Ch. 82: Skin Dz - see JS doc for flaps Flashcards
(Gretta) Chu JAVMA 2020
Comparison of lateral surgical margins of up to 2 cm with margins of 3 cm for achieving tumor-free histologic margins following excision of grade I or II cutaneous MCTs in dogs
Grade I or II CUTANEOUS MCT
- what did they consider conservative vs wide margin?
- clean margin comparison between groups?
- conclusion re: non-inferiority bw groups?
Conservative – equal to tumor
diameter for tumors < 2 cm in diameter or 2 cm for larger tumors
Wide – margins > 3 cm acquired
Proportion of excised MCTs with tumor-free histo margins was similar between conservative 93% and wide margin 92% groups
Conclusions: The conservative-margin approach appeared to be noninferior to the wide-margin approach for achieving tumor-free histologic margins
Arz JFMS 2023
Lymph node metastasis in FELINE CUTANEOUS LOW-grade mast cell tumours (retrospective)
- what procedures did they do on what tumor grade?
- % of LN considered metastatic?
- % of cats affected by LN mets?
- conclusion?
cutaneous MCT resection and concurrent lymphadenectomy (enlarged and non-enlarged LN)
All 21 MCTs were graded as low grade and 30 nodes were removed
40% of LN were considered early or overtly metastatic (HN2 or HN3, respectively)
Based on nodal status, 60% cats were affected by LN mets
Conclusions: In contrast to previous reports, high percentage of cats with cutaneous MCTs in which lymphadenectomy was performed were presented with metastatic lymph nodes. !!
Cherzan VSURG 2023 ** large SQ retrospective
Factors affecting prognosis in CANINE SUBCUTANEOUS mast cell tumors: 45 cases
Retrospective, 45 dogs with 48 SQMCTs
- overall disease recurrence?
- local recurrence?
- metastatic recurrence?
- local recurrence effect on MST? what were MST? margins association?
- % with or developed LN mets?
- LN Mets affect on DFI and MST?
- Conclusion re: LN METS & SQ MCT?
Overall disease recurrence 30%
- Local recurrence occurred in 18%
- 11% developed metastatic recurrence
Local recurrence resulted in a significantly shorter MST of 550 days compared to 1720 days for dogs without local recurrence
- Incomplete margins were not associated with recurrence
27% developed LN metastasis (either at time of sx or later)
- Dogs with lymph node metastases had a median DFI 195 days, while median DFI was not reached for dogs without LN metastasis
- MST for dogs with LN metastasis was 550 days & 1720 days without metastasis (yes, same #s as local recurrence MST)
Conclusion: LN METS decreased DFI AND survival.
Subcutaneous mast cell tumors may be a more aggressive disease than previously reported. !!!
Alvarez-Sanchez VSURG 2023 **
Comparison of indirect computed tomographic lymphography and near-infrared fluorescence sentinel lymph node mapping for integumentary canine mast cell tumors
Prospective, clinical, 23 dogs ***
- What 2 techniques were compared for SLN mapping?
- % agreement bw the 2 techniques? complete vs partial vs no
- % failure of each technique?
- Biggest take away – % of dogs considered low grade pre-op, and then what % found to be metastatic?
**look at pics of mapping
Compare the independent and combined use of indirect CT lymphography (ICTL) and near-infrared fluorescence (NIRF) for sentinel lymph node (SLN) mapping in dogs with integumentary MCT
Performed preoperative ICTL, then intraoperative NIRF SLN mapping and excision of the anatomic lymph node (ALN) and/or SLN, and primary MCT.
Complete agreement between ICTL and NIRF was seen in 40%
Partial agreement in 40%
(considered this agreement of at least one SLN in 80%)
No agreement in 20% dogs
Detection of ICTL-SLN and NIRF-SLN failed in 1/20 (5%) and 4/20 (20%), respectively.
Tumor grade: Grade II/low-grade in 19/20 (95%) and grade III/high-grade in 1/20 (5%) dogs
Metastatic disease: 19/20 (95%) dogs had HN2-3 (metastatic) LN.
Conclusions: Technique agreement of at least one SLN was seen in 80% dogs. Although most MCT were classified as intermediate to low grade, LN metastases were commonly detected.
Chalfon JSAP 2022
Lymphadenectomy improves outcome in dogs with resected Kiupel high-grade cutaneous mast cell tumors and overtly metastatic regional lymph nodes
HIGH GRADE TUMORS + LN METS -
- Median time to progression bw lymphadenectomy vs not?
- MST bw lymphadenectomy vs not?
- Lack of lymphadenectomy associated with higher risk of what 3 factors & what hazard ratios?
- Tumor size associated with higher risk of what? HR?
Median time to progression was significantly shorter in dogs that did not undergo lymphadenectomy (150 days) compared to the other dogs (229 days).
MST was also shorter in dogs that did not undergo lymphadenectomy (250 days) compared to other (371 days).
Lack of lymphadenectomy was associated w/ higher risk of:
Overall tumor progression (hazard ratio: 2)
Nodal progression (hazard ratio: 3)
Tumor-related death (hazard ratio 3.6),
Tumor size was associated w/ higher risk of:
Local recurrence (hazard ratio: 3.6).
Beer JSAP 2022
Near-infrared fluorescent image-guided lymph node dissection compared with locoregional lymphadenectomies in dogs with mast cell tumors
- what % of metastatic LN did near infrared group have?
- what % of met LN in dissection group?
At least 1 metastatic LN was identified in:
68% of dogs w/ near-infrared fluorescent image-guided LN dissection,
vs.
33% of dogs for LN dissection w/o imaging.
Iodence JAVMA 2022
Dogs undergoing surgical excision of mast cell tumors are not at increased risk of incisional complications
- Comps for MST vs STS? Different?
- Factors that increased risk of comps for MCT (3)?
- What factor was significant on multivariable analyses for incisional comps?
- What suggestion re: chemo did they make?
- What affect did steroid admin have?
MCTs vs STS: Complications not different (13% vs 14%)
MCTs - increased risk of complications with:
incomplete margins (vs complete vs narrow)
increasing tumor grade (Patnaik)
postop chemotherapy
Multivariable- postop chemo for MCT and both groups combined was associated with increased odds of incisional complications
they suggest that chemotherapy be used with caution ≤ 30 days after surgery for dogs with MCTs.
Corticosteroid administration was not associated with incisional complications for the MCT group in this study
TIGILANOL TIGLATE PAPERS (3)
De Ridder JVIM 2021
Randomized controlled clinical study evaluating the efficacy and safety of intratumoral treatment of canine mast cell tumors with tigilanol tiglate (EBC-46)
- CR in what %? recurrence rate?
Reddel JVIM 2021
Wound formation, wound size, and progression of wound healing after intratumoral treatment of mast cell tumors in dogs with tigilanol tiglate
- wounds fully manifested by what day? did what wound care? healed by what day? depended on what 2 factors?
Jones JVIM 2021
Recurrence-free interval 12 months after local treatment of mast cell tumors in dogs using intratumoral injection of tigilanol tiglate
- % tumor free? % recurrence?
De Ridder JVIM 2021- A single TT treatment resulted in 75% complete response (CR) by 28 days, with no recurrence in 93% of dogs by 84 days. (Resp Rate 7% in 3 months)
Reddel JVIM 2021 - maximal wound area fully evident in 90% of dogs by day 7. In dogs achieving complete tumor resolution, all wounds were left to heal by secondary intention (all but 5). Time to healing (ie, full re-epithelialization) depended on wound area and location on the body, with most wounds being fully healed between 28-42 days after treatment.
Jones JVIM 2021 - 89% remained tumor free at the treatment site
11% had recurrence → All within 6 months, most (70%) within the first 3 months
Hlusko 2020 VET SURG PQ
The effect of surgery on lymphoscintigraphy drainage patterns from the canine brachium in a simulated tumor model
- What affect did surgery have on lymphatic drainage? PQ
Sentinel lymph node identification occurred immediately in three of eight dogs preoperatively and in eight of eight dogs postoperatively.
Conclusion: Sentinel lymph node identification occurred faster postoperatively. –> Surgery appears to have an effect on lymphoscintigraphy drainage patterns. - makes identification faster?
Ferrari Vet Sx 2020 PQ
Biopsy of sentinel lymph nodes after injection of methylene blue and lymphoscintigraphic guidance in 30 dogs with MCT
- Injected what, where?
- Any complications with SLN?
- What seemed to affect SLN identification?
- SLN did not agree with expected abnormal regional LN in what %?
- Mets in what % SLN?
Technetium-99 m and methylene blue were injected peritumorally
SLN mapping was done for 34 MCT in 30 dogs without any complication.
SLN were not identified in 3/34 tumors, all with previous scar tissue (suggests scar tissue affects SLN mapping).
Sentinel lymph nodes did not correspond to expected Regional LN in 63% tumors.
Histological examination confirmed an early or overt metastasis 55% SLN extirpated.
Conclusion: SLN mapping and biopsy with radionuclide and injection of methylene blue was associated with low morbidity and allowed detection of SLN in dogs with MCT at first presentation without scar tissue.
Villedieu JAVMA 2021
Prevalence of pulmonary nodules suggestive of metastasis at presentation in dogs with cutaneous or subcutaneous soft tissue sarcoma
- Presence % of nodules overall?
grade 3 vs 1, 2? - Odds for pulmonary mets # x timer in grade 3? What other factor 3x higher?
- Conclusion?
90% of cases had CT, 10% had TXR
nodules present in 12% of dogs:
5% w/ grade 1 STS, 5% w/ grade 2 and 40% w/ grade 3
odds for pulmonary mets were 11x higher in dogs w/ grade 3 (vs grade 1 or 2) and 3x higher if STS present >3mo
conclusion: pulmonary staging is a low yield test in dogs w/ grade 1 or 2 STS especially when present for <3mo
Dobromylskyj JFMS 2020
Prognostic factors and proposed grading system for cutaneous and subcutaneous soft tissue sarcomas in cats, based on a retrospective study
- what 3 factors was grading scheme made of?
- what were MST #s for low, int, high grade?
- what was most common cause of poor outcome?
Grading scheme based on mitotic score, tumor necrosis score, and inflammation score
novel grading system applied to these tumours produced significant differences in MST between cats with low (MST = 900 days), intermediate (MST = 515 days) and high grade tumours (MST = 280 days).
Conclusions: This is the first study applying a histological grading system to these common tumours. Local recurrence is often the cause of a poor outcome, with metastatic disease apparently rare
Milovancev Vet Sx 2020
Long-term outcomes of dogs undergoing surgical resection of MCTs and STSs: A prospective 2 year long study
- what margins did they do?
- % in each group that had <1mm margin on histo?
- what was recurrence and mets for MCT? STS?
- conclusion re: narrow margins and mets/recurrence rates?
Median intraop margins 20 mm for MCT and 30 mm STS with 1 fascial plane resected en bloc
The narrowest histologic tumor-free margins measured < 1 mm in 40% MCT and 40% STS
2/50 (4%) low-grade MCT had local recurrence
2/36 (6%) dogs with low-grade MCT developed visceral mets
1 of 2 dogs with high-grade MCT got local recurrence
No local recurrence or mets diagnosed after excision of 19 STS
Conclusions: local recurrence rates for low-intermediate grade MCT/STS low despite high prevalence of tumor-free margins < 1 mm
Crownshaw JAVMA 2020
Evaluation of variables associated with outcomes in 41 dogs with incompletely excised high-grade STSs treated with definitive-intent radiation therapy with or without chemotherapy
- MST? 1 year, 3, and 5 year survival rates?
- MEAN time to progression?
- % developed mets?
- % developed local recurrence?
- what 2 factors increased death hazard?
- conclusion re: chemo? RT?
MST was 980d, with 1 yr survival 85%, 3 yr 45% and 5 yr 20%
Median time to progression not reached, but mean TTP was 1580d
25% dogs developed metastasis, and 20% developed local recurrence
Hazard of death over study period increased as RT duration or surgical scar length increased
Overall chemo did not show improved survival, but improved MST and TTP was seen with strict adherence to RT schedule
