https://www.vetsurgeon.org/f/clinical-questions/24229/mct-and-palladia Greeting, some opinions and experiences would be appreciated. I have a patient who I recently removed a patnaik grade 2 or kiupel low grade mast cell tumour from her shoulder (cutaneous) with a good &gt;1cm margins all sides and deep. this is the 2nden-USTelligent Community 10https://www.vetsurgeon.org/thread/157531?ContentTypeID=1Mon, 02 May 2016 22:30:14 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:122644ad-8f9d-40b2-8e02-6e0ae9da4095Christopher Saul<p>Hi Tony,</p> <p>I suspect that Braden is totally right and this is a de novo tumour; I also suspect he&#39;s right in that adjunctive therapy won&#39;t be needed in this case but to be&nbsp;sure however I would want to know a little more information:-</p> <p>- what is the mitotic index (you can find this by looking at the histo report; it is the number of mitotic figures per 10 high powered fields)?</p> <p>- I would suggest staging with survey imaging and FNAs of the local lymph nodes (you may need to do this under ultrasound guidance), liver and spleen.</p> <p>- If cost is not a major restriction then Ki67 may be useful (It is particularly useful when the mitotic index is in the &#39;grey zone&#39; of 2-5 ish) as this is independent of histological grade.</p> <p>Should the mitotic index be low (0,1,2), the staging not reveal any evidence for metastasis and the Ki67 (if performed) be low then adjunctive therapy will not be indicated; just what I term passive aggressive monitoring would be suitable.</p> <p>If mitotic index is high (certainly &gt;5 but also if it is less than 5 but with a high Ki67) or if there is documented metastasis then adjunctive treatment would be indicated.</p> <p>Regarding the choice of adjunctive therapy, the jury&#39;s still out regarding the choice between TKIs and conventional cytotoxic (vinblastine/CCNU).</p> <p>Regards which TKI, my own preference this case would be Masivet over Palladia. Masivet is narrower spectrum and generally better tolerated. I generally don&#39;t like Palladia for MCTs</p> <p>Just a few thoughts</p> <p>hope this helps</p> <p>Chris&nbsp;</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/157518?ContentTypeID=1Mon, 02 May 2016 10:40:37 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:cc2b2d50-5aae-4b54-aeb3-b158dcb57ef5Braden Collins<p>Each of those tumours is a new tumour, and if you&#39;ve got cleam margins on a low grade tumour I don&#39;t think you need to worry about recurrence or spread.&nbsp;</p> <p>I wouldn&#39;t use palladia at this point as I don&#39;t know of any evidence of it preventing new tumours, and I think the risks far outweigh any benefits. I would just encourage the owner to check the dog weekly and represent straight away if any lumps found.&nbsp;</p><div style="clear:both;"></div>