Ability of ultrasonography to predict the presence and location of histologic lesions in the small intestine of cats

Abstract

Background Diagnosis of infiltrative small intestinal (SI) disease in cats is challenging, and debate continues regarding optimal biopsy techniques. Ultrasonography may facilitate selection of biopsy type and location. Hypothesis/Objectives Assess ability of ultrasonography to predict histologic lesions by SI segment and tissue layer. Animals One‐hundred sixty‐nine cats that had abdominal ultrasonography and full‐thickness SI biopsies performed. Methods Ultrasonographic images and full‐thickness biopsy samples were retrospectively reviewed, and each SI wall layer evaluated for lesions according to published standards. Results Ultrasonographic SI lesions were present in 132 cats (63 duodenum; 115 jejunum; 71 ileum). Samples were obtained at laparotomy (60) or necropsy (109). Ultrasonographic abnormalities had high positive predictive value (PPV) for histologic lesions (duodenum, 82.0%; 95% confidence interval [CI], 68.6‐91.4; jejunum, 91.0%; 95% CI, 81.5‐96.6; ileum, 88.1%; 95% CI, 74.4‐96.0), but poor negative predictive value (duodenum, 27.1%; 95% CI, 17.2‐39.1; jejunum, 27.3%; 95% CI, 10.7‐50.2; ileum, 40.4%; 95% CI, 26.4‐55.7). The ability of ultrasonography to predict histologic lesions in this population, which had high disease prevalence (SI histologic lesions in 78.1% of cats) was high for mucosal lesions (PPV, 72.7%‐100%) but low for submucosal or muscularis lesions (PPV, 18.9%‐57.1%). Conclusions and Clinical Importance In a population with high disease prevalence, most cats with SI mucosal ultrasonographic lesions will have mucosal histologic lesions. Small intestinal submucosal and muscularis ultrasonographic lesions are not predictive of histologic disease in those layers, suggesting that full‐thickness biopsy may not be essential in these cats. Ultrasonography may help guide decisions about biopsy type in individual cats.

Characterization of the intestinal mucosal proteome in cats with inflammatory bowel disease and alimentary small cell lymphoma

“…However, our results indicated that histopathological changes and clonality results were not predictive for the development of clinical disease 10 . Moreover, studies by other groups also found poor correlation between intestinal ultrasonographic findings and health status 49 or histopathologic changes 50 . Overdiagnosis, overtreatment and false positive results have become major concerns in human medicine and led to several statements and guidelines issued by the U.S. Preventive Services Task Force, 51 National Comprehensive Cancer Network 52 and the EuroClonality/BIOMED‐2 consortium 21,22,48 .…”

Ex vivo comparison of ultrasonographic intestinal wall layering with histology in horses: A feasibilty study

“…In humans, dogs, and cats, ultrasound has been helpful in recognizing features of gastrointestinal disease such as the segment of bowel affected, the intestinal wall layer affected, the presence or absence of thickening, or the loss of layering pattern are indicative of specific diseases or disease processes. 9,23,[31][32][33] Although ultrasound has become a popular tool in the evaluation of horses with gastrointestinal disease, the knowledge about specific features of different diseases is sparse. This study characterizing the detailed sonographic appearance of healthy intestinal wall segments is an important first step toward clinical application in horses.…”

“…The four clinical cases were included to demonstrate that identifying intestinal layering is possible in vivo in horses. In humans, dogs, and cats, ultrasound has been helpful in recognizing features of gastrointestinal disease such as the segment of bowel affected, the intestinal wall layer affected, the presence or absence of thickening, or the loss of layering pattern are indicative of specific diseases or disease processes 9,23,31–33 . Although ultrasound has become a popular tool in the evaluation of horses with gastrointestinal disease, the knowledge about specific features of different diseases is sparse.…”

Intestinal S100/Calgranulin Expression in Cats with Chronic Inflammatory Enteropathy and Intestinal Lymphoma

“…antigen ELISA ( n = 20), and abdominal ultrasonography. Sonographic findings were evaluated based on the presence of increased total GI wall thickness (>2.5 mm for the duodenum and jejunum and >3.2 mm for the ileum; level of increase graded as normal, mildly increased, or markedly increased [ 46 ]), loss of GI wall layering, increased thickness of the muscularis layer (>0.3 mm for the duodenum, >0.4 mm for the jejunum, and >0.9 mm for the ileum; graded as normal, mildly increased, or markedly increased [ 46 ]), enlarged mesenteric lymph nodes, and the presence of (scant) ascites [ 47 ].…”