Tumour follow-ups ?

Re: Tumour follow-ups ?

Mark Hedberg — Sun, 12 Dec 2010 15:49:26 GMT

No worries, Richard; It's just good to know more about stuff 'behind the curtain' so to speak. :)

Re: Tumour follow-ups ?

Richard Fox — Sun, 12 Dec 2010 11:07:27 GMT

Mark, don't worry that wasn't my intention of the OP. In the main its fine but we often don't get much history and ask quite a few questions in the report but rarely get an answer or is genuinely an interesting case. None of us has oodles of time to spare and when we do we catch up with things we have on the back burner. Its quite understandable. I was just wanting a quick bit of feedback about something you would probably never phone us up about Its just you get more out of the money the client spends and a phone call is free

Re: Tumour follow-ups ?

Mark Hedberg — Sat, 11 Dec 2010 21:49:22 GMT

The practice I work at uses Abbey for histopathology; I'll confess to not being good at getting back in touch with the pathologists after I get a report. This I now realize has been rather rude of me. I apologize, and I'll try my best to ring up and let the undersigned pathologist know about the case.

I guess I just forget sometimes that I'm not the only vet around who's curious about case progression. Sorry! :)

Re: Tumour follow-ups ?

Kate Richardson — Sat, 11 Dec 2010 11:42:36 GMT

I would say I get about 10% non diagnostic samples, mainly due to insufficient cells. Some masses don't exfoliate easily as well. I have generally found more of my non diagnostic samples are from ones where I DIDN't aspirate with a syringe interestingly enough. I usually do aspirate, except when takings FNAs from liver/spleen.

Re: Tumour follow-ups ?

Louise6732 — Fri, 10 Dec 2010 22:35:04 GMT

On a similar thread to masses etc, when discussing options with owners re. 'lumps and bumps' I always say that there is around 20% chance of getting a non-diagnostic sample from FNA (mainly to cover me when it comes back non-diagnostic and they ask what was the point in paying for it!). This is a fairly made up figure, is really a rough guess from results I get back, but it would be interesting to restrospectively look at my FNA samples and see the rate of non-diagnostic samples obtained.

What do other people find? Would you estimate around 20%?

P.S. I do use the 'correct' FNA techinique of not actually aspirating with a syringe, it's amazing how successful this is!

Louise

Re: Tumour follow-ups ?

Richard Fox — Fri, 10 Dec 2010 16:19:36 GMT

More like that really

Re: Tumour follow-ups ?

Vikki Halliday LLB — Fri, 10 Dec 2010 15:56:00 GMT

Re: Tumour follow-ups ?

Richard Fox — Fri, 10 Dec 2010 13:59:51 GMT

Don't go there with the wallace thing - Thats my other nickname ;)

Re: Tumour follow-ups ?

Bob Russell — Fri, 10 Dec 2010 13:36:19 GMT

[quote user="bob lehner"]

[quote user="Richard Fox"]I have been known to fit 6 bourbon biscuits in it or a whole orange [/quote]

Hope you keep it well closed when racing on your velocipede - could create quite a lot of wind resistance otherwise.

[/quote]

Funnily enough this flashes up images of Wallace (not Gromit of course) in 'a close shave'!

Re: Tumour follow-ups ?

bob lehner — Fri, 10 Dec 2010 13:29:53 GMT

[quote user="Richard Fox"]I have been known to fit 6 bourbon biscuits in it or a whole orange [/quote]

Hope you keep it well closed when racing on your velocipede - could create quite a lot of wind resistance otherwise.

Re: Tumour follow-ups ?

Richard Fox — Thu, 09 Dec 2010 18:34:39 GMT

Sounds perfect - Hmm how long is a piece of string maybe 12-18 mo and then chuck but I guess you would have to have a large cupboard?

Re: Tumour follow-ups ?

Bob Russell — Thu, 09 Dec 2010 18:04:44 GMT

It costs next to nothing to keep a lump in formalin. We have cupboard space for them to be stored. If owners cannot or will not send for path we keep it. The real question is how long for?

Re: Tumour follow-ups ?

Hannah Wynne Richards — Thu, 09 Dec 2010 17:40:00 GMT

Can't insist-and RoyalCollege would say I wasn't giving clients a range of treatment options-and anyway some don'twant to know-but always advise it-and get signed consent if they refuse-then if it turns out to be a nasty-they haven't a leg tostand on-it's as important to get consent NOT to do something as it is to do it

Wynne

Re: Tumour follow-ups ?

Richard Fox — Thu, 09 Dec 2010 12:02:49 GMT

I think my OP has gone off a tangent - It all depends on money as its private medicine I have no probs with not sending tissue in - as I say I have not control over it I just advise it.....

Re: Tumour follow-ups ?

Alex Gough — Thu, 09 Dec 2010 11:37:50 GMT

I showed this thread to our surgeon, and he did note that even he realises that money is important sometimes. I think many years of teaching students the right way to do it colours his comments somewhat, but now he is in private referral practice he knows that sometimes compromises have to be made!

Re: Tumour follow-ups ?

Richard Fox — Thu, 09 Dec 2010 11:26:42 GMT

Hmm - I would not be happy - sounds negligent to me!

Re: Tumour follow-ups ?

bob lehner — Thu, 09 Dec 2010 11:24:06 GMT

[quote user="alex gough"]Our surgeon doesn't give the owners a choice regarding histopathology of possibly malignant lumps[/quote]

Probably very wise (although I can envisage financial considerations being an issue). I had an interesting experience myself many years ago when I had a small lump above my nose. My GP said he would take it off under LA (he was also an FRCS) - anyway lump regrew quite soon afterwards- asked him what the histo had shown -'Oh, I didn't do any - I just threw it away'. Unbelievable ! Needed fairly extensive plastic surgery to sort out what was in fact a basal cell carcinoma with nasty potential.

Re: Tumour follow-ups ?

Richard Fox — Thu, 09 Dec 2010 09:53:20 GMT

Yup - we have had a few now. Also histiocytomas can occur multiply and also can be found in the local lnn, thay can also persist for some time. We are only talking about 5% or less though

I would advise the sample be reviewed just as a precaution (not that I am at all doubting the original dx). I would myself want to re-check :) Obviously it maybe worth aspirating the new lesion just to make sure it still resembles a HCT?

Re: Tumour follow-ups ?

Clive Ansell — Thu, 09 Dec 2010 09:19:47 GMT

I always advise histopathology of all masses I remove, but the final decision rests with the client. Even if I think it is a lipoma, I will say " I'm 99% sure, but for absolute confirmation histopathology is needed".

I had an unusual one last night. A 2 year old otherwise healthy JRT that had a small mass removed from his lip August this year, confirmed by histology as a regressing histiocytoma at a well known and well respected commercial lab. A mass has now (re)appeared in the same site. Has anyone heard of a recuring regressing histiocytoma??????. We will get the lab to relook at the sample and book for re excision, it is only 5mm or so and the dog will need sedation or ga for an FNA, so will just excise the thing wholesale.

Re: Tumour follow-ups ?

Laurence Webb — Thu, 09 Dec 2010 09:03:17 GMT

Although you're working in referral practice so you've probably screened out a lot of owners for whom the additional cost would be prohibative.

I aim to send post excision samples for all masses but some owners will decline it because an additional £60 is more than they can/are willing to afford. Some owners also say that they don't intend to do any follow up treatment whether a mass is completely excised or not (or likely to metastesise), so in that instance it makes no difference to the outcome of an individual case.

Re: Tumour follow-ups ?

Alex Gough — Thu, 09 Dec 2010 08:24:03 GMT

Our surgeon doesn't give the owners a choice regarding histopathology of possibly malignant lumps. He says, "You don't give the owners the option as to whether you will close the wound after surgery do you?"

alex

Re: Tumour follow-ups ?

Richard Fox — Thu, 09 Dec 2010 07:40:54 GMT

The best thing you can do in most instances - at least you keep them and can go back if necc. Once its in the bin its gone.

Don't worry its your / your clients decision so send it for examination. obviously we like to recieve samples but I have to admit there are a small number that don't need to be send or are non-diagnostic. I would say that we do get a lot of biopsies which the ddx are way out and the vet is surprised to get the result!

I just had a case of lymphoma in a 9 week old puppy in which we have sent of the sample to a colleague in the US for clonality testing. It has come back as a very unusual B cell lymphoma (confirmed clonal) and does not express the usual CD markers! It has also clinically regressed! Gone! I think the vet was concerned about my initial Dx but I and my colleagues were adamant based on the initial behavior and morphology it was both malignant and representative of lymphoma. These things don't read the text books!

Re: Tumour follow-ups ?

Michael Woodhouse — Thu, 09 Dec 2010 00:21:02 GMT

Removed a mass from a dog ~2 months ago. Discussed sending away, but owner was on limited finances and since was unlikely to change anything we put it in formalin and forgot about it. Six weeks later owner makes appointment, lump was back. Came in for a consult with a colleague of mine who discussed options and they decided to spend the money sending the lump of to an un-named lab. The result came back:

Ttrichoblastoma, benign tumour - margins appear to be adequate and recurrence unlikely [or words to that effect]!

Not sure if they realised that it was the original lump I sent? Did a more radical revision surgery yesterday, but no money for any more hysto [no money really for any more Sx]. We shall see.

We only send off about 1 in 3 lumps, not many insured pets and it usually doesn't change the clinical picture. We have quite an archive in formalin on the shelf, going back a long time!

Re: Tumour follow-ups ?

Richard Fox — Wed, 08 Dec 2010 19:25:36 GMT

I have been known to fit 6 bourbon biscuits in it or a whole orange during my years at uni and my nick name was the reach toothbrush man

Re: Tumour follow-ups ?

Vikki Halliday LLB — Wed, 08 Dec 2010 17:36:00 GMT

[quote user="Richard Fox"] hope that was a joke as it would be mean - I might be opinionated [/quote]

It was a joke, and yes I noted from another thread you admitted to having a "large gob"!