Diagnostics in Veterinary Oncology
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Title: Diagnostics in Veterinary Oncology Presented by: Ariana Verrilli, DVM, DACVIM (Oncology) Description: This session will discuss the various tests currently available in veterinary oncology, from cytology and histopathology to DNA sequencing and genetic testing. We will review the pros and cons of multiple tests, the best use for each test, and how to interpret results. We will also review sample submissions and specific lab requirements as appropriate.
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Diagnostics in Veterinary Oncology
- 1. THE OLD, THE NEW, AND THE IN BETWEEN ARIANA VERRILLI, DVM, DACVIM (O) DIAGNOSTICS IN VETERINARY ONCOLOGY
- 2. WWW.UVSONLINE.COM Radiographs Ultrasound CT scan MRI PET CT Nuclear scintigraphy IMAGING MODALITIES 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 3. WWW.UVSONLINE.COM RADIOGRAPHS: STAGING 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 4. WWW.UVSONLINE.COM RADIOGRAPHS: PRIMARY TUMORS 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 5. WWW.UVSONLINE.COM RADIOGRAPHS: BONE LESIONS 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 6. WWW.UVSONLINE.COM Widely available, relatively inexpensive Good for: Screening Staging Assessing response to therapy Evaluating for comorbidities Guided tissue sampling ULTRASOUND 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 7. WWW.UVSONLINE.COM CT SCAN 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 8. WWW.UVSONLINE.COM CT IMAGES 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 9. WWW.UVSONLINE.COM MRI Nuclear Scintigraphy PET / CT ADDITIONAL IMAGING 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 10. WWW.UVSONLINE.COM Cytology Histopathology Immunohistochemistry Immunocytochemistry Melanoma panel MCT panel BASIC TISSUES DIAGNOSTICS 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 11. WWW.UVSONLINE.COM Advantages Inexpensive Readily available Low risk to patient Fast turnaround time Evaluate appearance of individual cells May give definitive diagnosis Disadvantages Small sample Poor sample quality Lack of architecture May not give diagnosis CYTOLOGY 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 12. WWW.UVSONLINE.COM Carcinoma Sarcoma CYTOLOGY IMAGES 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 13. WWW.UVSONLINE.COM Tumor vs. Not Benign vs. Malignant Histologic type Histologic grade (if appropriate) Assess surgical margins HISTOPATHOLOGY 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 14. WWW.UVSONLINE.COM Identifies antigens that are relatively specific to one cell type Can help ID poorly differentiated tumors Likely multiple stains will be required Must be used in conjunction with morphology IMMUNOHISTOCHEMISTRY 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 15. WWW.UVSONLINE.COM IHC against: Melan-A PNL-2 TRP-1 TRP-2 Highly sensitive and specific Panel also includes prognostic markers MELANOMA PANEL 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 16. WWW.UVSONLINE.COM Includes: Ki67 and AgNORs C-Kit PCR for ITD mutations in exons 8 & 11 IHC for KIT expression pattern Can help predict behavior and need for adjuvant treatment MCT PANEL 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 17. WWW.UVSONLINE.COM PARR Flow cytometry Cadet BRAF Genome sequencing Cell free DNA Nucleosome testing Chemosensitivity assay MOLECULAR DIAGNOSTICS: 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 18. WWW.UVSONLINE.COM PCR for antigen receptor rearrangement Clonality assay Best for differentiating reactive from neoplastic lymphocytes or confirming lymphoid neoplasia Can be used for immunophenotyping PARR 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 19. WWW.UVSONLINE.COM Analysis of individual cell properties Cells must be in suspension and alive Primarily hematopoietic tumors Provides better immunophenotyping and prognostic information Currently limited use in cats FLOW CYTOMETRY 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 20. WWW.UVSONLINE.COM BRAF Canine urine sample Evaluates for BRAF mutation No present in healthy dogs or inflammatory conditions Sensitivity 85%, specificity 100% BRAF-Plus Add on test when BRAF is negative Looks for specific copy number variations Increases sensitivity to 95% Very low limit of detection (10 cells) CADET BRAF 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 21. WWW.UVSONLINE.COM FidoCure Extracts tumor DNA for NGS ID genetic mutations within tumor Makes recommendations for targeted therapies Can use on formalin-fixed or fresh biopsy samples Vidium Extracts tumor DNA for NGS Identifies unique mutations Provides diagnostic, prognostic, and therapeutic biomarkers Reports available drug therapies that target those mutations Can use on FNA, formalin-fixed, or fresh frozen samples DNA SEQUENCING 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 22. WWW.UVSONLINE.COM FIDOCURE REPORT 9/26/2023 INSERT YOUR PRESENTATION HERE
- 23. WWW.UVSONLINE.COM Biological fluids used to detect CTCs, cfDNA, or other cellular structures Prognosis, targetable mutations, response to treatment, relapse Pros & cons LIQUID BIOPSY 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 24. WWW.UVSONLINE.COM cfDNA liquid biopsy Identifies cancer-associated genomic alterations Screening or diagnostic test High specificity; not as sensitive Has been positive for 30 different cancers ONCOK9 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY https://www.veterinarypracticenews.com/clinical-validation-of-oncok9-a-blood-based-multi-cancer-early-detection-liquid-biopsy-test-for-dogs/
- 25. WWW.UVSONLINE.COM Nucleosomes released from cancer cells Measures nucleosomes in blood Detects 76% of systemic cancers at 97% specificity 77% lymphoma, 82% hemangiosarcoma, 54% histiocytic sarcoma Only for dogs, patient must be fasted 4+ hours Point-of-care option Screening, diagnosis, response to treatment NU.Q® 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY https://vetmed.tamu.edu/gilab/service/assays/nu-q-vet-cancer-screening-test/
- 26. WWW.UVSONLINE.COM Chemosensitivity assay Hypercalcemia of malignancy panel CBC Chemistry panel ADDITIONAL DIAGNOSTICS 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 27. WWW.UVSONLINE.COM Chemosensitivity assay 13 most common drugs Immunophenotyping data provided Uses flow cytometry + PARR + drug sensitivity + patient data AI algorithm predicts drug response IMPRIMED 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 28. WWW.UVSONLINE.COM Hypercalcemia: Most common with lymphoma or AGASACA Typically, from production of PTHrP Will often note signs of hyperCa before tumor symptoms Panel can help differentiate causes of hypercalcemia PTHrP may be negative for some malignancies HYPERCALCEMIA OF MALIGNANCY PANEL 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY Diagnosis ICa PTH PTHrP HCM High Low Positive* 1° HPT High Normal / high Negative Hypervit D High Low Negative Granulomatous disease High Low Negative
- 29. WWW.UVSONLINE.COM Lymphocytosis Leukemia vs. Stage V lymphoma Acute vs. Chronic Hyperglobulinemia Plasma cell neoplasia, B cell neoplasia Hypercalcemia Elevated liver enzymes Azotemia CBC / CHEMISTRY PANEL 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 30. WWW.UVSONLINE.COM Lots of different tests available to help us get a definitive diagnosis Can be difficult to know what tests to use when New tests are continuing to come to market Usefulness of individual tests will become clearer with time REVIEW 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 31. WWW.UVSONLINE.COM Thank you for your attention! QUESTIONS? 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
- 32. WWW.UVSONLINE.COM 1. Withrow and Macewen’s Small Animal Clinical Oncology. ELSEVIER HEALTH SCIENCES; 2020. Accessed September 16, 2023. https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso,uid&db=edsgob&AN=edsgob.300950102&site=eds-live&scope=site 2. Nemanic S, London C, Wisner E. Comparison of thoracic radiographs and single breath-hold helical CT for detection of pulmonary nodules in dogs with metastatic neoplasia. JOURNAL OF VETERINARY INTERNAL MEDICINE. 2006;20(3):508-515. Accessed September 11, 2023. https://research-ebsco-com.proxy.library.upei.ca/linkprocessor/plink?id=1cbd8817-e6e0-389a-92a2-5ad2dc41e35e 3. Vail DM, Thamm DH, Reiser H, et al. Assessment of GS-9219 in a Pet Dog Model of Non-Hodgkin’s Lymphoma. CLINICAL CANCER RESEARCH. 2009;15(10):3503-3510. Accessed September 18, 2023. https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso,uid&db=edsbl&AN=RN251841959&site=eds-live&scope=site 4. Meuten DJ, ed. Tumors in Domestic Animals. Fifth edition. John Wiley & Sons Inc.; 2017. Accessed September 18, 2023. https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso,uid&db=cat01065a&AN=upei.1500264&site=eds-live&scope=site 5. Ramos-Vara JA, Kiupel M, Baszler T, et al. Suggested guidelines for immunohistochemical techniques in veterinary diagnostic laboratories. Journal of Veterinary Diagnostic Investigation. 2008;20(4):393-413. Accessed September 18, 2023. https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso,uid&db=cbt&AN=20093185790&site=eds-live&scope=site 6. Raskin R, Meyer DJ. Canine and Feline Cytology : A Color Atlas and Interpretation Guide. Vol 3rd edition. Saunders; 2016. Accessed September 19, 2023. https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso,uid&db=edsebk&AN=1000099&site=eds-live&scope=site 7. Ramos-Vara JA, Miller MA. Immunohistochemical identification of canine melanocytic neoplasms with antibodies to melanocytic antigen PNL2 and tyrosinase: Comparison with melan A. Veterinary Pathology. 2011;48(2):443-450- 450. doi:10.1177/0300985810382095 8. Krick EL, Kiupel M, Durham AC, Thaiwong T, Brown DC, Sorenmo KU. Investigating Associations Between Proliferation Indices, C-kit, and Lymph Node Stage in Canine Mast Cell Tumors. Journal of the American Animal Hospital Association. 2017;53(5):258-264. doi:10.5326/JAAHA-MS-6265 9. Stefano Comazzi, Fulvio Riondato. Flow Cytometry in the Diagnosis of Canine T-Cell Lymphoma. April 2021. Accessed September 20, 2023. https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso,uid&db=edsago&AN=edsago.DJ20220791381&site=eds-live&scope=site 10. Mochizuki H, Shapiro SG, Breen M. Detection of BRAF Mutation in Urine DNA as a Molecular Diagnostic for Canine Urothelial and Prostatic Carcinoma. PloS one. 2015;10(12):e0144170. doi:10.1371/journal.pone.0144170 11. Aghamir SMK, Heshmat R, Ebrahimi M, Khatami F. Liquid Biopsy: The Unique Test for Chasing the Genetics of Solid Tumors. Epigenetics Insights. January 2020:1-7. doi:10.1177/2516865720904052 12. Flory A, Kruglyak KM, Tynan JA, et al. Clinical validation of a next-generation sequencing-based multi-cancer early detection “liquid biopsy” blood test in over 1,000 dogs using an independent testing set: The CANcer Detection in Dogs (CANDiD) study. PLoS ONE. 2022;17(4):1-33. doi:10.1371/journal.pone.0266623 13. Wilson-Robles HM, Bygott T, Kelly TK, et al. Evaluation of plasma nucleosome concentrations in dogs with a variety of common cancers and in healthy dogs. BMC Veterinary Research. 2022;18(1):1-11. doi:10.1186/s12917-022- 03429-8 14. Koo J, Choi Kyucheol, Lee P, et al. Predicting dynamic clinical outcomes of the chemotherapy for canine lymphoma patients using a machine learning model. Veterinary Sciences. 2021;8(12). doi:https://www.mdpi.com/2306- 7381/8/12/301 REFERENCES: 9/26/2023 DIAGNOSTICS IN VETERINARY ONCOLOGY
Editor's Notes
- Top 3 use often Not using MRI frequently – neuro uses often PET CT (positron emmision tomography) Nuclear scintigraphy
- - Widely available, relatively inexpensive Staging, screening, secondary findings / comorbidities, response to therapy / progressive disease Thoracic radiographs for staging: are useful for staging – looking for pulmonary metastasis Can reliably detect pulmonary nodules >9mm in size Good initial screen test 3 views recommended, allows for capture of most lesions Mis-diagnosis in 15% of patients with only 2 views CXR Not mandatory for all tumor types lymphoma / leukemia – does not necessarily change treatment, may impact prognosis MCT also not mandatory Do recommend for all carcinomas, sarcomas, HS, plasma cell neoplasia, melanomas, etc. Abdominal radiographs not recommended for staging – not enough soft tissue detail Images: two patients with metastatic pulmonary lesions
- Can be used for screening – to evaluate for primary tumors Useful for diagnosis mediastinal masses Left - Canine mediastinal mass on left Right - Feline mediastinal mass on right For identifying primary lung tumors Can also be used to evaluate for pleural effusion (carcinomatosis or other) Abdominal radiographs as screen for primary tumors is more limited Are unable to ID all tumors or tissue of origin Used less frequently
- Useful for evaluating bone lesions Left: Primary osteosarcoma distal tibia Right: Metastatic bone lesions (carcinoma) proximal humerus Also useful for looking for bone lesions in multiple myeloma cases Not great at evaluating: skull for nasal / oral / facial tumors
- Left: Right: abdomen w/ enlarged LN & thickened GIT dog Widely available, relatively inexpensive Screening, staging, assessing response to therapy Evaluate for comorbidities Good for: Abdominal US: primary tumors, metastatic disease, lymphadenopathy Cervical US: thyroid, LNs, etc. Thoracic US: mediastinal masses, pulmonary lesions Echocardiogram for heart based tumors, cardiac HAS, etc. Sampling tissues w/ ultrasound guidance AUS useful for staging all tumors Not mandatory for lymphoma / leukemia – does not necessarily change treatment, may impact prognosis Important for MCTs / HS/ plasma cell, sarcomas, carcinomas, melanomas Can also be used for lymph node mapping and other specialized techniques
- Left: primary lung tumor; right: osteosarcoma More sensitive than radiographs at detecting lesions Best for staging & surgical planning Thorax Able to detect pulmonary nodules as small as 1mm – catches what CXR miss Better at evaluating thoracic LNs vs. CXR Abdomen: Able to imaging in pelvis & around gas filled structures Better imaging for some abdominal tumors (I.e. insulinoma) US still better for evaluating some abdominal lesions (i.e. GI layering) Also good way to detect bone lesions – primary and metastatic (60% OSA will develop bone mets) Much better than radiographs for skull / cervical imaging Able to better ID tumor extent / margins / tissue invasion Often important for surgical planning and / or radiation therapy Better able to delineate tumor boarders vs. Palpation or other imaging modalities Detect local tumor invasion Cannot differentiate tumor vs. Tumor associated inflammation Can also be used for guided sampling of tissues
- - Left: MLO - Right: nasal tumor
- MRI: good soft tissue resolution but not widely used outside of CNS tumors Will sometimes use in conjunction with CT for brain or nasal tumor RT Nuclear Scintigraphy: Evaluation of radiopharmaceutical accumulation Low resolution – limited anatomic detail Thyroid and bone is where this is used most often For bone sensitive but not specific – no differentiation between cancer and other bone change other imaging modality needs to be used in conjunction Typically not preferred modality Other imaging modalities work well so not used as often – especially given more ready access to CT scan Access limited PET / CT: (image - lymphoma) Positron emission tomography / computed tomography Combines function imaging of NS w/ high spacial resolution of CT Uses radiopharmaceuticals to target areas of interest on scan Tumors are often hypermetabolic so can be easily targeted them with glucose analogs or other markers F-18 FDG most common radiopharm– detects increased metabolic activity – not cancer specific Others available: F-18 NaF for bone lesions; F-18 FLT for proliferating tissues; Cu-ATSM for hypoxic tissues Likely has similar value in vet patients as humans but is currently not widely available and cost prohibitive Don't have ready access and cost prohibitive outside of research environment
- Useful for: Obtaining diagnosis / preliminary diagnosis Staging Monitoring response to therapy Detecting recurrence Advantages Alone may give definitive diagnosis (i.e. most round cell tumors) Disadvantages Small sample – may not be representative of whole tumor or tissue Poor quality – due to tumor (necrosis, doesn't exfoliate) or technique (lysed cells) Lack of architecture can make it hard to differentiate inflammatory / neoplastic and benign / malignant tissues May not give diagnosis (i.e. hepatocellular carcinoma)
- Sampling: Try to get a representative sample (multiple areas or multiple LNs) Be delicate when smearing – tumor cells are often fragile and can easily rupture (esp. Lymphoma)
- Histopath can tell us: Tumor vs. not Benign vs. malignant Histo type and grade Surgical margins Pretreatment: Core, punch, wedge, tru-cut, etc. obtain additional information before definitive treatment Posttreatment: excisional biopsy Gives information about grade, subtype, invasion, margins, etc. If clinical behavior not matching pathology consider second opinion, special stains, etc. 10% diagnostic disagreement If histo path doesn't give answers you need --> IHC may be recommended Image is lingual carcinoma
- Antibodies bind antigens that are expressed by certain cell types A color reaction allows it to be visualized Can help give definitive diagnosis which can have a big impact on treatment and prognosis Ex. Oral tumor – r/o OMM vs. Poorly differentiated sarcoma vs. HS Would treat all very differently! Quick note on immunocytochemistry Done in similar way to IHC Similar panel of markers Not done as often, limited clinical use
- Specificity close to 100%, Sensitivity ~98% This includes for amelanotic melanomas which are typically the ones we need IHC for Includes Ki67, nuclear atypia, MC, & degree of pigmentation which are all prognostic
- Includes: Proliferation indices: Ki67 & AgNORs (argyrophilic nucleolar organizer regions) Ki67 tells about number of proliferating cells AgNORs relate to speed of proliferation Combining these 2 tests is predictive of metastasis and survival Shown that MCTs with low proliferation indices don't need adjuvant therapy even w/ incomplete surgical margins C-Kit PCR for ITD mutations in exon 8 & 11 Internal tandem duplication mutations 20-30% of cMCTs have ITD in exon 11 --> correlated with more aggressive behavior but respond better to TKIs 2-5% have mutations in exon 8 --> not correlated with behavior, expected to respond to TKIs IHC for KIT expression pattern Increased cytoplasmic labeling and loss of membrane-associated labeling --> more aggressive behavior
- PCR for antigen receptor rearrangement Clonality assay --> all cells derived from a single clone Detects unique genes of an individual B or T lymphocyte that encode the antigen binding region Detects immunoglobulin gene in B cells and T-cell receptor genes in T cells If most cells from a node (or multiple nodes or lymphocyte center) have the same receptor gene --> most likely neoplastic, not reactive A reactive process will have different-sized TCR and immunoglobulin genes Best for differentiating reactive from neoplastic population Can be used for immunophenotyping but not as good (i.e. peripheral T cell vs. T-zone) Very high sensitivity and high specificity for dogs; specificity good for cats but not as sensitive (~60%) Does have some variation from lab to lab
- Analysis of individual cells as they pass in front of a laser Light absorbance and scatter properties --> cell size and complexity Can also bind antibodies to look for and quantify intracellular and surface marker expression Allows for rapid identification of a large number of cells Most often used for hematopoietic tumors Cells must be in suspension: anti-coagulated blood or fluids, or FNA suspended in media Must be shipped overnight --> cells need to be alive on arrival Cannot always differentiate reactive from neoplastic cells Can do this if there is aberrant expression of markers (i.e. loss of CD45 in T-zone lymphoma/leukemia) Does provide better immunophenotyping & prognostic information I.e. T-zone vs. Peripheral T cell; acute leukemia (CD34+) vs. CLL Helps differentiate thymoma from cranial mediastinal lymphoma Thymoma has CD4+ CD8+ lymphocytes --> coexpression only found in thymus Mediastinal lymphomas will only express one marker – not both Can be used for peripheral lymphocytosis in cats to help differentiate neoplastic vs. Reactive For solid tissue samples PARR is more often recommended Hopefully we will continue to add markers and flow for cats will improve
- Uses for BRAF: Screening high risk patients / breeds Diagnosis: for patients w/ visible tumor or clinical signs consistent with TCC Monitoring response: BRAF should decrease as tumor response to treatment, increase w/ progressive disease
- NSG = next generation sequencing FidoCure: Evaluates tumor DNA for targetable mutations Makes tx recommendations for targeted drugs available through compounding pharmacy Provide recommended dose and monitoring plan Vidium: Evaluates important mutations in 120+ cancer genes using next-gen sequencing Both take several weeks for test results
- Dog with mandibular osteosarcoma Biopsy sample submitted to FidoCure – report above O not interested in surgery or radiation therapy Unfortunately euthanized before treatment able to be initiated Results take 2-3 weeks so can be tricky to start therapy quickly Do offer Data-base results for common tumors Most common mutations for common tumor --> can start treatments before individual results available
- CTCs = circulating tumor cells Cells that have released from primary tumor and are in circulation CfDNA = cell free DNA DNA fragments that are circulating in blood Other structures: exosomes, nucleosomes Uses: Predict prognosis Reveal targetable mutations Monitor response to treatment May detect marker before measurable disease Pros: Non-invasive Easily repeatable Can use for tumors that cannot be easily sampled Able to monitor response / relapse earlier than may be clinically evident Cons: Very small amounts found in blood Cannot provide architecture or info on the tumor microenvironment --> still need histopathology Limited targeted therapies in vet med Not tumor specific
- Screening test: Use for older dogs or dogs at high risk of developing cancer Diagnostic test Use to help confirm cancer when there is a high level of suspicion but not clinically evidence OR when the tumor is difficult to access High specificity = 98.5% If positive your patient has cancer Lower sensitivity: 85% for top 3 tumors; 55% for all tumor types Lymphoma, hemangiosarcoma, osteosarcoma – most likely to be positive Many other types have had positive tests, but not as reliable For monitoring relapse would need a positive sample at time gross tumor present
- Nucleosomes are DNA around a histone protein cores Released into circulation during apoptosis & necrosis (cancer, severe inflammation, trauma) Measure by using antibodies specific to neucleosomes Oral malignant melanoma had high detection rates Cutaneous melanoma, MCTs, and STS had lowest detection rates Sensitivity only ~50% overall Test details: Collecting data on cats 2-5mLs of EDTA blood Idexx, Texas A&M GI lab, or point-of-care Heska machine $200-300, POC test $50 Most patients with a CR will have test results go to negative --> w/ relapse will become positive again Summary: not all cancers detected, negative result does not mean no cancer, positive result means likely cancer, severe systemic inflammation could result in false positive
- For canine lymphoma or leukemia only Predicts single drug response (image) Also can predict CHOP failures Can help select best treatment options Can be used for naïve or relapse patients
- Most common tumors to cause hyperCa = lymphoma, AGASACA Multiple myeloma, functional parathyroid tumors, thymoma, melanoma, mammary = most common in dogs Lymphoma, myeloma, squamous cell carcinoma = most common in cats Multiple others can cause also Can be caused by other cytokines ( IL-1, IL-6, TNF, calcitriol) or osteolysis Symptoms: pu/pd, anorexia, vomiting, muscle weakness or twitching Secondary dehydration, renal damage --> azotemia may/ may not be reversible If elevated iCa found consider additional diagnostics: PE including digital rectal exam, malignancy panel, thoracic radiographs, abdominal ultrasound
- Most findings are non-specific CBC: Lymphocytosis most often Other leukemias: monocytes, erythrocytosis, etc. Cytopenias for mylopthesis (myeloma, leukemia, lymphoma, etc.) Chemistry panel: Hyperglobulinemia w/ myeloma, B cell Hypercalcemia (as discussed on other slide) Elevated liver enzymes – hepatocellular carcinoma, lymphoma, HS, etc. Azotemia – renal neoplasia (lymphoma, carcinoma, metastatic), TCC, myeloma, leukemia, hypercalcemia