Vet360 Vet360 Vol 05 Issue 04 - Page 4

CPD ACCREDITED ARTICLE Maximising Histopathology in Oncology The 3 Pillars for Diagnostic Success and Effective Therapy Dr Rick Last (BVSc; M.Med.Vet(Path); MRCVS) Specialist Veterinary Pathologist Although surgical pathology forms only a portion of veterinary oncology, if used correctly within the framework of the veterinary team (clinician, veterinary nurse, owner, pathologist), it provides the opportunity for rapid accurate diagnosis and immediate implementation of relevant therapy. The pathologist reading the biopsy is removed from the patient and outside the mainstream flow of medical information, pertaining to the particular patient circulating within the practice. The pathologist must therefore rely on members of the clinical team to provide important information which is almost always essential to reaching a diagnostic conclusion or diagnostic rule out’s. Surgical pathology is a prospective disease investigation on a live patient under medical care and whose disease course can theoretically be altered by therapy. Therefore, a premium is placed on speed and accuracy. However, there are numerous and significant problems in surgical pathology that negatively impact the desired result of a speedy and accurate specific tumour diagnosis. Effective veterinary oncology requires the import of different skills of two different but related groups of veterinarians. 1. The pathologist does not see the gross lesion. This can be circumvented to some degree by more efficient use of digital photography by clinicians. 2. There is often a poor or no history provided. 3. The pathologist does not select the tissue and lesions to be examined. 4. Specimens submitted are often very small, distorted and marginally adequate for a thorough evaluation. 5. Tissues are sometimes improperly fixed and partially autolyzed. 6. In many instances the pathologist cannot get additional tissue to examine so they must make a diagnosis with what they have before them. 7. The clinician needs an answer quickly so there is minimal time for reflection. What is a surgical biopsy? This procedure is a temporary partnership between a clinician and his support team of practice staff and the pathologist acting on behalf of the patient to aid the clinician in: 1. Making or confirming a diagnosis. 2. Assisting in the prognosis of the case by assessing the progress of therapy, grading and staging of neoplasms and determining the completeness of surgical excision. vet360 Issue 04 | SEPTEMBER 2018 | 4 The upside of surgical pathology is that there is usually no or very minimal autolysis which facilitates accurate identification of morphological detail and accuracy of tumour marker stains. On the downside one needs to consider the following: