One of the most common and challenging moments in practice is discovering a lump on a patient. It may be discovered incidentally during a routine exam, or a worried pet owner may bring it up after noticing something new at home. No matter how the mass is found, the questions come quickly. What is it? Should we be worried about it? What do we do next? That conversation matters. For veterinarians, lumps and bumps are part of everyday practice. For pet owners, these moments can feel stressful and emotional–especially because pets are family. Recent research reports 21 percent of pet owners found the death of their pet the most distressing loss they had ever experienced.1 The emotional bond is why uncertainty around a mass can feel so heavy, and why early, practical, and affordable diagnostics matter. One of the key messages I share with veterinary teams and pet owners is simple: No one can look at a mass or feel a mass and know what it is. Not a pet owner, not a general practitioner, and not a veterinary oncologist like myself. That is why cytology is such an important first step. It helps move the conversation from guessing and waiting to gathering information, making a diagnosis, and creating a plan. This is also the foundation of my See Something, Do Something. Why Wait? Aspirate.® program, which was created to empower veterinary teams and pet owners to be more proactive with lumps and bumps.2 The guidelines are intentionally simple: if a mass is the size of a pea (1 cm) and has been present for one month, aspirate it. The goal is not to make every lump feel alarming, but to move away from guessing and waiting when a simple fine-needle aspirate can provide meaningful information and help guide next steps. Start with cytology Fine-needle aspiration is a simple, minimally invasive technique that can provide valuable information about a mass. In many cases, it allows us to determine whether we are dealing with inflammation, a benign growth, or a malignancy, without guessing, waiting, or rushing that patient straight into surgery. This is why I consider cytology such a powerful first step in oncology diagnostics. It can help guide staging, treatment decisions, referral if needed, and the next conversations with the pet owner. Cytology is valuable but not without challenges. Sample quality can vary, and interpretation depends on the cells present, slide quality, clinical picture, and the experience and confidence of the person collecting and reviewing them. In general practice, time, cost, and access to pathology support can also shape how quickly and sometimes whether we get answers. When samples are sent to conventional external laboratories, cytology can add to the cost for the pet owner and may take several days to return results. In that space, uncertainty has time to build, both for the veterinary team and for the owner sitting at home waiting. For some owners, the cost of cytology is the barrier to taking the next diagnostic step. Unfortunately, small or not-urgent-looking do not always mean benign. Many skin and subcutaneous masses, even many malignant ones, can be cured with early diagnosis and treatment while still small. In oncology, timing matters. Not every mass is an emergency, but delays in interpretation can influence how we move forward, and in some cases, how the disease progresses. Just as importantly, timing shapes how we communicate. It is difficult to guide a client through the next steps when we do not yet have enough information to offer real clarity. Over the past several years, advances in digital cytology and artificial intelligence (AI) have begun to change how we approach these early stages of diagnosis. We are already seeing this change play out in real time. In the U.S., nearly 40 percent of veterinary professionals now incorporate AI into their everyday practice.3 AI-supported digital cytology can help make cytology more practical and accessible as a screening diagnostic, especially when cost, time, or access to pathology support may otherwise delay the first step. That matters because when cytology is supported at the point of care, we are not waiting days for the first layer of information. With AI-supported digital cytology, once the slide is scanned, the report can provide useful information quickly, often in the same visit, with results typically available in about 20 minutes. In practical terms, that means veterinarians may be able to see what cell populations are present and whether the findings support an inflammatory process, a benign lesion, or concern for a malignant tumor, such as a mast cell tumor (MCT). When I use AI-supported digital cytology, I have the owners wait for results if they are able, so I can review the findings and next steps in person. That information can change a conversation immediately. If an MCT is identified, for example, I can explain how we typically approach the disease and discuss treatment options. Depending on the mass, location, cytology findings, and the overall patient, it may mean staging, surgery, intratumoral injection, referral, add-on expert review, or other treatment options. For MCT, I recommend an add-on expert review of cytologic grading, as this can inform staging and treatment recommendations. AI-supported digital cytology does not replace veterinarian judgment. The report still needs to be interpreted in the context of the patient, physical exam, sample quality, and what was seen on the slide. Some cases are straightforward enough to guide the next step, while others are more complex or ambiguous. In those other cases, a clinical pathologist’s expert review can be especially valuable. For me, the value is not that AI gives every answer; it is that AI-supported digital cytology can be a practical, efficient, and cost-effective way to screen masses, help identify benign processes, and diagnose malignant MCT, the most common malignant cutaneous cancer in dogs. It brings useful cytological information into the exam room sooner, instead of asking the owner to go home and wait before we can begin a real conversation. We can discuss the findings, what we still do not know, and the next step, often in person during the appointment. Case in context: Same-visit clarity with AI-supported cytology Zoe, an eight-year-old spayed female American bulldog, presented for recheck of a previously diagnosed follicular lymphoma with salivary gland involvement. This was an atypical lymphoma presentation, and, unlike more common forms of lymphoma, she had not been treated with a traditional chemotherapy protocol after lymph node removal. On physical examination, Zoe’s peripheral lymph nodes were normal, but a new, flat, movable subcutaneous mass was noted on the left ventrolateral abdomen. Zoe, an eight-year-old spayed female American bulldog. Photo courtesy Dr. Sue Ettinger Given the new mass, fine-needle aspiration was performed. Clinically, I thought the mass was likely lipoma. It was difficult to aspirate because the mass was very flat and mobile, but the sample was submitted through AI-supported digital cytology, which identified findings consistent with an MCT. Having that information available during the visit changed the conversation. Instead of asking the owner to wait several days before discussing the possibilities, we were able to talk in person about the findings, why this was not a matter to simply monitor, and the next step. Based on the AI Masses findings, I recommended an add-on expert review to confirm the diagnosis and provide cytologic grading, which supported a low-grade MCT. Because the mass was subcutaneous and located on the trunk, I recommended surgical removal with her primary veterinarian rather than an intratumoral injection. Zoe went on to have surgery eight days later. Histopathology confirmed a low-grade subcutaneous MCT, with no infiltrative pattern, no multinucleated cells, and a mitotic count of 0. Margins were narrow laterally but complete, with a good, deep margin and a tissue plane deep to the tumor. A separate ventral thoracic lipoma was also removed. The owner then returned for a post-operative oncology recheck so we could review the biopsy report in detail. We discussed that subcutaneous MCTs are distinct from dermal MCTs and often have a favorable prognosis when completely excised, although a small subset can behave more aggressively. Additional prognostic testing was discussed but declined at that time, with the option to add it later if needed. presented for recheck of a previously diagnosed follicular lymphoma with salivary gland involvement. This was an atypical lymphoma presentation, and she had not been treated with a traditional chemotherapy protocol after lymph node removal. Photo courtesy Dr. Sue Ettinger This case highlights the practical value of AI-supported digital cytology as a screening diagnostic. It did not replace clinical judgment or expert review, but it helped identify a malignant tumor sooner, enabled us to have a more informed in-person conversation, and facilitated Zoe’s efficient transition from cytology to surgery to post-operative planning. Veterinary expertise supported by AI AI-supported tools are not a substitute for veterinary expertise. Cytology remains an interpretive discipline, and clinical context will always be central to how we understand and act on any result. These technologies are best seen as an additional layer of support, one that can bring greater consistency, improve efficiency, expand access to cytologic information, and help veterinary teams make more informed next-step recommendations. For general practitioners, this can be especially valuable because they are often the first to evaluate the skin and subcutaneous masses that walk through the door every day. AI-supported digital cytology can help bridge the gap between an initial assessment and specialist input when needed. It can support more streamlined workflows and earlier, more confident case triage in everyday practice. For pet owners, these conversations can be clearer because we can explain what we are seeing, what we are concerned about, and what may come next. For patients, earlier information can mean reaching a diagnosis sooner and starting the appropriate, recommended strategy. Earlier intervention often improves outcome and prognosis. In other cases, it may simply help avoid delays, repeated procedures, or prolonged uncertainty that can add stress to the family and veterinary team. There is also a broader impact when we think about access to care. Not every practice has immediate access to a clinical pathologist, specialist, or advanced diagnostic services. Bringing more cytological support into the clinic in a cost-effective, time-efficient manner helps narrow that gap and supports a more consistent standard of care, regardless of setting. At the same time, it is essential we remain thoughtful in how we integrate these tools into practice. High-quality sample collection still matters. The report still needs to be interpreted within the clinical picture. Early cancer detection is never the result of a single test or a single technology. It is a process, one that relies on careful examination, appropriate use of diagnostics, clear communication, and sound clinical judgment. What these advances offer is not a shortcut. They strengthen that process by helping us to gather useful information sooner, interpret more efficiently, and move forward with greater clarity and confidence. Final thoughts Our role is not only to diagnose diseases, but also to guide our patients and their families through what can be a very difficult, often emotional journey. When used thoughtfully, AI-supported digital cytology can help us move from “Let’s keep an eye on it,” to “Let’s get more information and make a plan.” That is where I think these tools are most valuable—not as a replacement for the veterinarian, but as support for making better decisions, having better conversations, and taking earlier action. When we find a lump, getting useful information sooner helps us stop guessing, start planning, and guide the pet owner with greater confidence. Sue Ettinger, DVM, DACVIM (Oncology), practices at Guardian Veterinary Specialists in New York and was recognized as the 2019 Western Veterinary Conference Small Animal Continuing Educator of the Year. Dr. Ettinger pioneered the “See Something, Do Something, Why Wait? Aspirate®” initiative to promote early cancer detection in pets. Beyond her clinical work, Ettinger connects with pet owners and veterinary professionals on social media, where she shares valuable education and support with more than 140,000 followers. She is the co-author of the Second Edition of The Dog Cancer Survival Guide. References Hyland, Philip. No pets allowed: Evidence that prolonged grief disorder can occur following the death of a pet. PLOS ONE 21, no. 1 (January 14, 2026): e0339213. https://doi.org/10.1371/journal.pone.0339213 https://drsuecancervet.com/why-wait-aspirate/ Digitail and AAHA. AI in Veterinary Medicine: The Next Paradigm Shift. (February 2024.) https://digitail.com/blog/artificial-intelligence-in-veterinary-medicine-the-next-paradigm-shift/
