Hydropulsion to Biopsy and Debulk Nasal Tumors
ACVIM 2008
E.A. Ashbaugh1; B.C. McKiernan2; C.J. Miller1; B. Powers3
1Wheat Ridge Veterinary Specialists, Wheat Ridge, CO, USA; 2Southern Oregon Veterinary Specialty Clinic, Medford, OR, USA; 3Colorado State University, Fort Collins, CO, USA

Intranasal neoplasms of dogs and cats account for approximately 1% of all neoplasia in these species. Rhinoscopy accompanied with histopathology is the most definitive method to confirm a diagnosis of nasal neoplasia. It has been shown that rhinoscopic obtained biopsies can miss the diagnosis of nasal tumor up to almost 17% of the time. A relatively non-invasive technique to obtain a larger portion of mass tissue would help to increase the specificity of nasal biopsy. A technique for nasal hydropulsion is described here which allows for collection of a large portion of nasal tissue mass. This technique also has value by immediately improving clinical signs while awaiting histology results and treatment options.

Between January 2006 and January 2007, 24 patients (17 dogs and 7 cats) were evaluated with rhinoscopy and a nasal mass confirmed at Wheat Ridge Veterinary Specialists. Rhinoscopy of the anterior and posterior nasal cavities using both a 2.7-mm multi-purpose rigid telescope and a 5.0-mm flexible bronchoscope is performed. Once a nasal mass is confirmed, hydropulsion is performed as described: One side of the nares is digitally occluded. A 20-60 cc syringe containing room temperature sterile saline is inserted in the contralateral past the alar fold and sealing it with digital pressure. Typically a large catheter tip syringe is used except for small cats and dogs where a regular leur tip syringe could only be fitted into the nares. The saline (20-60cc volume) is forcefully infused, or hydropulsed, into the nasal cavity. This process is repeated on the contralateral nares. Tissue is collected from the wet laboratory table or the oropharynx and preserved in 10% buffered formalin for histopathological evaluation. The oropharynx is suctioned and cleaned thoroughly after the procedures The patient is then recovered routinely.

Hydropulsion was attempted in all 24 patients with a visible nasal mass. A diagnostic sample was successfully dislodged from the nasal cavity in 22 of 24 nasal tumors (92% success rate). Cats had a 100% success rate of diagnostic specimen obtained whereas dogs success rate was slightly lower at 88%. Nasal tumors that were identified include: adenocarcinoma (5), other carcinomas (8), lymphoma (2), osteosarcoma (1), other sarcomas (5) and one spindle cell tumor. Two cats and three dogs had hydropulsion performed multiple times in order to alleviate recurring clinical signs of obstructive nasal breathing and epistaxis. The symptom free interval ranged from four months to fifteen months for these patients. In the 2 cases where hydropulsion was unsuccessful, endoscopic pinch biopsies or true cut biopsies (multilobulated osteosarcoma) were obtained. Post operative complications included sneezing, mild post-operative epistaxis, and rarely, temporary retrobulbar swelling with subsequent buphthalmia.

Hydropulsion allows for minimally invasive debulking of some tumors providing clinical relief and biopsy collection to direct further therapies.

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Elizabeth Ashbaugh