Article

Diagnostic transvitreal fine-needle aspiration biopsy of small melanocytic choroidal tumors in nevus versus melanoma category.

Department of Ophthalmology, Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Transactions of the American Ophthalmological Society 01/2002; 100:225-32; discussion 232-4.
Source: PubMed

ABSTRACT To report an experience with fine-needle aspiration biopsy of selected small melanocytic choroidal tumors during the interval from April 13, 1983, through January 19, 2001.
Retrospective descriptive case series report of 34 patients with a small melanocytic choroidal tumor (maximal diameter, < or = 10 mm; thickness, > or = 1.5 mm but < or = 3 mm) evaluated diagnostically by transvitreal fine-needle aspiration biopsy prior to treatment. None of the tumors had invasive features at the time of biopsy.
Patients ranged in age from 26 to 73 years (mean, 50.9 years). The evaluated choroidal tumors had a mean maximal basal diameter of 8.0 mm and a mean maximal thickness of 2.4 mm. Eighteen of the 34 tumors (52.9%) had been documented to enlarge prior to biopsy. Biopsy was performed in all cases using a 25-gauge hollow lumen needle and a transvitreal approach via a pars plana puncture site. The biopsy yielded a sufficient aspirate for cytodiagnosis in 22 of 34 cases (64.7%). In these cases, the tumor was classified as malignant melanoma in 16 (47.1% of total), intermediate lesion in 4 (11.8%), and benign nevus in 2 (5.9%). The 12 tumors that yielded an insufficient aspirate and the four lesions that yielded intermediate cells continued to be classified as "nevus versus melanoma" and were monitored periodically for growth or other changes. Four of the 12 tumors that yielded an insufficient aspirate for cytodiagnosis and all four lesions that yielded intermediate cells were eventually reclassified as small choroidal melanomas and treated. The remaining eight tumors that yielded an insufficient aspirate and the two tumors that yielded benign nevus cells were classified as benign nevi at the most recent follow-up evaluation.
Fine-needle aspiration biopsy showed that a substantial proportion of small melanocytic choroidal tumors likely to be classified clinically as small choroidal melanomas in many centers were in fact benign nevi or intermediate lesions.

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    ABSTRACT: HintergrundIn den meisten Fällen intraokularer Raumforderungen kann die Diagnose mittels biomikroskopischer Untersuchung und unter Zuhilfenahme der heute verfügbaren bildgebenden Verfahren (Ultraschall, Angiographie, Computertomographie und Magnetresonanz) mit großer Sicherheit gestellt werden. Dennoch bleibt in einem kleinen Prozentsatz der Fälle die Diagnose auch unter Anwendung aller nicht-invasiven Untersuchungstechniken unsicher. Aus diesem Grund hat sich seit vielen Jahren die Technik der Biopsie intraokularer Tumore zur Gewinnung von Zellmaterial und damit der Möglichkeit zur zytologischen Diagnostik beständig weiterentwickelt. Die Bedeutung dieser diagnostischen Methode ist jedoch nicht unumstritten und sie wird an nur wenigen Zentren durchgeführt. Seit Beginn 2003 wird an der Augenklinik der Medizinischen Universität Graz die Biopsie zur Diagnosesicherung bei verdächtigen intraokulären Raumforderungen in speziellen Fällen und bei genau definierter Fragestellung durchgeführt. Ziel der folgenden Arbeit ist die Darstellung der angewandten Technik sowie der damit erzielten Resultate und der in diesem Zeitraum gewonnenen Erfahrung. Patienten und MethodeBei 6 Patientinnen, 4 mit Verdacht auf Aderhautmelanom und je einer Patientin mit subretinaler Blutung bzw. Astrozytom, wurde die Biopsie zur Diagnosesicherung vor weiterer Therapie durchgeführt, 3-mal auf transskleralem, 3-mal auf transvitrealem Weg. ErgebnisseDie Verdachtsdiagnose konnte in 4 Fällen bestätigt werden, in einem Fall konnte in der zytologischen Untersuchung keine klare Diagnose gestellt werden, in einem Fall war das gewonnene Material unzureichend. In 2 der 6 Fälle kam es zu einer Visusverschlechterung durch Blutungs-komplikationen. SchlussfolgerungDie Biopsie scheint uns, trotz einiger gegenteiliger Meinungen, nach wie vor das Mittel der letzten Wahl zu sein, um eine Diagnose zu sichern. Die Risiken der Methode und das Problem des weiteren Vorgehens bei zytopathologisch unklarem Befund rechtfertigen, insbesondere bei gutem Ausgangsvisus, den Nutzen einer frühzeitigen Diagnosesicherung durch Biopsie nur in wenigen Fällen. BackgroundMost cases of intraocular tumors can be diagnosed clinically by slitlamp examination and biomicroscopy, if needed together with noninvasive imaging techniques, such as ultrasound, angiography, CT and MRI. However a small percentage of patients remains with a clinically uncertain diagnosis. For that reason, biopsy has been used as a diagnostic modality for intraocular tumors and simulating lesions for almost 25 years. There still is an ongoing discussion about when we should perform this procedure. At our department we have been using this technique since 2003 in selected cases. The aim of this paper is to present the patients we had and the technique we used as well as the results we had. Patients and methods6 patients (4 with the differentialdiagnosis of choroidal melanoma vs nevus, 1 with subretinal hemorrhage and 1 with astrocytic hamartoma) have been selected for biopsy. In three cases we used a transscleral approach, three times we peformed biopsy through a transvitreal route. ResultsClinical diagnosis has been confirmed in four cases. One case had to be judged inconclusive, in one case the material obtained was not sufficient for cytopathological diagnosis. In two cases visual acuity detoriated due to bleeding complications. ConclusionAspiration biopsy has been reported as a save technique in clinically undecisionable cases. However, in contrary to the recommendations of other authors, in our opinion, biopsy should be used for selected cases only, because of the severe risk of vitreous and subretinal bleeding.
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