A veterinarian uses the HT Vista device to perform a non-invasive cancer screening on canine patients. Photo courtesy HT Vista Introduction Subcutaneous and cutaneous tumors are the most common tumors encountered in dogs, representing approximately one-third of all tumors diagnosed in this species. Various studies have shown that between 20 percent and 30 percent of all cutaneous and subcutaneous tumors are found to be malignant.1 In routine veterinary practice, the identification of subcutaneous and cutaneous masses is a frequent clinical presentation. The implications of misdiagnosis or delayed diagnosis can be severe, as the prognosis for dogs with malignant tumors often worsens if treatment is delayed. Therefore, the goal for every veterinary general practice should be to detect cancer in subcutaneous and cutaneous masses as early as possible. While biopsy followed by histopathology is considered the gold standard for definitive diagnosis, this method is invasive, can be time-consuming, and often incurs significant costs. Consequently, fine-needle aspiration (FNA) is widely utilized for initial evaluation due to its minimally invasive nature. However, it is important to note that cytological samples obtained via FNA can be non-diagnostic in approximately 20 percent of cases, and the diagnostic sensitivity of this method may vary.2,3 These challenges illustrate the need for novel, non-invasive diagnostic tools to support the triage of superficial masses in clinical settings. Current status in veterinary medicine The current state of cancer detection in subcutaneous and cutaneous masses in veterinary medicine reveals a concerning trend. Oncologists have increasingly warned that a prevailing “wait and see” culture can delay treatment and worsen patient outcomes. Every week, thousands of dogs leave clinics with undiagnosed masses. While many are benign, others are malignant, and delaying diagnosis can mean lost treatment opportunities and poorer prognoses. These delays can result in advanced stages of cancer that require more aggressive treatments and ultimately lead to lower survival rates. A nationwide survey of over 240 veterinary professionals, predominantly working in a general practice setting, has identified a considerable gap in the diagnosis of canine dermal and subcutaneous growths, indicating that 62 percent of masses presented in U.S. practices are sent home without any diagnostic evaluations, often adopting a “wait and see” approach. "Innovative technology can provide a non-invasive, rapid, and cost-effective assessment that can guide further diagnostic and treatment decisions." Photo courtesy HT Vista The survey goes on to identify the common barriers preventing veterinarians from conducting more widespread testing. The primary reason cited was the assumption a mass is benign based on its gross characteristics. Although benign masses are more common than malignant masses, it is not possible to diagnose benign masses based on palpation alone. This assumption can lead to inaction, particularly when pet owners express concerns regarding the costs associated with diagnostics. Additionally, time constraints during consultations often prevent veterinarians from discussing the need for further testing, and limited access to in-house cytology can hinder timely diagnoses. These barriers highlight a missed opportunity for earlier cancer detection, which in turn can limit the ability of veterinary teams to improve medical outcomes for their patients. Effective communication between veterinarians and pet owners is crucial to overcome these challenges, including educating owners about the importance of timely diagnostic testing and the potential treatment options available. Introducing innovation It is critical to invest in technology that offers a non-invasive diagnostic approach. HT Vista, a company specializing in cancer detection, uses heat diffusion imaging (HDI) to differentiate between healthy and malignant tissues. Healthy and malignant tissue display different thermophysical characteristics, resulting in varying responses to heat. The thermal diffusivity responses of tissues are influenced by several key factors, including density, thermal conductivity, metabolism, vascular network, and heat capacity. Thermal diffusion is the process by which heat transfers through materials and biological tissues. With the HDI technology, the rate of heat transfer and the thermal responses of tissues are measured during a 40-second scan. The thermal sensor continuously records changes in tissue temperature throughout this period, providing real-time data on the thermal properties of the examined masses. Photos courtesy HT Vista After the 40-second scan, the technology utilizes artificial intelligence (AI) and machine learning to analyze the heat transfer properties of the tissue and delivers results in under two minutes, enabling efficient operation by veterinary technicians. The risk stratification produced by the device categorizes findings into three cancer risk levels: Low risk indicates that the mass is likely to be benign with a 98 percent negative predictive value, and is therefore safe to monitor. Moderate risk suggests a one in four chance of malignancy, and high risk indicates a three in four chance of malignancy. Moderate or high-risk results prompt further action, such as aspiration, biopsy, or surgical removal. In addition, the company’s tumor-specific algorithms for lipoma and Mast Cell tumor provide diagnostic alerts, which support a more science-backed diagnostic approach. How innovation can help improve our quality of care Innovative technology can provide a non-invasive, rapid, and cost-effective assessment that can guide further diagnostic and treatment decisions. Adapting new approaches allows veterinary teams to evaluate the risk of cancer of masses in real-time, enabling them to ultimately detect cancer earlier, and more efficiently. Early detection not only enables veterinarians to intervene sooner but may also reduce the invasiveness of follow-on procedures, thereby minimizing the associated risks and costs. Further, as veterinarians become more confident in their diagnostic capabilities, they can foster stronger relationships with pet owners, who are increasingly seeking comprehensive care for their animals. Gillian Dank DACVIM -Oncology, DECVIM- Ca-Oncology, has published and participated in studies evaluating novel diagnostic and treatment modalities for dogs and cats. Dr. Dank has lectured to veterinarians all over Europe and Asia through Improve International. She shares her home with her husband Ronen, four children, and a golden retriever. Dank is the chief veterinary officer at HT Vet. References Withrow SJ, Vail DM, Page RL. Withrow & MacEwen’s Small Animal Clinical Oncology. 6th Edition.; 2019. Cohen M, Bohling MW, Wright JC, et al. Evaluation of sensitivity and specificity of cytologic examination: 269 cases (1999-2000). J Am Vet Med Assoc 2003;222:964–7. Simeonov RS. The Accuracy of Fine-Needle Aspiration Cytology in the Diagnosis of Canine Skin and Subcutaneous Masses. Comp Clin Path 2012;21:143–147.
