to biopsy or no?

[aorticorbit]

hi all,

my 2 year old cat is in the ibd/lymphoma conundrum. the vet took a fine needle aspirate on tuesday, the results of which came back inconclusive today. they want to do a full biopsy, but the vet did say he can draw up an alternative treatment plan if i don't want to do surgery (which would involve prednisone, so i wouldn't be able to do the biopsy later). I'm not sure what to pick or what to do. Since going to the vet on Tues, Roma was taken off all previous medications, and prescribed 1/2 tab of cerenia 2x a day to control for nausea. i've also been giving her much smaller meals more frequently, so she hasn't had any trouble keeping everything down. aside from occasional nasuea but no vomiting, she's been doing great. eats well, meows, plays, poops, the whole nine yards. she slept a lot yesterday, which i figured was exhaustion from tuesday and the FNA procedure, but today she's been doing really well. she has had previous issues with food allergies, which is why i'm hopeful its IBD and not lymphoma, but i'm not sure. i ordered novel protein (rabbit) cat food yesterday, hoping it comes by tomorrow. the vet also ordered a blood test, the results of which we are still waiting on. anyone want to weigh in on whether or not to move forward with the biopsy?

 

[Margot Lane]

All I can tell you is it brought me peace of mind to do it, though two years old seems awfully young. It might also depend on whether or not you have pet insurance, how far away you are from your vet. I would at least wait for the blood test. Bottom line really is this a decision between you and your vet.

 

[aorticorbit]

i do have pet insurance, and the vet is only 30 minutes away thankfully. but i would just hate to put my cat through serious abdominal surgery over what is more likely to be ibd, especially because she's so young. i know at the end of the day the decision is up to me, but i was just hoping for input from others before having to make the final decision. we're still waiting on blood test results, which if shows indication of serious illness (ex. elevated wbc count) then i'll definitely schedule for the biopsy, but if it shows regular results, i'm not sure how i'll move forward

 

[Margot Lane]

Well, I can tell you I believe the biopsy was actually much harder on me than my cat. All the sleepless stress and waiting. HE came out and acted fine. But since your cat is so much younger than mine, I’d wait for the blood results. To me it sounds as if you are listing towards the right call, looking for what the wbc will be. Some people here have opted for an ultrasound, rather than a biopsy.

 

[FeebysOwner]

The FNA tissue is usually 'stored' for a period of time - if you can find out if that has happened, you can ask for a PARR Assay to be done on that same tissue. It is just another step in further analyzing the cells in that tissue. It isn't an absolute guarantee but might make the decision to treat without an actual biopsy.

When my cat's FNA came back inconclusive, we did the PARR Assay and it did confirm lymphoma.

 

[aorticorbit]

unfortunately roma already had an ultrasound done on tuesday, it showed thickening in her duodenum and swollen lymph nodes, but nothing concrete enough to indicate either way. you're probably right that she'll be mostly fine for surgery, just a few days of soreness is probably worth knowing. i am leaning towards biopsy just so i can know for sure what's going on.

 

[aorticorbit]

The FNA tissue is usually 'stored' for a period of time - if you can find out if that has happened, you can ask for a PARR Assay to be done on that same tissue. It is just another step in further analyzing the cells in that tissue. It isn't an absolute guarantee but might make the decision to treat without an actual biopsy.

When my cat's FNA came back inconclusive, we did the PARR Assay and it did confirm lymphoma.

did your vet offer a PARR assay as an option, or did you have to look for a vet that will send the samples in? and do you think you could tell me about how much it cost? i would love if i could get a confirmation either way without having my poor cat have to undergo such an invasive surgery

 

[FeebysOwner]

did your vet offer a PARR assay as an option, or did you have to look for a vet that will send the samples in? and do you think you could tell me about how much it cost? i would love if i could get a confirmation either way without having my poor cat have to undergo such an invasive surgery

I was working with an internal med specialist and asked about the PARR Assay. The FNA tissue was sent out to the Colorado State University for the initial FNA analysis, and they apparently hold onto the tissue for a period of time. The request for the PARR Assay was sent from the IM vet to them to pursue the additional analysis. The FNA cytology was $245 and the PARR Assay was almost $500.

The FNA and the PARR Assay was done on one of her enlarged intestinal lymph nodes. There was no thickening of her intestinal wall - if that helps any.

The PARR Assay can still come out inconclusive, so it is not an absolute guarantee, as I said. But, if it does come out inconclusive, it could be IBD. As a general rule of thumb, the treatment is usually the same for both - Pred, and either concurrently or later, Chlorambucil for small cell lymphoma.

 

[aorticorbit]

i know that the treatments are functionally the same, but i worry that if i don't get a definitive "no" on the lymphoma diagnosis, i'll be sitting here every day wondering how much longer my cat has. i don't think my vet will prescribe chlorambucil without a diagnosis (and i wouldn't want to put my cat through chemo if she doesn't have to!!). honestly, i feel like the best option is to just go for the biopsy and get a clear answer. since roma is so young, doing what would essentially be pallative care by giving prednisone and no chemo if she does have lymphoma doesn't quite feel right. i'll be sure to ask my vet's opinion on the PARR assay though, and see if he thinks it is better suited for roma's case

 

[FeebysOwner]

If the lymphoma is elsewhere besides in the tissue they collect, it can also be missed through a biopsy as well. So, include that aspect in your discussion with the vet.

 

[aorticorbit]

the results of roma's blood test came back today, and thankfully everything was normal, so i'm not extremely worried about cancer in other areas right now. she's been on cerenia tablets since wednesday, and today she's experiencing some nasuea and decreased appetite i think, but her rabbit food should be coming in today, and i'm hopeful that making the switch will entice her to eat again and curb future nausea. im planning on speaking with the vet later today, and moving forward with the biopsy just to be sure of what her next steps should be. does anyone have experience with biopsy recovery? this will be her first major surgery since her spay in 2021, so i am a little nervous. thank you all for your input, i appreciate it immensely

 

[silent meowlook]

Hi.
My cat has suspected lymphoma and IBD. They have very similar symptoms and IBD will often lead to lymphoma from all the inflammation. The thickening of the intestines and enlarged lymph nodes are classic symptoms of GI lymphoma.

I decided not to do the biopsy because I have seen many results that came back inconclusive, Also, although I have worked in the veterinary field (not a vet) I do not like to put my cat under anesthesia unless it cannot be helped. The treatment for severe IBD and intestinal lymphoma is basically the same. I don't need to have the definitive answer because I know there is a good chance that I won't get the answer, it won't change what I would do treatment wise. If it did turn out to be large cell lymphoma, I would not do any of the chemotherapy treatments that involves taking my cat in to the hospital for injections and blood tests every week. My cat is very timid, and this stress wouldn't be good for her.

In situations like this, it is good to ask yourself the following questions and also ask your vet
What information will this test give us?
What will the plan be if the test doesn't yield a result? Will we have to repeat the test?
Will the information this test provides change the treatment plan we are now doing?

Don't ever hesitate to ask your vet questions and get their opinion. One thing that helps is to ask them what they would do if it was their pet. It also helps to write your questions down so you don't get caught up in the stress of the vet visit and forget to ask.
Good luck with whatever you decide to do.

 

[aorticorbit]

hi all

just an update. i decided to go through with the biopsy. i switched her to a novel protein diet and she was doing really well on it, but i wanted to make sure i did everything possible to know for sure what was going on. roma came out of surgery today, she did really well according to the vet. she's exhausted and uncomfortable now but i'm hoping her pain medication kicks in soon and she starts feeling better. i feel so guilty that she's in pain now and miserable, but i know that isn't logical so i'm trying to just be there for her any way i can. thanks for all your support everyone, i really appreciate everyone's thoughtful input.

 

[silent meowlook]

Hi. Don’t hesitate to call your vet tomorrow if she isn’t feeling better.
There is no logical thinking regarding cats.

 

[aorticorbit]

she's actually doing great today! all she's done is eat, drink, sleep, and use the box, but that's all she's allowed to do anyways so i'm happy. her sutures look great and she seems more comfortable too now that she's 1 day out and on those good painkillers lol. i still feel guilty but less so now since she woke me up more than a few times last night sticking her behind in my face as revenge for taking her to the vet lol. i figure if she has the energy to enact her vengeance she likely isn't feeling tooooo terrible. thanks everyone!!