[Show abstract][Hide abstract]ABSTRACT: Cytology often is used to obtain a diagnosis, such as that of malignant neoplasia. When a diagnosis is uncertain, pathologists often express probability using qualitative terms, such as "probable," that have imprecise meanings.
Terms expressing probability are interpreted variably by veterinary practitioners and affect decisions regarding treatment and euthanasia.
An online survey of members of the Veterinary Information Network was conducted. Veterinarians were asked to assign percentage probabilities to 18 modifiers of a diagnosis of lymphoma. They also were asked to select their most likely clinical action based on a diagnosis of lymphoma qualified one of 4 modifiers. Results were analyzed using descriptive and nonparametric methods. Percentage probabilities were analyzed by ANOVA after variance stabilization.
For 871 valid surveys, probabilities assigned to the 18 modifiers overlapped substantially, with medians (interquartile range) of 50% (50-70%) for "possible," 66% (66-85%) for "probable," and 70% (70-90%) for "consistent with." More (P < .001) veterinarians (50.4%) chose to initiate treatment with a diagnosis of "consistent with lymphoma" as compared with "probable" (14.6%) or "possible" (1.6%) lymphoma. For clients considering euthanasia if the diagnosis was cancer, more (P < .001) veterinarians recommended euthanasia with a diagnosis of "consistent with lymphoma" (62.5%) as compared with "probable" (35.3%), or "possible" (2.0%) lymphoma.
Probability expressions are interpreted variably yet have a major impact on clinical decision-making, including the decision to recommend euthanasia. Standardized terminology could improve decision-making and enhance clinical outcome.
Full-text available · Article · Mar 2010 · Journal of Veterinary Internal Medicine
[Show abstract][Hide abstract]ABSTRACT: To determine the extent of use of cytology as a diagnostic method in veterinary practice and assess how veterinarians in practice communicate with veterinary clinical pathologists.
An online survey was made available to members of the Veterinary Information Network from October 1, 2004, through December 1, 2004.
Respondents reported obtaining a median of 7 cytology samples weekly (range, 0 to 100). On average, respondents reported that 48.1% of the samples they collected were evaluated in-house, 29.5% were submitted to a veterinary diagnostic laboratory, and 21.6% were evaluated in-house and then submitted to a diagnostic laboratory. Most respondents (89.2%) reported using cytologic assessments to guide additional testing, and most (80.3%) indicated that they found the comments section of the cytology report to be the most important section. When asked to indicate the importance of various factors in their decision to use cytology as a diagnostic method, respondents overwhelmingly indicated that accuracy was very important. The most common reasons for consulting with a clinical pathologist were to discuss a discrepancy between clinical and cytologic findings, to clarify a diagnosis, and to ascertain the pathologist's confidence in a diagnosis. Respondents expressed more confidence in results when board-certified clinical pathologists were examining cytology samples than when others were.
Results suggested that improving communication between veterinary practitioners and veterinary clinical pathologists could enhance the diagnostic value of cytologic examinations and improve clinical decision-making.
Article · Apr 2008 · Journal of the American Veterinary Medical Association
[Show abstract][Hide abstract]ABSTRACT: Bile peritonitis is a severe, nonseptic inflammatory response to bile in the peritoneal cavity. It may result from generalized or localized leakage of bile due to spontaneous rupture of the biliary system or as a complication of biliary tract inflammation, obstruction, manipulation, or trauma. Cytologically, bile in abdominal fluid appears as golden-green granular pigment.
The purpose of this report is to describe the atypical cytologic features of abdominal fluid in 3 dogs with bile peritonitis.
As part of a diagnostic workup, abdominal fluid was obtained from 3 dogs with bile peritonitis and analyzed. In 2 dogs, fluid bilirubin concentration was determined and Hall's bile stain, Alcian blue-periodic acid-Schiff stain, and Mayer's mucicarmine stain were applied to direct smears of the fluid.
Acellular mucinous fibrillar material in clumps and lakes was the prominent cytologic finding in the abdominal fluid from all 3 dogs. Bile pigment was not observed. Fluid from the 3 dogs contained increased numbers of inflammatory cells, predominantly neutrophils. Total protein concentration ranged from 2.9 to 5.6 g/dL. Fluid total bilirubin concentration was greater than twice that of the concurrent serum bilirubin concentration. Based on results of the special stains, the amorphous material was positive for mucosubstances, but was negative for bilirubin. In all dogs, bile peritonitis originated from a rent in the common bile duct.
Bile peritonitis with fibrillar mucinous material in abdominal fluid has not been described previously in dogs. The material was similar to "white bile" observed in humans and experimentally in dogs as a sequela to extrahepatic biliary tract obstruction. When mucinous material is observed in abdominal fluid from dogs and the fluid bilirubin concentration is greater than twice the serum bilirubin concentration, rupture of the extrahepatic biliary tract should be suspected.
Article · Feb 2003 · Veterinary Clinical Pathology
[Show abstract][Hide abstract]ABSTRACT: Although not a substitute for histologic examination, lumps, bumps, and lesions of the skin and subcutis readily lend themselves to cytologic examination via FNB, fine-needle nonaspiration biopsy, imprinting, or scraping of lesions. These techniques are used to obtain cells that can be examined by a clinical pathologist or cytologist to provide a diagnosis, decide a course of therapy, or offer a prognosis. Although histologic and cytologic examinations do not always agree, many times there is excellent correlation between the two disciplines. There are few patients with cutaneous lesions that would not benefit from cytologic examination of their lesion.
Article · Feb 2003 · Veterinary Clinics of North America Small Animal Practice