Clinical Pathology 2

Research title:

Preoperative and intraoperative sentinel lymph nodes mapping in malignant canine spontaneous tumors.

Tutor: Dott. Davide Danilo Zani

 

Research group:

Dott. Davide Danilo Zani (Dipartimento DiMeVet, Università degli Studi di Milano)

Prof. Mauro Di Giancamillo   (Dipartimento DiMeVet, Università degli Studi di Milano)

Dott.ssa De Zani Donatella (Dipartimento DiMeVet, Università degli Studi di Milano)

Dott.ssa Roberta Ferrari (Contrattista DiMeVet)

Dott. Maurizio Longo (Royal (Dick) School of Veterinary Studies, The University of Edinburgh)

Dott.ssa Cinzia Pettinato (Esperto qualificato di III grado, Policlinico S.Orsola-Malpighi)

 

Contact details

Dipartimento di Medicina Veterinaria (DiMeVet)

Via Celoria 10, 20133 Milano

Polo Veterinario di Lodi

Via dell’Università 6, 26900 Lodi

This email address is being protected from spambots. You need JavaScript enabled to view it.   Phone number: 02 503 31120

 

State of the art 

Lymph nodes that are  most likely to be involved with metastatic cancer cells are called Sentinel lymph nodes (SLNs). Lymphatic mapping allows to target SLNs and thereby limit the extent of surgery needed and decrease surgical complications and long-term side effects associated with extensive lymph node removal.

In human medicine lymphoscintigraphy and radiosurgery probe are routinely used to detect SLNs, mostly in breast cancer and malignant cutaneous melanoma (Mariani et al., 2004, Journal of Surgical Oncology, 85: 141–151). Application of SPECT/CT (Single Photon Emission Computed Tomography) combined with lymphoscintigraphy has also been described to increase SLNs detection. SPECT/CT in fact shows the exact anatomical location of SLNs already detected on planar images (Sieira-Gil et al., 2015, Journal of Cranio-Maxillo-Facial Surgery, 43: 2205-2213). These techniques allow a more accurate tumoral staging, as they are able to detect micrometastasis and to avoid the side effects of a radical lymphadenectomy (e.g. lymphedema) (Farinetti, 2010, Bollettino di Ginecologia Endocrinologica, 4: 1-9). Veterinary CT is routinely used for tumor staging, however few studies have been conducted on the use of SPECT/CT in oncologic patients (LeBlanc et al., 2014, Seminars in Nuclear Medicine, 44:47-56) and a very small number of works on lymphoscintigraphy for SLNs detection. These studies clearly demonstrated the feasibility of lymphoscintigraphy and intraoperative detection SLNs in canine mammary carcinoma, thyroid and parathyroid carcinoma, and fibrosarcoma. (Balogh et al., 2002, Nuclear Medicine Review, 5(2):139-144).

zani1

 

Planar scintigraphic images of a thyroid nodule in a dog

 

zani2

SPECT exam in a dog

 

Aims of the project

The aim of this project is to apply to veterinary oncologic patients the diagnostic imaging techniques routinely used in human medicine for an early detection of SNLs. The project is focused on the preoperative and intraoperative utilization of Nuclear Medicine Imaging, particularly lymphoscintigraphy and SPECT/CT. These diagnostic modalities could permit a more accurate staging of malignant canine spontaneous tumors, as they consent to identify metastatic lymph nodes and micrometastasis in clinically normal lymph nodes, allowing the targeted removal. Therefore the project will involve dogs with highly metastatic tumors, particularly mammary carcinoma, oral melanoma and high-grade STS (Soft Tissue Sarcoma), which are some of the most common cancers in the canine patient and they’ve already been studied in preliminary works for the detection of sentinel lymph node. A correct cancer staging permits to make an adequate prognosis and, consequently, to choose the most appropriate treatment for the oncological patient.

 

 

Recent publications of the tutor in the field

1. De Zani D., Pettinato C., Longo M., Ravasio G., Di Giancamillo M., Zani D.D. Nuclear medicine in veterinary practice: preliminary experiences at Az. Polo Veterinario di Lodi. EANM 28th annual meeting, 10-14 October 2015, Hamburg, Germany

2. Pettinato C., De Zani D., Longo M., Ravasio G., Di Giancamillo M., Zani D.D. Radiation protection in a veterinary nuclear medicine facility. EANM 28th annual meeting, 10-14 October 2015, Hamburg, Germany