¶ Predicting Splenic Masses in Dogs"
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You're listening to Veterinary Vertex , a podcast of the AVMA Journals . In this episode we chat about calculators used to preoperatively determine the etiology of splenic masses in dogs with our guests Janet Grimes and Townes Hillier .
Welcome to Veterinary Vertex . I'm Editor-in-Chief Lisa Fortier , and I'm joined by Associate Editor Sarah Wright . Today we have Janet and Townes joining us . Janet , welcome back , and Townes , thank you so much for taking time out of your busy schedule to be with us here today .
Thank you so much for having us . We're very excited to chat with you all today . Yes , thank you for having us .
All right , let's dive right in Towns . Your JAVMA article discusses how improved predictability is needed for calculators used to preoperatively determine the etiology of splenic masses in dogs . Please share with our listeners the background on this study .
Yeah , of course . So , as most of us know , the diagnosis of splenic masses prior to surgery and histopathology is very challenging , because they can either be benign or malignant and have very different prognoses . So most veterinarians rely on the double two-thirds rule to inform owners of the prognosis of splenic masses .
This rule basically implies that two-thirds of splenic masses are malignant and then two-thirds of those masses are hemangiosarcoma , and recent studies have actually found that this rule may not be as accurate as we previously thought , and so recently there have been two different calculators that have been developed to predict the etiology of splenic masses prior to surgery .
So calculators are a great idea and would be an easy way for owners to get more clarity on the situation before deciding to move forward with treatment , and so one of the calculators that was recently developed is the hemangiosarcoma likelihood prediction , or HELP score , and so this model was developed for dogs with non-traumatic chemoabdomens from any organ , and this
calculator uses patient body weight , total plasma protein , platelet count and thoracic radiograph findings to give each dog a score from either zero to greater than 55 , which is considered the cumulative help score , and then , based off this number , they are then assigned into a risk of low , medium or high for hematomandiasarcoma and that is called the categorical help
score .
And the other calculator that was developed is the Tufts Splenic Tumor Assessment Tool , or TSTAT , and so this was developed to estimate the probability of malignancy in dogs with splenic lesions , with or without hemoperitoneum , and this calculator uses eight different variables from blood work and abdominal ultrasound to determine the probability of malignancy , and these animals
are then assigned a percentage of one to 100% no-transcript .
I'm an equine orthopedic surgeon so I was like , do people really use these calculators ? That was the true genesis of the question , that's true .
So , with that being said , Towns . What were some of the pivotal findings from this study ?
So both of these scores report an area under the curve , or AUC , which basically helps us compare different scoring systems . And so an AUC of 0.5 is like a coin flip , so 50-50 chance that it predicts the correct diagnosis , whereas a score of one is perfect accuracy , so it will predict the right diagnosis 100% of the time .
And the AUC is then given a score of either poor , acceptable , excellent or outstanding . And so our study's purpose was to compare these scores . And so what we found is that the T-STAT had an AUC of 0.68 for this diagnosis of malignant lesions , which is actually considered poor performance , and this is less than what they had originally reported .
But for the cumulative help score it had an AUC of 0.79 . And then the categorical help score had an AUC of 0.73 for the diagnosis of hemangiosarcoma , which is considered acceptable performance , and this is very similar to the original study .
We also found that the cumulative help score performed better than the categorical help score , which was possibly due to dogs , you know , at the different extremes of each categorical score being incorrectly categorized .
Janet , you're starting to get a reputation a bit of like a myth buster when it comes to hemoabdomen splenic masses . What sparked your research interest in this area ?
So I really became interested in splenic masses during my surgery residency . It was the focus of my master's project and it really has become a true passion of mine , and so I think part of it is the challenge right .
So we don't know what these are prior to surgery , and it's a huge challenge for the owner and the veterinarian having to try to counsel this owner as to you know what the best next steps are , and so it's . It is such a dichotomy .
As Towns mentioned , you know , it could be hemangiosarcoma , which is a devastating tumor with short survival times , even with multimodal treatment . But on the flip side , the dog could be cured , and we don't get to say cure a ton when we're dealing with masses . So it is really difficult .
And so I got really interested in research to try to help solve that challenge , to try to figure out how do we figure out what the etiology is before surgery , and so I think it's really fascinating , and then there's just so much potential to help clients and their dogs and the veterinarians having to help make these decisions .
Yeah huge , huge problem and if you can keep going until we figure it out and again I said earlier , welcome back to the podcast and thank you for submitting this manuscript , as well as your others , to JAVMA
¶ Splenic Masses in Dogs
. Why did you choose to submit this manuscript to JAVMA ?
Yeah , so one of the main reasons is splenic masses are so common and I really wanted to make sure we were able to disseminate this information to as many veterinarians as possible .
And so JAVMA is , you know , one of the most widely read journals , reaches not only specialists but also the primary care practitioners , who are seeing infinitely more of these than we are , and so I knew if we were published with Javma , that we would reach that huge audience . And , just as a plug for y'all , I've really appreciated the changes y'all have made .
It's a really quick , quick process from submission to publication and the review process is , you know , the reviewers tend to be friendly and really I think they , you know , of course help improve the manuscript with their questions as well , but it's been a really smooth process and I know we can get the information out there quickly .
Yeah , thank you . We have a fabulous team . Our current time from submission to publication is less than 100 days , with double reviews . So we're really proud of the team and the authors have really responded and provided us with really clinically important manuscripts , like you have . So we're grateful for that .
Townes , sarah asked you earlier what were some of the pivotal findings of your manuscript , but always when we write manuscripts , articles , we're surprised by some findings . What was the most surprising finding from your study ?
All right .
So the most surprising finding for us was that the HELPS score categorized dogs with hemangiosarcoma very evenly between risk categories , so about a third of dogs were in each category , so either low , medium or high risk , and it was actually better at classifying dogs with benign masses , and so 76% of those dogs with benign masses were classified as low risk .
And so we believe that one factor that may have affected this score is the platelet count , and so the assigned score for platelet count is very similar for the different degrees of thrombocytopenia , and low platelet count has also been found to have a high positive predictive value for hemangiosarcoma , but a relatively low negative predictive value , and so this is
likely because a low platelet count more represents severe hemorrhage rather than a specific diagnosis , and so dogs with hemangiosarcoma are more likely to have hemorrhage than dogs with other diagnoses . So while use of a platelet count may be accurately classify some dogs , it is still a nonspecific marker .
I think that's really good information for clinicians because it's so easy , you know , just to get a quick platelet count and then have , like you know , a technician do a manual count right , just to make sure . So important not to rely on that too heavily .
And for those of you just joining us , we're discussing calculators used to preoperatively determine the etiology of splenic masses in dogs , with our guests Janet Grimes and Towns Hillier . So , towns , how did your advanced training prepare you to write this manuscript ?
So prior to this study , I didn't have much experience with research and this is actually one of my first studies that will be published , I think .
To get experience and be prepared to write a manuscript it takes really great mentorship and I was lucky enough to have a great mentor like Dr Grimes , who has so much experience , as you guys have already said , in research , and she really helped me write this manuscript .
Yeah , it's great to hear . And just putting in a plug , for our journal awards , which are available to students and house officers that have published in JAVMAR or AJVR , the deadline for our manuscripts published in 2024 will be in March of 2025 . So , for anyone listening , feel free to submit a nomination .
They are rolling until that date for this year's manuscripts . And now this next set of questions is really important for our listeners Townes . What is one piece of information the veterinarian should know before discussing calculators used to preoperatively determine the etiology of splenic masses in dogs with the client ?
So I think the most important thing is to keep in mind that they still need to rely on their clinical judgment and the full clinical picture for each patient . These calculators , you know , may be able to help you with your conversation with the owner , but they aren't always accurate , as we've kind of found in this study .
Yeah , I think that's good information to have , always important to remember that you are one of the best tools in your toolkit , so good to keep that in mind . And then Janet , on the other side of the relationship , what's one thing clients should consider around ? Calculators used to preoperatively determine the etiology of splenic masses in dogs .
So I think it's pretty similar to what Town said for the veterinarians . I think clients should know there's more to the diagnosis than just the score , and so the scores are also reliant upon the data put into the calculator .
So if your veterinarian's asking for an ultrasound or for more blood work , it may be to help them , help you , make that diagnosis and or , you know , make that prediction of what they think the diagnosis will be .
But still , I think it's important to remember that , even if the score indicates a high likelihood of hemangiosarcoma or malignancy , there's still a chance the tumor's benign and , conversely , if you go into it thinking , oh , everything pointed to benign disease , with the calculators , histopathology may still return with hemangiosarcoma as a diagnosis , and so I think it's
really helpful to have these in the toolkit , because it is a difficult situation . It makes the decision . You know it's a very hard decision to make , and so I think they could be useful to help . You know , sway a client who's really on the fence but you can't put . You know all your stake in that .
You know it's not perfectly accurate , and so I think for me this really emphasizes that we need to do more work to find a calculator that's going to have perfect accuracy or some sort of biomarker to help diagnose that disease process accurately before surgery .
And so if they ever have an opportunity to be part of that research , you know I hope they would jump at the chance to help future dogs and owners with that condition .
So important , you know , and I hear lots more manuscripts coming our way , so we look forward to your next steps , yours and Towns , on trying to figure out this dilemma that's so important for our profession and our pets . Yeah , absolutely . As we start to wind down a little bit , we try to ask a little more of a personal fun fact .
So , townes , for you , what is your favorite animal fact ?
So one of my favorite animals is otters , and so otters actually hold hands while sleeping so they don't float away from each other , which I think is really cute .
So that's adorable . Yeah , we haven't gotten that one before , janet , a little bit different for you . When you do a puzzle , do you start with the inside or the exterior border pieces ?
So I always start with the edge pieces and then , once I've got those , I sort the inside pieces by color . So I try to do everything in a methodical way , which may not surprise you , given my profession as a surgeon .
Yeah , I would say that's true . That's a predictor of surgeons .
Yeah , definitely our most common answer . I think too , and , towns , you might appreciate this . I have a bunch of otter prints in my office . One is a hand-drawn picture from one of our marine mammal trainers from a previous fellowship that I did , and I also have some nose prints and little paw prints too , which are cute .
¶ Veterinary Podcast With Janet and Towne
But thank you both , jana and Towns , we really appreciate you being here today and sharing the knowledge from your manuscript , too , with our listeners .
Well , thank you so much for having us . We really appreciate you giving us the opportunity to share more about our work .
Yes , thank you so much . It's been nice talking to you guys .
And to our listeners . You can read Janet and Towne's article and print Javma or online using your favorite search engine . I'm Sarah Wright with Lisa Fortier . We want to thank each of you for joining us on this episode of the Veterinary Vertex podcast . We love sharing cutting edge veterinary research with you and we want to hear from you .
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