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Hugen S, Ankringa N, Robben JH, Valtolina C. Assessment of misdiagnosis in small animal intensive care patients using the Modified Goldman criteria. Vet Q 2023; 43:1-8. [PMID: 37401620 PMCID: PMC10506425 DOI: 10.1080/01652176.2023.2233584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/10/2023] [Accepted: 07/01/2023] [Indexed: 07/05/2023] Open
Abstract
The postmortem examination can be used as a means of quality control for clinical diagnoses. A retrospective study on 300 dogs and cats that had been admitted to a small animal intensive care unit was performed comparing the clinical and postmortem findings, using the Modified Goldman criteria. All patient files were reevaluated for clinical diagnoses and all postmortem material was reevaluated for pathological diagnoses. After this, the Modified Goldman criteria were applied to score the discrepancies between them, and factors associated with the occurrence of an undiagnosed major unexpected finding were analyzed. The postmortem examination revealed additional findings in 65% of the cases. Major discrepancies, defined as those affecting treatment and possibly outcome of the patient, were present in 21.3% of the cases. The most frequently missed diagnoses detected at necropsy were pneumonia of various etiologies, meningitis/meningoencephalitis, myocarditis and generalized vasculitis. A shorter ICU stay was associated with increased odds of a major discrepancy. Conditions affecting the urinary or gastrointestinal system were negatively associated with major discrepancy.
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Affiliation(s)
- Sanne Hugen
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
| | - Nynke Ankringa
- Department of Biomolecular Health Sciences, Utrecht University, Utrecht, The Netherlands
| | - Joris Henricus Robben
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
| | - Chiara Valtolina
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
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Rafalko JM, Kruglyak KM, McCleary-Wheeler AL, Goyal V, Phelps-Dunn A, Wong LK, Warren CD, Brandstetter G, Rosentel MC, DiMarzio L, McLennan LM, O’Kell AL, Cohen TA, Grosu DS, Chibuk J, Tsui DWY, Chorny I, Flory A. Age at cancer diagnosis by breed, weight, sex, and cancer type in a cohort of more than 3,000 dogs: Determining the optimal age to initiate cancer screening in canine patients. PLoS One 2023; 18:e0280795. [PMID: 36724177 PMCID: PMC9891508 DOI: 10.1371/journal.pone.0280795] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023] Open
Abstract
The goal of cancer screening is to detect disease at an early stage when treatment may be more effective. Cancer screening in dogs has relied upon annual physical examinations and routine laboratory tests, which are largely inadequate for detecting preclinical disease. With the introduction of non-invasive liquid biopsy cancer detection methods, the discussion is shifting from how to screen dogs for cancer to when to screen dogs for cancer. To address this question, we analyzed data from 3,452 cancer-diagnosed dogs to determine the age at which dogs of certain breeds and weights are typically diagnosed with cancer. In our study population, the median age at cancer diagnosis was 8.8 years, with males diagnosed at younger ages than females, and neutered dogs diagnosed at significantly later ages than intact dogs. Overall, weight was inversely correlated with age at cancer diagnosis, and purebred dogs were diagnosed at significantly younger ages than mixed-breed dogs. For breeds represented by ≥10 dogs, a breed-based median age at diagnosis was calculated. A weight-based linear regression model was developed to predict the median age at diagnosis for breeds represented by ≤10 dogs and for mixed-breed dogs. Our findings, combined with findings from previous studies which established a long duration of the preclinical phase of cancer development in dogs, suggest that it might be reasonable to consider annual cancer screening starting 2 years prior to the median age at cancer diagnosis for dogs of similar breed or weight. This logic would support a general recommendation to start cancer screening for all dogs at the age of 7, and as early as age 4 for breeds with a lower median age at cancer diagnosis, in order to increase the likelihood of early detection and treatment.
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Affiliation(s)
- Jill M. Rafalko
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
- * E-mail:
| | - Kristina M. Kruglyak
- Information Technology & Bioinformatics, PetDx, La Jolla, California, United States of America
| | | | - Vidit Goyal
- Information Technology & Bioinformatics, PetDx, La Jolla, California, United States of America
| | - Ashley Phelps-Dunn
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Lilian K. Wong
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Chelsea D. Warren
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Gina Brandstetter
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Michelle C. Rosentel
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Lauren DiMarzio
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Lisa M. McLennan
- Clinical Studies, PetDx, La Jolla, California, United States of America
| | - Allison L. O’Kell
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Todd A. Cohen
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Daniel S. Grosu
- Chief Executive Officer, PetDx, La Jolla, California, United States of America
| | - Jason Chibuk
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Dana W. Y. Tsui
- Research & Development, PetDx, La Jolla, California, United States of America
| | - Ilya Chorny
- Information Technology & Bioinformatics, PetDx, La Jolla, California, United States of America
| | - Andi Flory
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
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Schertenleib TI, Pospischil A, Hässig M, Kircher PR, Hilbe M. Comparison of Clinical and Pathological Diagnoses in Cats and Dogs. J Comp Pathol 2017; 156:217-234. [PMID: 28233522 DOI: 10.1016/j.jcpa.2017.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 12/19/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
The comparison of clinical ante-mortem and pathological post-mortem diagnoses is a prerequisite for quality control, but is rarely done in veterinary medicine. This study reports the occurrence and concurrence of clinical and pathological diagnoses linked to death in 1,000 cats and 1,000 dogs examined and subjected to necropsy examination at the University of Zurich, Switzerland. Potential factors influencing the correlation between diagnoses were examined retrospectively. In 5.8% of cats and 5.2% of dogs no diagnosis was made; in 2.6% and 3.8% of cases only a clinical, and in 17.8% and 11.2%, respectively, only a pathological diagnosis was available. Of the 73.8% of cats and 79.8% of dogs with both diagnoses present, 38.3% and 36.2% were in agreement, while there was disagreement in 17.9% and 16.0%, respectively. The remaining cases (43.8% and 47.8%) had different levels of further diagnostic procedures following necropsy examination. In both species, the manner of death, the clinical discipline submitting the animal for necropsy examination and the quality of the necropsy submission request, as well as the timespan between death and necropsy examination in dogs, proved to influence the concurrence between diagnoses. In contrast, the organ system affected and the type of disease entity were, for both species, the most influential factors in the concurrence of diagnoses. Therefore, in veterinary medicine, even in times of improving diagnostic abilities, necropsy examination still reveals important information for quality control and education.
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Affiliation(s)
- T I Schertenleib
- Institute of Veterinary Pathology, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, Zürich, Switzerland
| | - A Pospischil
- Institute of Veterinary Pathology, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, Zürich, Switzerland
| | - M Hässig
- Department of Farm Animals, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, Zürich, Switzerland
| | - P R Kircher
- Department of Small Animals, Division of Diagnostic Imaging, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, Zürich, Switzerland
| | - M Hilbe
- Institute of Veterinary Pathology, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, Zürich, Switzerland.
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Abstract
The identification of biomarkers that distinguish diseased from normal individuals is of intense interest in many health-related fields. Potential applications for biomarkers in veterinary oncology include diagnosis, staging, prognosis and monitoring responses to therapy. By definition, effective biomarkers for cancer screening facilitate disease identification in sub-clinically affected patients and lead to subsequent improvements in clinical outcome. Although the methods and techniques of biomarker discovery and clinical application are translatable from humans to animals, veterinary medicine has lagged behind its human counterpart in several areas. Veterinarians have previously had a flawed understanding of how to use biomarker assays appropriately and have not had the positive influence on product research and development that could advance this field. The controversies, potentials biases, and considerations relative to the clinical application of biomarker assays for cancer screening are discussed in this review.
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Affiliation(s)
- Carolyn J Henry
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA.
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