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Melinda Chang, Ben J Glasgow, Tara A McCannel; Comparison of Uveal Melanoma Cytopathologic Sample Retrieval in Transscleral Versus Vitrectomy-Assisted Transvitreal Fine Needle Aspiration Biopsy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6022.
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Fine needle aspiration biopsy has become a standard technique to obtain material from primary uveal melanoma for cytopathology, prognostication and research. The purpose of this investigation was to compare sample retrieval for cytopathology between transscleral and vitrectomy-assisted transvitreal biopsy in the same tumor in patients who underwent iodine-125 brachytherapy in combination with vitrectomy.
All clinical records of patients who underwent iodine-125 brachytherapy for the treatment of uveal melanoma in conjunction with pars plana vitrectomy from whom transscleral and vitrectomy-assisted transvitreal fine needle biopsies were obtained, were reviewed. Transscleral and transvitreal biopsies were performed using a 30-gauge and 27-gauge needle, respectively. Baseline patient and tumor characteristics, biopsy sample yield for cytopathology, and surgical outcomes were reviewed.
Thirty-eight patients with a mean follow-up time of 4.3 months were included. The mean tumor height was 4.8 mm (range 1.74 to 13.27 mm) and the mean tumor largest basal diameter was 10.7 mm (range 5.47 to 15.9 mm). Overall, 71.1% of transvitreal biopsies and 65.8% of transscleral biopsies yielded sufficient material for cytopathologic analysis (p = 0.62). Greater tumor height and largest basal diameter were significantly associated with increased cytopathologic yield in both transvitreal (p = 0.03 and p = 0.02, respectively) and transscleral biopsies (p= 0.015 and p = 0.007, respectively). Tumor location was not significantly associated with cytopathologic yield for transvitreal (p = 0.26) and transscleral (p = 0.63) biopsies. Fifteen eyes (39.4%) developed transient localized vitreous hemorrhage. No eye developed diffuse or non-clearing vitreous hemorrhage, rhegmatogenous retinal detachment, local treatment failure or metastatic disease during follow-up interval.
Both transscleral and vitrectomy-assisted transvitreal fine needle aspiration biopsy resulted in similar tissue yield for cytopathologic analysis when compared during biopsy of the same uveal melanoma. As molecular prognostication becomes the standard of care for obtaining patient information and directing clinical management, further investigation of biopsy techniques is warranted.
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