Page 53 - VetCPD Jnl Volume 7, Issue 4

2011; Demetriou et al. 2012 ). Metastatic margins, but the extent of a ‘clean’ margin
rates are higher in tumours with higher that is needed to reduce recurrence has
mitotic index (Kuntz et al. 1997).Twenty not been demonstrated. Frustratingly,
to thirty percent of dogs will die of disease tumours can recur despite reported ‘clean’
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related to the tumour (Kuntz et al. 1997; margins (17-28%) whereas some tumours HOURS
HOURS
Ettinger et al. 2006). with ‘dirty’ margins never recur (5-22%) There are many papers looking at (Kuntz et al. 1997; Chase et al. 2009;
McSporran 2009).This can make decision outcomes after soft tissue sarcoma CPD
treatment.As with most veterinary papers, making difficult if faced with unexpected case numbers are small, so there is not ‘dirty’ margins.
an unexpected variation in reported Tumour grade is also very important outcomes. Most papers published are for predicting recurrence, and is more from referral centres, where high-grade predictive than mitotic index alone tumours account for 17-29% of all (McSporran 2009). For example, one study tumours, compared to just 6% in first showed local recurrence rates of 7%, 34% opinion practice (Bray et al. 2014). It is and 75% for grade 1, 2 and 3 marginally therefore possible that dogs treated in excised tumours respectively (McSporran first opinion practice may have improved 2009). Other features predictive of recurrence rates and survival times, as they outcome include: increased mitotic index are more likely to be low-grade. and increased AgNOR and Ki67 scores Most papers in the veterinary literature (Ettinger et al. 2006). Reduced disease-free
intervals and survival times for tumours
1) What is the best first line diagnostic tool for a skin mass on the carpus of a dog present for three months?
A) In house cytology
B) External cytology
C) Incisional biopsy
D) Excisional biopsy
2) Which is the most likely scenario when pre-operative biopsy results do not match post-excision results?
demonstrate a worse prognosis in high- grade tumours and tumours removed by marginal excision, with recurrence rates up to 60% in older literature (Bostock and Dye 1980).This led to the advice to resect tumours with wide margins. However, a few recent papers showed low recurrence rates - 10-20% - in low-grade tumours
of >5cm and for tumours appearing fixed
A) Under-interpretation of a low-grade soft tissue sarcoma
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removed by marginal excision (Stefanello
et al. 2008; Chase et al. 2009; Bray et al. Only thigh of a dog. Assuming the mass 2014). In people, smaller margins are For a full list of references please visit: invades panniculus muscle, what acceptable for low-grade tumours only. In www.vetcpd.co.uk/references deep margin of tissue (or part of the dogs, marginal excision is only acceptable tissue) must be taken?
for low-grade tumours or tumours of READ PREVIOUS VETCPD A) Rectus femoris muscle the distal extremities where wide surgical SURGERY ARTICLES B) Biceps femoris muscle
excision is not an option, but caution is C) Panniculus muscle recommended in marginal excision of Available for download at: D) Tensor fascia lata muscle
of the extremities, many of which were
(Liptak and Forrest 2013).
3) A soft ti
to deep tissue have been demonstrated
B) Over-interpretation of a low-grade soft tissue sarcoma
in some studies (Monteiro et al. 2011).
C) Under-interpretation of a high-grade soft tissue sarcoma
Anecdotally, some authors consider rapid
growth, tumour ulceration and gross
D) Over-interpretation of a high-grade soft tissue sarcoma
tumour necrosis to be negative prognostic
indicators, but these remain unproven
References
skin and subcutis of the caudolateral
0.5 1.0
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rs
ssue sar
coma is present in the
sarcomas considered low-grade based on www.vetcpd.co.uk/modules
a pre-operative biopsy report, as 30% will Only £20 + VAT 4) Which chemotherapeutic drug
be wrongly graded.
In dogs treated with combined marginal surgical excision and adjuvant radiation therapy, recurrence rates of approximately 20% are reported, with 9-25% metastasis. In one study, there was a 5-year survival rate of 76%; in another, median survival was 3.7 years, but 65% died of other diseases without having had recurrence (McKnight et al. 2000; Demetriou et al. 2012).
Histopathological features are predictive of outcomes, including recurrence and/ or reduced disease-free intervals.An important predictor of recurrence is the extent of the margin on histopathological examination; therefore good surgical planning is imperative. However, the ability to obtain a margin is not known before surgery. Recurrence is ten times more likely in soft tissue sarcomas with incomplete or ‘dirty’ histopathological
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can be given as metronomic chemotherapy to treat incompletely excised soft tissue sarcomas?
A) Doxorubicin
B) Vincristine
C) Cisplatin
D) Cyclophosphamide
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