral metastasis and 7% had overt metastasis on cytology; 67% with visceral metastasis had regional LN metastasis. US was a poor predictor of metastasis with sensitivity, specificity, positive predictive value and negative predictive value for the spleen of 67%, 68%, 21% and 94%, respectively and for the liver of 29%, 93%, 56% and 82%, respectively. Median time to progression (TTP) for dogs with no metastasis, early metastasis and overt metastasis was not reached, 305 and 69 days, respectively (P < .001). Median survival time (MST) for the 3 groups were not reached, 322 and 81 days, respectively (P < .001). High Patnaik or Kiupel grade, early metastasis, overt metastasis and adequate local control were significantly associated with outcome. Early visceral metastasis was associated with poorer outcome compared to dogs without metastasis, however, a subset of dogs experienced long-term control.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Ultrasound is a poor predictor of early or overt liver or spleen metastasis in dogs with high‐risk mast cell tumours

Pecceu

Varela

Handel

et al. 2020

Vet Comparative Oncology

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“…Interestingly, despite the paucity of literature on oral MCTs ( 4 , 62 ), respondents were equally as likely to recommend END (27.5%) for dogs with oral/labial MCTs as they were for OMM (approximately 32.5% overall). Unlike OMM, where distant metastasis poses a significant clinical challenge ( 5 , 7 , 52 , 63 ), literature supports that adequate local control of the primary tumor and regional nodes is the most important facet for long-term control for dogs with MCTs ( 54 – 56 ). Thus, it was surprising that given the high propensity for oral MCT to metastasize to lymph nodes and the significant effect of nodal metastasis on median survival time, that END is not recommend more often for the N0 neck ( 54 – 56 ).…”

Section: Discussionmentioning

confidence: 99%

“…Unlike OMM, where distant metastasis poses a significant clinical challenge ( 5 , 7 , 52 , 63 ), literature supports that adequate local control of the primary tumor and regional nodes is the most important facet for long-term control for dogs with MCTs ( 54 – 56 ). Thus, it was surprising that given the high propensity for oral MCT to metastasize to lymph nodes and the significant effect of nodal metastasis on median survival time, that END is not recommend more often for the N0 neck ( 54 – 56 ). Rather, in 53% of cases, nodes are extirpated only if suspicious for metastasis on imaging or cytologically confirmed as metastatic.…”

Section: Discussionmentioning

confidence: 99%

Variability in Recommendations for Cervical Lymph Node Pathology for Staging of Canine Oral Neoplasia: A Survey Study

2020

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There is no clear guideline regarding the indication for routine lymph node extirpation and pathologic evaluation during staging of canine oral tumors, despite a relatively high reported nodal metastatic rate for select tumor types. It is particularly unclear if clinicians recommend removal of lymph nodes only when there is confirmation of metastasis, defined as the N+ neck, or if elective neck dissection (END) is routinely recommended to confirm the true pathologic metastatic status of lymph nodes in the clinical N0 neck (no evidence of metastasis on clinical staging with diagnostic imaging or cytology). When clinicians are recommending END as a staging tool to confirm nodal status, there is also ambiguity regarding the surgical extent for subsequent histopathologic evaluation. The objective of this cross-sectional survey study was to determine the current recommendations given by practicing specialists regarding lymph node removal for dogs with oral tumors. Overall, 87 responses were obtained from 49 private practices (56%) and 38 academic institutions (44%). Respondents identified as oncologists (44%, N = 38), soft tissue surgeons (40%, N = 35), and dentists (16%, N = 14). Regardless of tumor type and stage, extirpation and histopathology were most commonly recommended in the clinical N+ neck only. The recommendation to routinely perform END in the N0 neck was significantly associated with tumor type. Bilateral removal of the mandibular and retropharyngeal lymph nodes was recommended more often for oral malignant melanoma (OMM) than for oral squamous cell carcinoma (OSCC; p ≤ 0.0039) or for oral fibrosarcoma (OFSA; p ≤ 0.0007). The likelihood of recommending END increased with increasing tumor size. Academic clinicians were significantly ( p < 0.01) more likely to recommend END compared to private practitioners for canine T1–T3 OMM, T3 OSCC, T2 OFSA, and MCT. This study highlights the variability in recommendations for lymph node pathology for dogs with oral tumors. While tumor type and size influenced the decision to pursue END, it was not routinely recommended, even for tumor types with a known propensity for metastasis. Prospective studies are warranted to determine the potential diagnostic and therapeutic value of END in the N0 neck in veterinary patients such that a consensus approach can be made.

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“…This finding corroborates our findings for high-intensity MCTs. High-intensity MCTs have a high rate of recurrence [ 48 ]. This result is also comparable with that of Thompson [ 49 ] who found an association between the c-kit mutation and higher grade in canine cutaneous MCTs.…”

Section: Discussionmentioning

confidence: 99%

Histological classification and expression of markers of canine mast cell tumors

et al. 2020

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Background and Aim: Mast cell tumors (MCTs) are malignant neoplasms that are common in dogs. Their biological behavior is variable and unpredictable. The aim of the present study was to analyze the histological classification and expression of markers of canine MCTs. Materials and Methods: Thirty samples of canine MCTs were graded according to the histological classification methods of Patnaik and those of Kiupel. The expression of phosphoprotein 53 (p53) and c-kit proteins was quantified by immunohistochemistry using image processing software, ImageJ - a public domain computer program, developed at the National Institutes of Health. Results: It was possible to determine the grade of 100% of the samples. According to Patnaik's classification, 20.00% of the samples were Grade 1, 43.30% were Grade 2, and 36.70% were Grade 3. According to Kiupel's classification, 56.67% of the samples were of high intensity and 43.33% were of low intensity. Grade 1 tumors had the highest expression of p53 and c-kit, and Grade 2 had the lowest expression. The results showed that it is necessary to perform both histological grading methods. The classification into high and low intensity may provide more consistent results than the three-level grading system. However, a smaller number of categories, although it facilitates the classification, may not be sufficient for the prognosis. Conclusion: Quantitative evaluation of p-53 and c-kit expression is a useful tool to increase the accuracy of the analysis and to aid in choosing the treatment method for canine MCTs. Histological grading should be combined with other diagnostic methods.

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Treating the locoregional lymph nodes with radiation and/or surgery significantly improves outcome in dogs with high‐grade mast cell tumours

Cited by 31 publications

References 17 publications

Ultrasound is a poor predictor of early or overt liver or spleen metastasis in dogs with high‐risk mast cell tumours

Ultrasound is a poor predictor of early or overt liver or spleen metastasis in dogs with high‐risk mast cell tumours

Variability in Recommendations for Cervical Lymph Node Pathology for Staging of Canine Oral Neoplasia: A Survey Study

Histological classification and expression of markers of canine mast cell tumors

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