Manfredi/Zani

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Martina Manfredi graduated in Veterinary Medicine from University of Milan in February 2017 with full marks and honor. Her final dissertation concerned equine teeth CT imaging technique, in particular she investigated the tomodensitometric appearance of the cheek teeth pulpar cavity. She is currently attending the Surgery and Diagnostic Imaging Unit at Centro Clinico Veterinario e Zootecnico Sperimentale in Lodi. She dedicates to both large and companion animals imaging techniques, such as X-ray, CT, MRI and Scintigraphy, and she is also interested in anesthesia during diagnostic and surgical procedures. Her research is mainly focused on sentinel lymph nodes mapping in dogs using different techniques and radioiodine treatment for hyperthyroidism in cats.

 

After graduating in Veterinary Medicine in 2001, he worked as an equine medicine practitioner, collaborating with Clinica Veterinaria Spirano (Bergamo). In 2006, he earned a PhD in Veterinary Clinical Sciences at the University of Milan with a project concerning MRI arthrography in the evaluation of cartilage lesions in the equine fetlock joint. He cooperated with New Bolton Center (University of Pennsylvania, Philadelphia) and the Centre for Equine Studies at Animal Health Trust (Newmarket, Suffolk). At present, he is a researcher and a teacher for the Department of Veterinary Medicine at University of Milan and he is the head of the Diagnostic Imaging Unit at Centro Clinico Veterinario e Zootecnico Sperimentale in Lodi. His research interest ranges from investigation of equine lameness to both small animals and large animals I and II level diagnostic techniques. He is the Scientific Responsible of the European project: “Preclinical optimization of treatment with inhaled argon to improve neurological outcome and survival after cardiac arrest” and the Principal Investigator of the research project “Eden-Horizon 2020” (Development of a new generation robotic probe for neurosurgery in an animal sheep model).

 

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

The notion of Sentinel Lymph Nodes (SLN) is widely studied in human medicine. A Sentinel Lymph Node (SLN) is defined as the first node to receive lymphatic drainage from a tumor. As a consequence, the SLN will most probably be the first one interested by metastasis through lymphatic flow and its condition should accurately predict the status of the regional lymphatic basin draining the tumor: when negative, the entire basin can be considered free from metastasis, and for tumor having a prevailing lymphatic metastatic spread, the presence of distant metastasis can be regarded as unlikely. In human oncology, SLN biopsy has become a routine procedure for the evaluation of clinically negative lymph nodes in women with early breast cancer and it is proved to be one of the most important diagnostic technique for patients with melanoma. In fact, SLN histological status is a major factor in determining stage, appropriate therapy and outcome in these oncological patients. It is proved to enhance staging accuracy by assessing the most relevant lymph nodes status and it also improves pathologic analysis as a more intensive metastasis research can be made on fewer dissected lymph nodes instead of the entire lymph node basin.

The necessity of a precise lymphatic mapping technique lies in the impossibility to rely on general anatomical notions to predict the specific functional lymphatic drainage of a tumor and, therefore, identify the real SLNs. Despite its widely utilization in human oncology, SLN detection is poorly investigated in veterinary medicine. This project aims to define a useful diagnostic protocol for SLN mapping in dogs with single malignant primary tumors, such as mammary carcinoma, mucosal/cutaneous melanoma or soft tissue sarcoma, comparing different techniques. Specifically, we want to investigate the utility of lymphoscintigraphy compared both to SPECT/CT imaging technique, which is proved to enhance SLN detection and provide additional guidance during biopsy surgery in human patient, and to CT indirect lymphography, which is demonstrated to be useful for the assessment of SLN metastasis in cases of mammary gland tumors in dogs.

Sentinel Lymph Node mapping technique in veterinary medicine would greatly improve oncological staging, allowing a more accurate stratification of oncological patients for appropriate treatment and providing an important prognostic value. Additionally, SLN biopsy offers a minimally invasive surgery that reduces patient morbidity by avoiding unnecessary prophylactic block dissection of the regional lymph node basin.

 

Fig. 1 – Sentinel Lymph Node (SLN) mapping using peritumoral radiotracer administration.

Fig. 2 – Lymphoscintigraphy for SLN detection in a dog with a thoracic mast cell tumor.