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Carozzi, Gregorio (2016) COMPUTED TOMOGRAPHIC EVALUATION OF CANINE PHARYNGEAL NEOPLASIA. [Tesi di dottorato]

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Abstract (inglese)

Computed tomography (CT) is commonly used to investigate head tumours in dogs, and is a fundamental part of the diagnostic work-up, for diagnosis, staging and planning therapy in neoplastic disease. Nasal diseases, either neoplastic or non-neoplastic diseases, oral neoplasia, brain disease, thyroid or carotid body neoplasia have been extensively studied. However little information are available for lesions of the pharyngeal area.
In this thesis, cases of dogs affected by pharyngeal neoplasia have been collected from the database of three private referral veterinary clinics for diagnostic imaging. The purpose of this multicentric retrospective study was to analyse the CT findings in 25 dogs affected by pharyngeal neoplasia to identify features possibly differentiating the tumour type. Further aim was to analyse the distribution and pattern of presentation of regional lymphadenopathy (mandibular and medial retropharyngeal lymph nodes) to have particular features that might indicate nodal metastatic spread enabling more accurate patient staging.

In the Chapter 1 the gross anatomy of the pharynx, its subdivision in nasal, oral and laryngeal part, the lymphatic drainage and the computed tomographic features and landmarks of these structures are described. The most important anatomical structures bounding the pharyngeal cavity and the most important structures surrounding the different pharyngeal parts have been identified and labelled, basing on available literature and anatomical images, and then matched on a sequence of computed tomographic images.

In the Chapter 2 has been reported the most common pharyngeal neoplasia in the dog, in descending order malignant melanoma, squamous cell carcinoma, and fibrosarcoma. The epidemiologic, clinical and biologic behaviour of these cancers have some features overlapping with the human cancer. These features, along with the relative shortness of the life span of the dog, and closely sharing of man’s environment makes the dog an excellent animal model for comparative epidemiologic studies.

In the Chapter 3 the tumour-nodal-metastasis (TNM) system provided by the World Health Organization for the staging of canine tumour is reported. Furthermore the imaging criteria, reported in human and veterinary literature assessed to evaluate the potential nodal involvement has been reviewed and compared.

In the Chapter 4 are reported the Material and Methods regarding the inclusion criteria of the cases, the computed tomographic protocol adopted, the computed tomographic features considered, and the criteria of analysis, and the statistical procedures. The imaging features has been divided in qualitative features including location of lesions, shape, margins, relationship with adjacent structures and vessels, attenuation characteristics, pattern and grade of enhancement, changes in lymph nodes size, shape and enhancement and presence of potential distant metasasis; and quantitative features including the measure of volume, and pre and postcontrast attenuation expressed in Hounsfiled Units (HU). The effect of final diagnosis on each CT feature was statistically tested.

In the Chapter 5 the caseload population and the results of the imaging and statistical analysis are described. The caseload included: 15 carcinomas, 5 sarcomas, 4 melanomas and 1 lymphoma. The oropharynx and laryngopharynx were more frequently involved. Lesions in the different groups were of similar size, irregular shape, ill-defined margins and moderate-to-marked heterogeneous contrast enhancement. Lysis of hyoid bones was recorded in two carcinomas and infiltration of the lingual artery in one case. Marked medial retropharyngeal lymphoadenomegaly was recorded in 11/14 carcinomas, in all sarcomas and in 2/4 melanomas. The single lymphoma case showed ill-defined thickening of the oropharyngeal and laryngeal wall as well as both retropharyngeal and mandibular lymphadenomegaly. Lung metastases were found in 2/5 sarcomas and 2/4 melanomas.

In the Chapter 6 the findings of this thesis are discussed. Findings indicate that computed tomography is precise and it has a good sensitivity in determining mass extension, lymph node involvement and distant metastatic spread. Nevertheless computed tomography specificity is low because most of the CT features were overlapping in the different groups of neoplasia, thus the biopsy is always required for a final diagnosis. However computed tomography is fundamental to assess nodal metastasis particularly in those lymph nodes not easily achievable during clinical examination. Furthermore the medial retropharyngeal lymph nodes are most frequently and severely involved than mandibular lymph nodes, and their analysis should be included in staging of pharyngeal neoplasia.

Abstract (italiano)

L’esame tomografico computerizzato è comunemente usato per indagare le neoplasie a carico della regione della testa ed è parte integrante del percorso diagnostico dei pazienti oncologici, per la diagnosi, la stadiazione ed il planning terapeutico. Le patologie nasali sia neoplastiche che non neoplastiche, le neoplasie a carico del cavo orale, patologie cerebrali, i tumori tiroide e dei glomi carotidei sono state largamente studiate. Tuttavia poco o nulla è stato descritto in merito alle patologie che interessano la regione faringea.
In questa tesi sono stati raccolti i casi di cani con neoplasie del cavo faringeo, raccolte dal database di tre cliniche veterinarie di referenza per la diagnostica per immagini. Lo scopo di questo studio retrospettivo multicentrico è quello di analizzare le caratteristiche imaging di 25 cani che presentano neoplasie faringee per identificare le possibile caratteristiche che potrebbero differenziare i diversi tipi di tumore. Inoltre questo studio si propone di descrivere e analizzare la distribuzione e le caratteristiche imaging delle alterazioni patologiche dei linfonodi regionali (linfonodi mandibolari e retrofaringei mediali) allo scopo di individuare caratteristiche peculiari che potrebbero indicare una possibile disseminazione metastatica e quindi permettere una migliore stadiazione dei pazienti.

Nel Capitolo 1 viene descritta la normale anatomia macroscopica della faringe, la relativa suddivisione nei tratti naso-, oro- e laringofaringei; il sistema linfatico e le caratteristiche tomografiche ed i punti di repere delle diverse strutture. Le principali strutture anatomiche sono state individuate Vengono riportate una sequenza d’immagini tomografiche in cui sono indicate le principali strutture anatomiche più importanti che delimitano la cavità.

Nel Capitolo 2 sono state riportate le più comuni neoplasie faringee del cane. In ordine discendete troviamo il melanoma, il carcinoma squamoso cellulare ed il fibrosarcoma. Il comportamento biologico, alcuni aspetti clinici ed epidemiologici di questi tumori sono simili a quelli riportati in medicina umana. Queste caratteristiche assieme alla relativa brevità della vita del cane ed al fatto che questa specie condivide strettamente lo stesso ambiente dell’uomo, ne fanno un eccellente modello animale per gli studi di epidemiologia comparata.

Nel Capitolo 3 viene riportato il sistema TNM (Tumour-Nodal-Metastasis) approvato dalla World Health Organization per la stadiazione delle patologie neoplastiche nel cane. Inoltre sono stati riesaminati i criteri imaging utilizzati in medicina umana ed in medicina veterinaria per la valutazione delle alterazioni a carico dei linfonodi.

Nel Capitolo 4 comprende la sezione dei Materiali e Metodi riguardanti i criteri di inclusione dei casi individuati, i protocolli di acquisizione delle immagini, le caratteristiche tomografiche considerate e i relativi criteri di analisi e le procedure di analisi statistica. Le caratteristiche imaging sono state suddivise in caratteristiche qualitative e quantitative. Le caratteristiche qualitative comprendono la localizzazione delle lesioni, la forma, i margini, i rapporti con le strutture circostanti e le strutture vascolari, le caratteristiche di attenuazione, il pattern ed il grado di enhancement, variazioni di dimensione, forma ed enhancement delle strutture linfonodali e la presenza di potenziali lesioni metastatiche a distanza. Le caratteristiche quantitative comprendono le misurazioni delle dimensioni e del volume delle lesioni e la loro attenuazione pre e postcontrasto espressa in Unità Hounsfield (HU). È stato testato l’effetto della diagnosi finale su ogni singola caratteristica analizzata.

Nel Capitolo 5 vengono descritte la popolazione dei soggetti che rientravano nei criteri di inclusione, i risultati dell’analisi imaging e dell’analisi statistica. La casistica include: 15 carcinomi, 5 sarcomi, 4 melanomi e 1 linfoma. L’orofaringe e la laringofaringe sono state le regioni più coinvolte. Lesioni dei diversi gruppi presentavano dimensioni simili, forma irregolare, margini mal definiti, con enhancement eterogeneo che variava dal moderato al marcato. La lisi dell’oso ioide è stata riscontrata in due carcinomi, mentre l’infiltrazione dell’arteria linguale è stata riportata in un solo caso. In 11/14 carcinomi, in tutti i sarcomi e in 2/4 melanomi è stata riscontrata una marcata linfadenomegalia retrofaringea mediale. Il singolo caso di linfoma si presentava come un irregolare e mal definito ispessimento della parete orofaringea e laringofaringea, associata a linfadenomegalia mandibolare e retrofaringea mediale bilaterale. Metastasi polmonari sono state individuate in 2/5 sarcomi e 2/4 melanomi.

Nel Capitolo 6 vengono discussi e commentati i risultati dello studio. I risultati indicano che l’esame TC è preciso ed ha una buona sensibilità nell’individuare e determinarne l’estensione delle lesioni, indicare il coinvolgimento dei linfonodi regionali e la disseminazione metastatica regionale e a distanza. Ciononostante l’esame TC non si è rivelato essere altrettanto specifico poiché le lesioni presentano caratteristiche simili, pertanto l’esame istologico o citologico è sempre necessario per ottenere una diagnosi certa. Tuttavia l’esame tomografico è fondamentale per la valutazione di metastasi linfonodali, in particolare in quei linfonodi che non sono raggiungibili durante l’esame clinico. Inoltre, i linfonodi retrofaringei mediali sono stati più frequentemente e gravemente coinvolti rispetto ai linfonodi mandibolari e per questo dovrebbero essere inclusi nella stadiazione di neoplasie faringee.

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Tipo di EPrint:Tesi di dottorato
Relatore:Zotti, Alessandro
Dottorato (corsi e scuole):Ciclo 28 > Scuole 28 > SCIENZE VETERINARIE
Data di deposito della tesi:28 Gennaio 2016
Anno di Pubblicazione:28 Gennaio 2016
Parole chiave (italiano / inglese):Tomography, Retropharyngeal, tonsillar, pharyngeal, metastasis, carcinoma
Settori scientifico-disciplinari MIUR:Area 07 - Scienze agrarie e veterinarie > VET/08 Clinica medica veterinaria
Struttura di riferimento:Dipartimenti > Dipartimento di Biomedicina Comparata ed Alimentazione
Codice ID:9266
Depositato il:10 Ott 2016 10:23
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