For tumors of the head, presence of lymph node metastasis can affect treatment recommendations and may negatively impact outcome ( 1– 7). Tumor staging including the evaluation of locoregional draining lymph nodes for metastasis is a critical step in the oral oncologic work-up. Prospective studies are warranted to determine the potential diagnostic and therapeutic value of END in the N0 neck in veterinary patients such that a consensus approach can be made. While tumor type and size influenced the decision to pursue END, it was not routinely recommended, even for tumor types with a known propensity for metastasis. This study highlights the variability in recommendations for lymph node pathology for dogs with oral tumors.
Academic clinicians were significantly ( p < 0.01) more likely to recommend END compared to private practitioners for canine T1–T3 OMM, T3 OSCC, T2 OFSA, and MCT. The likelihood of recommending END increased with increasing tumor size. Bilateral removal of the mandibular and retropharyngeal lymph nodes was recommended more often for oral malignant melanoma (OMM) than for oral squamous cell carcinoma (OSCC p ≤ 0.0039) or for oral fibrosarcoma (OFSA p ≤ 0.0007). The recommendation to routinely perform END in the N0 neck was significantly associated with tumor type. Regardless of tumor type and stage, extirpation and histopathology were most commonly recommended in the clinical N+ neck only. Respondents identified as oncologists (44%, N = 38), soft tissue surgeons (40%, N = 35), and dentists (16%, N = 14). Overall, 87 responses were obtained from 49 private practices (56%) and 38 academic institutions (44%). The objective of this cross-sectional survey study was to determine the current recommendations given by practicing specialists regarding lymph node removal for dogs with oral tumors. When clinicians are recommending END as a staging tool to confirm nodal status, there is also ambiguity regarding the surgical extent for subsequent histopathologic evaluation. It is particularly unclear if clinicians recommend removal of lymph nodes only when there is confirmation of metastasis, defined as the N+ neck, or if elective neck dissection (END) is routinely recommended to confirm the true pathologic metastatic status of lymph nodes in the clinical N0 neck (no evidence of metastasis on clinical staging with diagnostic imaging or cytology). There is no clear guideline regarding the indication for routine lymph node extirpation and pathologic evaluation during staging of canine oral tumors, despite a relatively high reported nodal metastatic rate for select tumor types. 3Department of Veterinary and Biomedical Sciences, University of Minnesota, St.2Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States.1College of Veterinary Medicine, University of Minnesota, St.Michael Congiusta 1, Jessica Lawrence 2,3, Aaron Rendahl 3 and Stephanie Goldschmidt 3 *
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