Response to letter regarding “ACVIM consensus statement on pancreatitis in cats”

[...]to what is stated by Dr Törner and Dr Aupperle-Lellbach, the focus of this consensus statement is not, and was not intended to be, the diagnosis of pancreatitis in cats, but rather a holistic summary of the disease. [...]many details in all of the sections had to be omitted. The reference by Törner et al does provide some summary data on the analytical validation of this assay, but allows no determination of the modifications to the assay or the details of the analytical validation of the assay, as no raw data were provided. 1 The statement concerning discordance of the 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester (DGGR) assay with serum fPLI was simply based on Cohen's kappa coefficient of 0.7 reported in the study by Oppliger et al and was appropriately cited. 5 The panel felt that no further discussion was needed as a value of 0.7 for 2 assays that supposedly measure the same analyte demonstrates discordance. 5 The panel agrees with the authors of the letter about the limited gold standard nature of histopathology (ie, when changes are identified on histopathology a diagnosis of pancreatic inflammation can be made; however, changes may be localized and thus the diagnosis may be missed), which is what was stated in the consensus statement. 2 However, as is the case in humans and in dogs, a histopathologic diagnosis of acute pancreatitis in cats is usually limited to patients that die of the disease or, as may be the case in dogs and cats, are euthanized, as the collection of a biopsy is often not in the best interest of the patient. [...]the panel also agrees with the authors of the letter that no single diagnostic test should be blindly trusted when arriving at a diagnosis of pancreatitis, which is why the panel concluded the consensus statement by stating that: “Pancreatitis is amenable to antemortem diagnosis by integrating all clinical and diagnostic information available.”