Zoe tussled around all morning Thursday.
For researchers at the University of Arkansas for Medical Sciences, that was a good thing. The curly-haired golden retriever was passing her test for the day, one that could earn her a spot on a team of dogs that can help detect thyroid cancer.
Two doctors -- Arny Ferrando, a UAMS professor in the Department of Geriatrics, and Donald Bodenner, director of the Thyroid Center at UAMS -- first set the wheels in motion about two years ago to study whether dogs could detect cancer. It started with two of Ferrando's own dogs, Frankie and Sophie, who were already scent-trained for search-and-rescue missions.
"Whenever we got together and talked, I would kind of tell him [Bodenner] the amazing things that they would do and how they would do it," Ferrando said. "I spent a lot of time with my mouth open and my jaw dropped."
Bodenner was the impetus behind the attempt to train the dogs to sniff out cancerous tissue that is difficult to detect.
Thyroid cancer is growing in prevalence and affects more women than men, doctors have said. Nodules or little bumps can form on a person's thyroid -- a flat, bow-tie shaped gland at the base of the neck -- but doctors don't know the cause behind the nodule formations. The difficulty in diagnosing thyroid cancer is mainly because of the number of nodules a person can have, Bodenner said.
"The big problem is trying to tell which one of those are malignant and which ones are benign," he said. "And we're kind of in a difficult position because we can't biopsy everyone who walks in the door. You just can't do it."
Coupled with that, tests on the tissue are inconclusive many times, in part because the needle used to grab the tissue doesn't gather enough cells.
Julee Turner of Arkadelphia had a biopsy on her thyroid three times after her gynecologist discovered a lump in her neck area. For the 31-year-old, all of the biopsies came up inconclusive -- the lump was suspicious, but tests couldn't say whether it was benign or malignant, she said.
"It was always on my mind, in my daily thoughts of wondering whether or not it was cancer," Turner said. "If anything, I would have rather just known than have had to wonder until they took it out."
After the third test -- her only one at UAMS -- Bodenner suggested she take out her thyroid. She had the surgery and is now taking synthetic thyroid medications.
After the surgery, Turner was asked whether she would take part in the clinical trial. She found out recently that the dogs had detected her sample as a cancerous one. It matched the pathology.
"I think that anything working towards early detection is a positive thing for cancer and cancer research," she said.
Once the idea to use the dogs came to mind, the two doctors assembled a team, bringing in people to help with the research and a dog trainer and handler. Then, they got to work.
First, the dogs were made to smell cancerous tissue from patients who had a portion, if not all, of their thyroids removed. Once the dogs grew familiar with that smell, they faced a test where vials were placed in several stations in a room. Stefani Waggoner, who is in charge of evaluating and training the dogs, would teach them to lie down or sit next to the vial filled with a cancer patient's urine or blood sample.
Sophie, Ferrando's border collie mix, would sniff out each station and lie down to signal the vial with the cancerous samples. But Frankie, Ferrando's German shepherd mix, was a toucher.
"He'd just paw, paw, touch," Ferrando said. "It looked like Godzilla over Tokyo, to be honest."
So, the team developed a calmer method for him: presenting him with individual vials instead.
The experiments were "double-blinded," meaning Bodenner didn't know what the dogs indicated about the sample and Ferrando didn't know the findings on a pathology test. When the pathology came back, the team would marry the answers to see how accurate the dogs were.
In 33 of 36 samples, the dogs correctly detected whether the sample was cancerous or not -- nearly 92 percent of the time.
Now, the team is moving to the second phase of the study.
The team is hoping to get hundreds of more patients. While other medical researchers have finished similar studies, they've mostly done so with limited data sets or patients, Bodenner said.
The doctors also are hoping to get more dogs involved. UAMS has helped create a crowdfunding site for the team at consano.org/projects/69-canine-diagnosis-of-cancer.
"Once we show it can be done in a great number of dogs, I think that's when it has merit to be used as a clinical adjunct," Ferrando said. "Because right now, it's like people say, 'Oh that's just a great dog. You just got a great dog.' But the idea for Stefani here is she's going to evaluate a lot of dogs and see what it's going to take to get those kinds of dogs."
The team has reached out to Auburn University, which has developed a genealogy for canines -- one that allows the dogs at birth to be predisposed to scent-detection. Between the two sites, the groups are hoping to raise the numbers, both of patients and dogs. As of last week, the study had almost 100 patients from UAMS alone.
Auburn has the purpose-bred dogs, while Waggoner is trying to train just about any dog. In total, she has evaluated about a half-dozen dogs.
"The thing that we do like to look for is the hunt drive, so we like hunt-driven dogs that live to search," said Waggoner, a former Marine Corps Explosive/Patrol Detection Canine handler/trainer.
And just like people, the dogs have their good days and their bad days.
The trick is never to build a negative association when working with them, she said, because to them, it's a game.
Evaluations usually start with a day without the dog's owners at UAMS to get the canines comfortable. Most of it is finding out whether the dog is motivated though, Waggoner said.
Zoe, the golden retriever, was doing well this time around, Ferrando said, adding that she usually gets separation anxiety when her owner isn't nearby. Zoe also has been scent-trained for search-and-rescue missions and will likely be another addition to the team, he said.
In the long run, the doctors are hoping to expand the study in other ways: Can the dogs detect whether a patient is in remission? Can they detect other cancers? Can they tell whether a cancer has spread to other areas of the body?
"Once we form the template with this cancer -- and it's a hard to diagnose cancer, that's why we started with it -- we're going to move to other hard-to-diagnose cancers that are perhaps more deadly like pancreatic, ovarian, colorectal even breast," Ferrando said. "Over the next year or so, we hope to get this to the point where we can do thyroid cancer, but there's so many questions to answer in each, just like any good research. I don't ever see this 'winding down.' I see it building up to a greater benefit to mankind."
Metro on 05/10/2015