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Pey P, Specchi S, Rossi F, Diana A, Drudi I, Zwingenberger AL, Mayhew PD, Pisoni L, Mari D, Massari F, Dalpozzo B, Fracassi F, Nicoli S. Prediction of vascular invasion using a 7-point scale computed tomography grading system in adrenal tumors in dogs. J Vet Intern Med 2022; 36:713-725. [PMID: 35233853 PMCID: PMC8965227 DOI: 10.1111/jvim.16371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous studies evaluating the accuracy of computed tomography (CT) in detecting caudal vena cava (CVC) invasion by adrenal tumors (AT) used a binary system and did not evaluate for other vessels. OBJECTIVE Test a 7-point scale CT grading system for accuracy in predicting vascular invasion and for repeatability among radiologists. Build a decision tree based on CT criteria to predict tumor type. METHODS Retrospective observational cross-sectional case study. Abdominal CT studies were analyzed by 3 radiologists using a 7-point CT grading scale for vascular invasion and by 1 radiologist for CT features of AT. ANIMALS Dogs with AT that underwent adrenalectomy and had pre- and postcontrast CT. RESULTS Ninety-one dogs; 45 adrenocortical carcinomas (50%), 36 pheochromocytomas (40%), 9 adrenocortical adenomas (10%) and 1 unknown tumor. Carcinoma and pheochromocytoma differed in pre- and postcontrast attenuation, contralateral adrenal size, tumor thrombus short- and long-axis, and tumor and thrombus mineralization. A decision tree was built based on these differences. Adenoma and malignant tumors differed in contour irregularity. Probability of vascular invasion was dependent on CT grading scale, and a large equivocal zone existed between 3 and 6 scores, lowering CT accuracy to detect vascular invasion. Radiologists' agreement for detecting abnormalities (evaluated by chance-corrected weighted kappa statistics) was excellent for CVC and good to moderate for other vessels. The quality of postcontrast CT study had a negative impact on radiologists' performance and agreement. CONCLUSIONS AND CLINICAL IMPORTANCE Features of CT may help radiologists predict AT type and provide probabilistic information on vascular invasion.
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Affiliation(s)
- Pascaline Pey
- Department of Veterinary Medical ScienceAlma Mater Studiorum, University of BolognaOzzano Emilia (BO)Italy,Antech Imaging Services, IrvineCAUSA
| | - Swan Specchi
- Ospedale Veterinario i Portoni RossiBologna (BO)Italy
| | - Federica Rossi
- Clinica Veterinaria dell'OrologioSasso Marconi (BO)Italy
| | - Alessia Diana
- Department of Veterinary Medical ScienceAlma Mater Studiorum, University of BolognaOzzano Emilia (BO)Italy
| | - Ignazio Drudi
- Department of Statistical SciencesAlma Mater Studiorum, University of BolognaBologna (BO)Italy
| | - Allison L. Zwingenberger
- Department of Surgical & Radiological SciencesSchool of Veterinary Medicine, University of CaliforniaDavisCaliforniaUSA
| | - Philipp D. Mayhew
- Department of Surgical & Radiological SciencesSchool of Veterinary Medicine, University of CaliforniaDavisCaliforniaUSA
| | - Luciano Pisoni
- Department of Veterinary Medical ScienceAlma Mater Studiorum, University of BolognaOzzano Emilia (BO)Italy
| | | | | | - Boris Dalpozzo
- Clinica Veterinaria dell'OrologioSasso Marconi (BO)Italy
| | - Federico Fracassi
- Department of Veterinary Medical ScienceAlma Mater Studiorum, University of BolognaOzzano Emilia (BO)Italy
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Hayes G. Update on Adrenalectomy. Vet Clin North Am Small Anim Pract 2022; 52:473-487. [DOI: 10.1016/j.cvsm.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chiti LE, Mayhew PD, Massari F. Renal venotomy for thrombectomy and kidney preservation in dogs with adrenal tumors and renal vein invasion. Vet Surg 2021; 50:872-879. [PMID: 33616246 DOI: 10.1111/vsu.13593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/28/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the surgical technique and report the outcomes of adrenalectomy and thrombus removal with kidney preservation by renal venotomy in a population of dogs with adrenal tumors and vascular invasion into the renal vein (RV) and caudal vena cava (CVC). STUDY DESIGN Short case series. ANIMALS Five client-owned dogs that underwent adrenalectomy. METHODS Dogs with adrenal tumors and vascular invasion into the RV and CVC were retrospectively enrolled in this multi-institutional study. Renal venotomy was performed at the time of adrenalectomy for tumor thrombus removal. Recorded data included signalment, clinical signs and results of laboratory testing, physical examination findings, diagnostic imaging results, surgical technique, surgical time, surgical complications, and outcome. RESULTS Tumor thrombus was removed by renal venotomy in five dogs. In one dog with an ectopic adrenal tumor located ventral to the left kidney, the thrombus was occluding 90% of caval flow, and a small caval venotomy was required to remove it. Kidney preservation was achieved in all dogs. No significant intraoperative or postoperative complications occurred, and all dogs were discharged 3 to 4 days postoperatively. Median surgical time was 125 minutes (range, 80-210). At the end of the study, four dogs were alive without signs of recurrence, while one dog died of a suspected pulmonary embolism at 510 days. Median follow-up was 510 days (range, 279-890). CONCLUSION Renal venotomy is feasible for thrombectomy in dogs with adrenal tumors and RV invasion and allowed for the preservation of the kidney in this case series, thus limiting perioperative morbidity.
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Affiliation(s)
- Lavinia E Chiti
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano-Lodi, Lodi, Lombardy, Italy.,Clinica Veterinaria Nervianese, Nerviano, Milan, Italy
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, California, USA
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Takagi S, Kanai E, Morishita K, Ogawa H, Ogawa J. Surgical treatment of an abnormally positioned right adrenal tumor on segmental caudal vena cava aplasia in two dogs. J Vet Med Sci 2020; 83:69-72. [PMID: 33191389 PMCID: PMC7870403 DOI: 10.1292/jvms.20-0584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Segmental caudal vena cava (CVC) aplasia is a rare congenital vascular anomaly in dogs. Two dogs were diagnosed by CT imaging to have right adrenal tumors with concomitant segmental CVC aplasia. During surgery, a firm connection between the right adrenal gland and CVC was observed in both cases. The adrenal glands were found ventral to the CVC and the adrenal tumor was resected including the vascular wall. CVC venectomy for tumor removal will be required if the right adrenal gland is displaced in dogs with segmental CVC aplasia, even if there is no intravascular invasion.
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Affiliation(s)
- Satoshi Takagi
- Laboratory of Small Animal Surgery, Department of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5201, Japan.,Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Kita-ku N18 W9, Sapporo, Hokkaido 060-0818, Japan
| | - Eiichi Kanai
- Laboratory of Small Animal Surgery, Department of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5201, Japan
| | - Keitaro Morishita
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Kita-ku N18 W9, Sapporo, Hokkaido 060-0818, Japan
| | - Hiroko Ogawa
- Ogawa Canine Feline Hospital, 1-9-14 Tsunishi, Kamakura 248-0034, Japan
| | - Junya Ogawa
- Ogawa Canine Feline Hospital, 1-9-14 Tsunishi, Kamakura 248-0034, Japan
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Use of Contrast-Enhanced Ultrasonography for the Characterization of Tumor Thrombi in Seven Dogs. Animals (Basel) 2020; 10:ani10091613. [PMID: 32927883 PMCID: PMC7552278 DOI: 10.3390/ani10091613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 01/11/2023] Open
Abstract
Simple Summary Some neoplasia—such as adrenal and thyroid glands tumors—have been associated with “tumor thrombi” both in humans and dogs. The detection and characterization of these venous tumor thrombi is important for both surgical planning and prognosis. In human medicine, contrast-enhanced ultrasonography (CEUS) is considered an accurate diagnostic technique for differentiating malignant from benign portal vein thrombosis in hepatocellular carcinomas. Data regarding the characteristics of tumor thrombi in dogs are currently lacking. Therefore, the aim of this study was to assess the feasibility of CEUS for the characterization of malignant venous thrombosis in dogs. On the basis of our results, CEUS appeared to be useful in the detection of malignant intravascular invasion; contrast uptake of the thrombus was present in all cases. In addition, CEUS may clearly detect newly formed vessels within the thrombus, and arterial-phase enhancement and washout in the venous phase were the main features in malignant thrombosis in our dogs. As CEUS is an easy to perform, noninvasive technique, its application in the detection of malignant thrombosis in dogs may be used to improve the diagnosis in oncological canine patients. Abstract Tumors of adrenal and thyroid glands have been associated with vascular invasions—so-called tumor thrombi, both in humans and dogs. The detection and characterization of venous thrombi is an important diagnostic step in patients with primary tumors for both surgical planning and prognosis. The aim of this study was to describe the use of contrast-enhanced ultrasonography (CEUS) for the characterization of tumor thrombi. Dogs with tumor thrombus who underwent bi-dimensional ultrasound (B-mode US) and CEUS were included. Seven dogs were enrolled in this retrospective case series. On B-mode US, all thrombi were visualized, and vascular distension and thrombus-tumor continuity were seen in three and two cases, respectively. On color Doppler examination, all thrombi were identified, seemed non-occlusive and only two presented vascularity. On CEUS, arterial-phase enhancement and washout in the venous phase were observed in all cases. Non-enhancing areas were identified in the tumor thrombi most likely representing non-vascularized tissue that could potentially be embolized in the lungs after fragmentation of the tumor thrombi. On the basis of these preliminary study, CEUS appeared to be useful for the characterization of malignant intravascular invasion.
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Pey P, Diana A, Rossi F, Mortier J, Kafka U, Veraa S, Groth A, MacLellan M, Marin C, Fracassi F. Safety of percutaneous ultrasound-guided fine-needle aspiration of adrenal lesions in dogs: Perception of the procedure by radiologists and presentation of 50 cases. J Vet Intern Med 2020; 34:626-635. [PMID: 32159260 PMCID: PMC7096638 DOI: 10.1111/jvim.15743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/14/2020] [Indexed: 01/30/2023] Open
Abstract
Background Percutaneous ultrasound (US)‐guided fine‐needle aspiration (FNA) of adrenal gland lesions is controversial in veterinary medicine. Objective To evaluate the frequency and radiologists' perception of the risk of the procedure as well as determining the incidence of complications. Methods Retrospective study. A first survey was submitted by e‐mail to all board‐certified radiologists of the American College of Veterinary Radiology (ACVR) and European College of Veterinary Diagnostic Imaging (ECVDI). A second survey was sent to radiologists who declared having performed the procedure at least once in their career (observational cross‐sectional case study). Results The first survey was sent to 977 diplomates and answered by 138. Of 138 diplomates, 40 currently performed the procedure and 98 did not; 44 of the 98 gave the hypertensive crisis risk in pheochromocytoma as a reason. To the second survey, 12 of 65 responded positively; 50 dogs with 58 lesions were recruited, including 23 pheochromocytomas. Complications were reported in 4 of 50 dogs; 3 hemorrhages (1 mild and 1 moderate) and 1 death from acute respiratory distress syndrome (possibly related to laryngeal paralysis). No hypertensive crisis was reported. There was no relationship between the method of FNA/type of needle used and occurrence of complications. Based on the recollection of these 65 radiologists, who performed approximately 200 FNA of adrenal lesions, a death rate of approximately 1% was estimated. Conclusions and Clinical Importance Percutaneous US‐guided FNA of adrenal lesions can be considered a minimally risky procedure, despite the negative perception by radiologists.
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Affiliation(s)
- Pascaline Pey
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alessia Diana
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Jeremy Mortier
- Service of Diagnostic Imaging, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| | - Ulrike Kafka
- James Cook University, Townsville, Queensland, Australia
| | - Stefanie Veraa
- Division of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht, The Netherlands
| | - Anna Groth
- North Downs Specialist Referrals, Bletchingley, United Kingdom
| | | | - Chiara Marin
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Federico Fracassi
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Mayhew PD, Boston SE, Zwingenberger AL, Giuffrida MA, Runge JJ, Holt DE, Raleigh JS, Singh A, Culp WTN, Case JB, Steffey MA, Balsa IM. Perioperative morbidity and mortality in dogs with invasive adrenal neoplasms treated by adrenalectomy and cavotomy. Vet Surg 2019; 48:742-750. [PMID: 31034643 DOI: 10.1111/vsu.13221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 03/11/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the morbidity and mortality associated with adrenalectomy with cavotomy for resection of invasive adrenal neoplasms in dogs and evaluate risk factors for perioperative outcomes. STUDY DESIGN Retrospective study. ANIMALS Forty-five client-owned dogs. METHODS Dogs that underwent open adrenalectomy with cavotomy for resection of adrenal masses with tumor thrombus extending into the vena cava were included. Clinicopathologic data were harvested from medical records. Selected clinical, imaging, and operative variables were statistically evaluated as risk factors for packed red blood cell transfusion, nephrectomy, perioperative death, and overall survival. RESULTS Thirty-six of 45 masses were pheochromocytomas, 7 were adrenocortical carcinomas, and 2 were unknown type. Caval thrombus terminated prehepatically in 21 of 45 dogs and extended beyond the porta hepatis but terminated prediaphragmatically (intrahepatic prediaphragmatic location) in 15 dogs and thrombi extended postdiaphragmatically in 5 dogs. Thirty-four (76%) dogs were discharged from the hospital, and 11 (24%) dogs died or were euthanized prior to discharge. Median overall survival time for all 45 dogs was 547 days (95%CI 146-710). Bodyweight, tumor type, and size and extent of caval thrombus did not affect survival to discharge, but postdiaphragmatic (rather than prediaphragmatic) thrombus termination was associated with a greater risk of death. CONCLUSION Long-term survival was common in dogs that survived the perioperative period. Postdiaphragmatic thrombus extension affected the prognosis for overall survival. CLINICAL SIGNIFICANCE Findings of this study help to stratify operative risk in dogs with adrenal neoplasia and caval invasion.
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Affiliation(s)
- Philipp D Mayhew
- School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Sarah E Boston
- VCA Canada, 404 Veterinary Emergency and Referral Hospital, Newmarket, Ontario, Canada
| | | | - Michelle A Giuffrida
- School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Jeffrey J Runge
- Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David E Holt
- Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph S Raleigh
- School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Ameet Singh
- Departments of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - William T N Culp
- School of Veterinary Medicine, University of California-Davis, Davis, California
| | - J Brad Case
- School of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Michele A Steffey
- School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Ingrid M Balsa
- School of Veterinary Medicine, University of California-Davis, Davis, California
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Use of Minimally Invasive Surgery in the Diagnosis and Treatment of Cancer in Dogs and Cats. Vet Sci 2019; 6:vetsci6010033. [PMID: 30897763 PMCID: PMC6466197 DOI: 10.3390/vetsci6010033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 12/31/2022] Open
Abstract
Surgical management of neoplastic disease is common in veterinary medicine. Minimally invasive surgery (MIS) has gained widespread acceptance by veterinary surgeons and is experiencing rapid growth and frequency of use. Many neoplastic diseases in the abdomen and thorax of dogs and cats can be treated as effectively with MIS as with traditional open surgery. Additionally, MIS allows for less invasive options for organ biopsy in cancer patients either for initial diagnosis or for staging to inform prognosis and treatment. Despite the recent increase in MIS, additional research is required to further characterize the benefits to oncology patients and to ensure that surgical oncologic principles and patient outcomes are not compromised by the use of MIS.
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Knight RC, Lamb CR, Brockman DJ, Lipscomb VJ. Variations in surgical technique for adrenalectomy with caudal vena cava venotomy in 19 dogs. Vet Surg 2019; 48:751-759. [DOI: 10.1111/vsu.13168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/12/2018] [Accepted: 12/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Rebekah C. Knight
- Department of Clinical Sciences and ServicesRoyal Veterinary College London United Kingdom
| | - Christopher R. Lamb
- Department of Clinical Sciences and ServicesRoyal Veterinary College London United Kingdom
| | - Daniel J. Brockman
- Department of Clinical Sciences and ServicesRoyal Veterinary College London United Kingdom
| | - Victoria J. Lipscomb
- Department of Clinical Sciences and ServicesRoyal Veterinary College London United Kingdom
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Sanders K, Kooistra HS, Galac S. Treating canine Cushing's syndrome: Current options and future prospects. Vet J 2018; 241:42-51. [PMID: 30340659 DOI: 10.1016/j.tvjl.2018.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 12/17/2022]
Abstract
Naturally occurring hypercortisolism, also known as Cushing's syndrome, is a common endocrine disorder in dogs that can be caused by an adenocorticotrophic hormone (ACTH)-producing pituitary adenoma (pituitary-dependent hypercortisolism, PDH; 80-85% of cases), or by an adrenocortical tumor (ACT; 15-20% of cases). To determine the optimal treatment strategy, differentiating between these two main causes is essential. Good treatment options are surgical removal of the causal tumor, i.e. hypophysectomy for PDH and adrenalectomy for an ACT, or radiotherapy in cases with PDH. Because these options are not without risks, not widely available and not suitable for every patient, pharmacotherapy is often used. In cases with PDH, the steroidogenesis inhibitor trilostane is most often used. In cases with an ACT, either trilostane or the adrenocorticolytic drug mitotane can be used. Although mostly effective, both treatments have disadvantages. This review discusses the current treatment options for canine hypercortisolism, and considers their mechanism of action, efficacy, adverse effects, and effect on survival. In addition, developments in both adrenal-targeting and pituitary-targeting drugs that have the potential to become future treatment options are discussed, as a more selective and preferably also tumor-targeted approach could have many advantages for both PDH and ACTs.
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Affiliation(s)
- K Sanders
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - H S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - S Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands.
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