Wyzwania w interpretacji wyników USG w przypadku przerzutów raka żołądka u psów

Ultrasound imaging is a valuable tool in veterinary oncology, particularly when assessing the spread (metastasis) of gastric cancer in dogs. Despite its many advantages, interpreting ultrasound results for metastasis in canine gastric cancer can present several challenges. These limitations often stem from the difficulty in distinguishing between malignant and benign abnormalities, as well as the reliance on subjective interpretation of the images. This article explores the challenges veterinarians face when using ultrasound to evaluate metastasis in canine gastric cancer and how to overcome these obstacles.

Understanding the Role of Ultrasound in Canine Gastric Cancer

Ultrasound is commonly used in diagnosing and staging gastric cancer in dogs because it provides detailed, real-time images of the stomach and surrounding organs. When it comes to metastasis, ultrasound helps detect abnormalities in areas such as:

1. Lymph Nodes
   Enlarged lymph nodes near the stomach may indicate the spread of cancer, but they can also enlarge due to reactive or benign causes such as infection or inflammation.
2. Liver and Spleen
   Metastasis from gastric cancer often spreads to the liver and spleen. Ultrasound can detect nodules or masses in these organs, which may suggest metastatic disease.
3. Other Abdominal Organs
   The pancreas, kidneys, and other abdominal structures can also be examined for potential signs of metastasis using ultrasound.

Challenges in Interpreting Ultrasound Results

1. Distinguishing Between Benign and Malignant Changes
   One of the primary challenges in interpreting ultrasound results is differentiating between malignant lesions and benign conditions. For example, nodules found in the liver or spleen may be benign hyperplastic nodules rather than cancer metastasis. Similarly, enlarged lymph nodes could be the result of reactive hyperplasia or inflammation, not necessarily metastatic spread. Ultrasound alone cannot definitively confirm whether abnormalities are malignant, which often leads to further diagnostic steps, such as biopsy or fine-needle aspiration.
2. Subjective Interpretation of Images
   Ultrasound is a highly operator-dependent procedure. The skill and experience of the veterinarian performing the ultrasound can significantly impact the accuracy of the interpretation. Variations in equipment, image quality, and interpretation criteria can also lead to inconsistencies in diagnosing metastasis. This subjective nature of ultrasound results makes it essential for veterinarians to be well-trained in veterinary oncology and diagnostic imaging.
3. Challenges with Small or Early Metastatic Lesions
   Early-stage metastatic lesions may be too small to detect on ultrasound. These tiny abnormalities might not cause noticeable changes in the organ’s appearance or texture, leading to false-negative results. This limitation can be particularly problematic for cancers that are prone to early and aggressive metastasis, such as gastric adenocarcinoma in dogs. To improve detection, veterinarians may use other imaging modalities like CT scans or MRIs alongside ultrasound for more comprehensive evaluations.
4. Interpreting Changes in the Gastric Wall and Layers
   In the case of gastric cancer, ultrasound is often used to assess the thickness and integrity of the stomach wall. While ultrasound can detect increased thickness in the gastric wall, it is not always clear whether this thickening is due to a tumor, inflammation, or another benign condition. Additionally, invasive tumors like adenocarcinoma can disrupt the layered appearance of the stomach wall, but these changes may not always be clearly visible, making interpretation challenging.
5. Ultrasound Artifacts and Image Quality
   Artifacts (unintended anomalies in ultrasound images) can complicate the interpretation of results. Poor image quality due to patient movement, gas interference, or suboptimal equipment can obscure key details, leading to inaccurate conclusions. For example, gas in the intestines can block ultrasound waves, making it difficult to visualize nearby structures or masses.

Addressing the Challenges in Ultrasound Interpretation

Veterinarians employ several strategies to address these challenges and improve the accuracy of ultrasound interpretation in cases of canine gastric cancer metastasis:

1. Combining Ultrasound with Other Diagnostic Tools
   To overcome the limitations of ultrasound, it is often combined with other diagnostic methods such as X-rays, CT scans, or endoscopic procedures. Biopsy or fine-needle aspiration can also provide a definitive diagnosis of whether an abnormality is malignant or benign.
2. Performing Serial Ultrasound Examinations
   Serial ultrasound examinations, or repeat scans over time, can help track the progression of abnormalities. By observing changes in size, shape, or location of lesions or masses, veterinarians can make more informed decisions about the likelihood of metastasis.
3. Using Doppler Ultrasound
   Doppler ultrasound, which measures blood flow, can help distinguish between benign and malignant lesions. Malignant tumors often have abnormal blood flow patterns, which can be detected using Doppler technology. This additional layer of information improves the accuracy of the diagnosis.
4. Expert Training and Second Opinions
   Veterinarians with advanced training in ultrasound and veterinary oncology are better equipped to interpret complex images accurately. Additionally, seeking second opinions or consulting specialists in veterinary diagnostic imaging can help clarify ambiguous results.

While ultrasound is an essential tool in evaluating metastasis in canine gastric cancer, interpreting the results presents several challenges. The difficulty in distinguishing between benign and malignant changes, the subjective nature of ultrasound interpretation, and the limitations in detecting small or early lesions all contribute to the complexity of this diagnostic tool. By combining ultrasound with other diagnostic methods, using advanced technologies like Doppler ultrasound, and seeking expert opinions, veterinarians can improve their ability to diagnose and manage metastasis in dogs with gastric cancer.