Cross-sectional comparison of superficial swab and fine-needle aspiration: Improving the diagnostic workup of horses with sarcoids

Abstract

Although bovine papillomavirus (BPV)-induced equine sarcoids are often identified solely by clinical examination, confirmation of the clinical diagnosis is essential for correct treatment selection. Only few approaches are presently available for this purpose. PCR-based screening for BPV in superficial swabs is widely-used to support clinical suspicion. While this method effectively detects sarcoid involvement in ulcerated lesions, sensitivity is lower in tumors with intact epithelium. This cross-sectional study compared the diagnostic characteristics of superficial swabs and fine-needle aspirates (FNA) with the aim to validate FNA as an alternative sampling method to detect BPV in suspect lesions. Among 63 lesions confirmed as sarcoids from 58 horses, compared to swabs FNA detected a greater proportion of BPV positives in general (swab, 70 %,;95 % confidence intervals [CI], 58.5 %−81.2 %; FNA, 98 %, 95 % CI, 95.3 %−100 %; P = 0.0001) and among a non-ulcerated subgroup (swab, 63 %, 95 % CI, 50.4 %−76.6 %; FNA, 98 %, 95 % CI, 91.4 %−100 %; P = 0.0001). Furthermore, the sensitivity, as well as the negative predictive value and accuracy of FNA for matched samples from 58 horses were superior to surface swabbing for the group of all horses and the subgroup that included only lesions with an intact epidermis (n = 48), with differences ranging from 23 % (95 % CI, 11.4 %−34.6 %) to 52 % (95 % CI, 25.9 %−78.1 %). Other advantages of FNA identified were a higher chance of adequate sampling and a reduced risk of unwanted detection of superficial contamination or latent BPV in keratinocytes. The ability to consistently detect BPV in all clinical lesion types indicates that FNA shows promise as a valid diagnostic tool to improve the consistency and quality of the diagnostic workup of equine sarcoids.