Veterinary Medicine - November 2008 - (Page DM7)

Robertson: We have mentioned that the fPLI is a more sensitive and speci c diagnostic tool for pancreatitis in cats. What is its sensitivity and speci city for the diagnosis of pancreatitis? Forman: This is one area where we have the data. We have numbers for the sensitivity and speci city. From our study, the sensitivity (ability to detect pancreatitis) of the fPLI test in cats with moderate to severe pancreatitis was 100%. In cats with mild pancreatitis the sensitivity did decrease to 54%, resulting in an overall sensitivity of 67%. The speci city (ability to rule-out pancreatitis) of the fPLI test was 100% in healthy cats and 67% in symptomatic cats with histologically normal pancreata, resulting in an overall speci city of 92%.12 Our clinical impressions correlate with these numbers. Steiner: Despite Dr. Forman’s study, I still do not believe we know the true sensitivity and speci city of the fPLI. The reason we don’t know is because it depends on the severity of the disease. The more severe the disease, the higher the sensitivity, until the Steiner: The equipment and training have dramatically improved during the past 20 years. We have better equipment now—and such a high level of suspicion for pancreatitis—that we have to be careful that we don’t over interpret ultrasonographic ndings. Many years ago it was believed that when you could nd the pancreas, that meant that the cat has pancreatitis. But the equipment got better and expertise with abdominal ultrasound rose and we realized that wasn’t the case any more. So what Dr. Forman said is important. You need expertise in this area; the ultrasonography needs to be done by either a trained radiologist or an internist who performs a lot of ultrasounds every day. Twedt: Years ago, people didn’t think cats had pancreatitis, so they did not try to look at the pancreas. Our level of suspicion has markedly increased since that time. The more you look, the more you can nd. Forman: But we need to consider all ndings in these cases. For example, we would never perform abdominal ultrasonography, look at changes in the kidneys, and say this cat is in chronic kidney failure, “ the fPLI is the most sensitive and most speciﬁc test available— no matter what group of patients you are looking at.” — Dr. Jörg Steiner pancreas is so heavily autolyzed that there is nothing left to be leaking. So the answer really depends on the patient. The important point is that the fPLI is the most sensitive and most speci c test available—no matter what group of patients you are looking at. Twedt: I agree. There is a need for more studies. We need to classify these diseases differently. Robertson: So what other diagnostic tests along with fPLI would you perform to enhance the sensitivity and speci city? Forman: I’d recommend an ultrasound, done by a skilled ultrasonographer using good equipment. This approach also allows evaluation for concurrent disease. Intestinal thickening is an example. Robertson: Two older retrospective studies showed that the sensitivity of ultrasound for pancreatitis was 24%15 to 35%.16 Dr. Forman’s more recent prospective study showed a much higher sensitivity of 80% in cats with moderate to severe disease and 62% in cats with mild disease.12 What do you think the difference is between these studies? so let’s start therapy. A correlation exists between changes we see in the kidneys on ultrasound and blood work changes. We use them together. We should probably go about evaluating the pancreas in the same way—if we see changes in the ultrasound, we should correlate that with the fPLI. Steiner: Excellent point. Robertson: Concurrent ultrasound is ideal. However, some practitioners may not have access to ultrasonography by an experienced radiologist, or the client may not have the nancial means to pursue that option. In these cases, how would you interpret an elevated fPLI test in a cat? Steiner: If a cat has an elevated serum fPLI concentration, you can assume pancreatitis exists. We don’t know of anything, such as dehydration or other diseases, which falsely increases fPLI concentrations. An ultrasound just adds more information; it doesn’t make the fPLI test invalid. Twedt: You have to evaluate the other laboratory information and put everything together to make the diagnosis, such as the clinical signs, fPLI, 7

Table of Contents Feed for the Digital Edition of Veterinary Medicine - November 2008

Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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