Regular ultrasound gives ill-defined images that are often almost useless diagnostically. A case in point is an ultrasound of my BFA’s liver, which showed two areas of differing echo intensity. It could be fibrosis, it could be hepatocellular carcinoma (HCC), who knows: the vet wants to do a biopsy. No matter how much the vets insist that their biopsies do not lead to needle tract implantation of tumors—if the cell masses in question should be cancerous—I don’t believe them, and, in fact refused a biopsy on my own liver a few years ago for that reason (I relied on what they called a “virtual” biopsy, which was a computer simulation based on a blood test.) Ziggy’s vet is good, and she is fully aware of the superiority of a laparoscopic biopsy to a percutaneous blind needle biopsy. Superiority does not mean absence of risk: whether you like it or not, you still have to physically puncture the tissue. Technically, the only way they could avoid the risk of needle tract implantation, which is what it is called when liver cancer follows the path of the biopsy needle, and is a well-documented phenomenon, is if they have figured out how to teleport the tissue sample in question, which, somehow or another, I don’t think is within our technical grasp yet. In the case of Ziggy, he is at least 27 years old, and the procedure itself would be a risk even if he were in perfect health.
I have three questions:
1. Is HCC in avian species easier to treat or more amenable to therapy than it is in humans? Is there anyone who knows about liver cancer in avian species? Is there an expert anywhere on the subject I could consult with before I decide on the biopsy?
2. I would like to get a high-definition ultrasound image of my Ziggy’s liver. The Mayo Clinic has offered endoscopic ultrasound (EUS) for two decades, and it is more accurate. However, they now have an even better version of ultrasound imaging available now, called MRE. I inquired of one of the Mayo Clinic doctors, and he told me that, “Although we have used MRE to evaluate the liver in animals as small as mice, it is not currently suited for assessing localized areas of the liver in small animals. Also, I am not aware of any vet imaging facilities that have the technology, as yet. There are some new ultrasound-based technologies that provide information similar to MRE, but I don’t think that they would yet be available in the vet care setting.” My second question is this: is there, anywhere in the US, any facility of any kind that offers or is even investigating one of these new ultrasound processes experimentally? I would drive my Ziggy wherever necessary in order to get such a diagnosis and avoid a biopsy, even if it is only an experimental procedure. It is inevitable that this technology will come to veterinary medicine, and I am certain that, even if it is not yet available, doctors who are aware of its existence are wishing that they had access to such a diagnostic technique. Any diagnostician would be begging for such a machine. It has got to be at least “in the works” somewhere, which leads to my third question:
3. Who has the most technically advanced avian diagnostic equipment in this country? I can’t believe that avian medicine is lagging that far behind human medicine. Which veterinary schools have the best post-graduate research facilities for avian species? Are there any which are currently studying the area of avian medicine that I need help in?
The question of the biopsy is whether the information gained is worth the risk: to cause a bird to suffer and potentially die in order to discover that the bird already has something that is fatal, but can be ameliorated, is senseless. The non-cancer diagnoses can all be treated nutritionally, which is already being done. I don’t know how much information can be gleaned from the new technology ultrasound imaging, if it were available, but I am hoping that it would avert a biopsy.