Abstract
Simple SummaryMast cell tumor (MCT) is the most common integumentary neoplasm in dogs. The draining lymph node (LN) is the first site of histologically detectable metastasis, even if not clinically altered. The recent literature showed the discrepancy between the regional LN and the truly draining LN (the so-called sentinel lymph node—SLN) in dogs with integumentary MCT. However, the mapping and biopsy of SLN include additional anesthesiologic, diagnostic and surgical procedures, and additional cost. The study aimed to assess the possible association between clinicopathological variables and SLN status. Sixty-six cases of low-grade cutaneous and subcutaneous MCT in dogs admitted to the mapping and biopsy of SLN were included. An MCT dimension smaller than 3 cm seems to correlate less with occult or overt SLN metastasis, although further study should confirm the exclusion of cases with this variable to the mapping and biopsy of the SLN. In contrast, the high association of tumor ≥ 3 cm and subcutaneous MCT with overt SLN metastasis involves a solid suggestion for those procedures in the presence of one of these variables.The recent literature supports the sentinel lymph node (SLN) biopsy in dogs with MCT due to discrepancy with the regional lymph node and the high percentage of occult metastasis. However, the SLN biopsy includes additional anesthesiologic, diagnostic, and surgical procedures, and additional costs. The study aimed to assess the association between clinicopathological variables and SLN status, determining the identification of dogs at lower risk of SLN metastases. Dogs with integumentary MCT were admitted to the lymphoscintigraphic mapping and subsequent biopsy of SLN. The association between clinicopathological variables of MCT and SLN status was statistically tested, both considering occult and overt metastasis together (HN2-HN3) and overt metastasis (HN3) alone. Fifty low-grade cutaneous MCT and 16 subcutaneous MCT were included. A small to moderate association between integumentary MCT ≥ 3 cm and HN2-HN3 SLN was found. A strong association of integumentary MCT dimension and subcutaneous MCT with HN3 SLN occurred. Dimension of low-grade cutaneous and subcutaneous MCT seems to correlate with SLN status, but additional study should confirm this data before excluding small MCT to the SLN biopsy. On the contrary, the study results induce a solid suggestion for mapping and biopsy of the SLN in MCT > 3 cm and subcutaneous MCT.
Highlights
The identification of nodal metastasis in canine mast cell tumor (MCT) has undergone several changes during the last decade
sentinel lymph node (SLN) excised in each dog has been consistently reported [4,5,6,7]. These results highlight the importance of SLN mapping and biopsy to achieve an accurate and personalized nodal staging and undermine the prognostic results reported in the previous studies focused on regional lymph node (RLN) evaluation
To be eligible for SLN mapping, dogs must have staged negative for distant metastasis at preoperative ultrasound-guided spleen and liver cytology and have no clinical/ultrasonographic evidence of RLN metastases [11]
Summary
The identification of nodal metastasis in canine mast cell tumor (MCT) has undergone several changes during the last decade. A high variability in the number of SLNs excised in each dog has been consistently reported [4,5,6,7] These results highlight the importance of SLN mapping and biopsy to achieve an accurate and personalized nodal staging and undermine the prognostic results reported in the previous studies focused on RLN evaluation. SLN mapping and biopsy include additional anesthetics, diagnostic and surgical procedures, and additional costs for the owner, to date there are no data available on the clinical benefits of these procedures, especially in case of non-high metastatic risk MCT [8,9,10]. Information is lacking on the potential morbidity related to the removal of non-metastatic SLN
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