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- Hypercalcemia may increase the likelihood of lymph node metastases in dogs with AGASACA
Hypercalcemia may increase the likelihood of lymph node metastases in dogs with AGASACA
Vet Med Sci 2023
Background: Anal sac adenocarcinoma (ASACA) is a malignant perianal tumour in dogs that often metastasizes to the iliosacral lymph nodes and causes hypercalcaemia. The association between hypercalcaemia and lymph node metastasis has not been investigated before.
Study: The authors conducted a retrospective study to determine if increased total serum calcium level is associated with iliosacral lymph node metastasis in dogs diagnosed with ASACA using abdominal ultrasonography.
Methods: The authors searched the medical records of a single referral hospital to identify dogs with ASACA that had serum total calcium and abdominal ultrasound within 6 weeks of diagnosis. The ultrasound images were reviewed by a board-certified radiologist to classify the lymph nodes as suspected/confirmed metastasis-free or suspected/confirmed metastatic. A Fischer’s exact test was used to assess the association between hypercalcaemia and lymph node metastasis.
Results: Of the 58 dogs included, 19 (33%) had hypercalcaemia and 24 (41%) had suspected/confirmed lymph node metastasis. Hypercalcaemia was significantly associated with lymph node metastasis (p < 0.01), with a positive predictive value of 68% and a negative predictive value of 72%. The sensitivity and specificity of hypercalcaemia for lymph node metastasis were 54% and 82%, respectively.
Limitations: The study had several limitations, such as the use of total calcium instead of ionized calcium, the use of abdominal ultrasound instead of computed tomography, the lack of cytology or histopathology for all lymph nodes, and the retrospective design.
Conclusions: The study suggests that hypercalcaemia may increase the likelihood of lymph node metastasis in dogs with ASACA, but it cannot be used as a screening tool. Dogs with ASACA should undergo full staging regardless of serum calcium levels.
Parasagittal/long-axis images of the medial iliac lymph nodes in two dogs. (A) Medial iliac lymph node in a dog classified as ‘normal’. A-plus signs denote the ventrodorsal thickness, and asterisks denote the craniocaudal length. This lymph node had a maximal thickness of 6 mm and a thickness-to-length ratio of 0.18. (B) Medial iliac lymph node in a dog classified as ‘abnormal’. Open calipers denote the ventrodorsal thickness, and asterisks denote the craniocaudal length. This lymph node had a maximal thickness of 22 mm and a thickness-to-length ratio of 1.0 and was classified as heterogenous.
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