Mastering Oral Biopsies in Dogs and Cats

Understanding the nuances of oral biopsies is crucial in diagnosing and treating various oral masses in our veterinary patients. Today, we'll delve into some key techniques and tips to optimize the biopsy process and ensure accurate diagnoses.

Histopathology: The Gold Standard

Histopathology remains the gold standard for diagnosing oral masses in dogs and cats. It provides invaluable insights into tissue pathology, aiding in treatment decisions. Whether it's an incisional biopsy, an excisional biopsy, or a curative-intent surgery with wide margins, histopathology offers vital diagnostic information.

Fine Needle Aspiration (FNA) vs. Biopsy

For skin and bone lesions, a fine needle aspirate for cytology is often a reasonable preliminary step, offering a high predictive value for diagnosing neoplasia. However, when it comes to oral lesions in dogs and cats, the decision between FNA and biopsy warrants consideration. Most patients require sedation for FNA of oral lesions, and due to the nature of common oral tumors like melanoma and fibrosarcoma, which do not exfoliate well, opting for a sedated biopsy is often preferred. Alternatively, obtaining both cytology and biopsy samples while the patient issedated can minimize costs and streamline the diagnostic process. That way, if the cytology is non-diagnostic, the biopsy can be submitted to follow, without an additional vet visit.

Tips for Oral Biopsies

When performing oral biopsies, it's essential to consider several factors:

• Types of Oral Tumors: Squamous cell carcinomas and fibrosarcomas are common in cats, while melanomas, squamous cell carcinomas, and fibrosarcomas prevail in dogs. Other tumor types like osteosarcoma and canine acanthomatous ameloblastoma are also encountered. Due to their tendency to exfoliate poorly with FNA, histopathology is recommended for all oral masses.
• Biopsy Approach: Oral biopsy samples should be obtained intraorally to avoid complications with lip tissue, which may be needed for reconstruction in surgical or radiation therapy scenarios.
• Biopsy Techniques: Soft oral masses can be biopsied using a scalpel or punch biopsy. For many bony oral masses, a similar approach can be used if a soft spot is palpated in the lesion. If there is no soft spot palpated, instruments like the Michelle trephine or osteotome and mallet are employed.
• Managing Bleeding and Hemostasis: Bleeding is a potential risk of oral biopsies, but various methods, including firm pressure, silver nitrate sticks, or cautery, can achieve hemostasis effectively. Suturing may also be necessary in some cases.
• Ensuring Representative Samples: Given the heterogeneity of oral lesions, multiple samples should be obtained to ensure a representative diagnosis.

Utilizing Vet-to-Vet Specialty Teleconsultations

Once histopathology results are obtained, leveraging specialty teleconsultations can provide invaluable insights into treatment planning. Platforms like Stratocyte offer seamless connections with specialists in various fields. When you call your client with test results that involve the “C-word”, they will want to know prognostic information and treatment options right away. Being able to share recommendations from a board certified veterinary oncologist will help bring your client peace of mind, and accelerate the process of getting your patients the definitive care that they need. To make the most of your specialty consultation, take pre-operative photos of the mass with and without your flash. Submit these photos, the full case history, and the histopathology results to your virtual specialist. Whether seeking advice on complex cases or refining treatment strategies based on histopathology findings, vet-to-vet consultations can enhance patient care and outcomes.

In conclusion, mastering oral biopsies in dogs and cats is essential for accurate diagnosis and effective treatment planning. By employing these techniques and tips, and utilizing resources like vet-to-vet teleconsultations, we can enhance patient care and outcomes in our veterinary practice.