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Arun D Singh, Carlos A Medina Mendez, Nakul Singh, Mary E Aronow, Hassan A Aziz, Charles V Biscotti; FNAB of Uveal Melanoma : Outcomes and Complications. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4333.
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© ARVO (1962-2015); The Authors (2016-present)
To report outcomes and complications of diagnostic fine-needle aspiration biopsy (FNAB) of uveal melanoma.
Prospective interventional series of 150 consecutive patients with uveal melanoma treated at the Cleveland Clinic Cole Eye Institute between May 2009 and August 2012. The FNAB approach (trans corneal [TCO], trans scleral [TSC], and trans vitreal [TSV] were primarily determined by the location of the tumor. The FNAB was performed using 25 Gauge needle using previously published technique. All aspirated material was flushed into in Cytolyt® solution for ThinPrep® processing. The diagnosis of uveal melanoma was based upon characteristic cellular features. The cytological reporting was divided into 4 conventional categories: 1. Unsatisfactory for interpretation, 2. Negative for melanoma, 3. Atypical cells (not diagnostic or consistent with melanoma) and 4. Positive for melanoma. Patients were evaluated 1-4 weeks postoperatively, then every 3 months for the first year, followed by every 6 months thereafter. Data were analyzed using STATA version 11.
FNAB was obtained via TCO (8), TSC (71), and TVT (64) approach and impression smear in 7 cases. Diagnostic yield was 92% (Positive for melanoma 122, Atypical cells : consistent with melanoma 9). False negative results were oserved in 8% (Unsatisfactory 7, Negative for melanoma 3, Atypical cells : not diagnostic 2). Diagnostic yield was significantly correlated to biopsy approach (TCO 100%, TSC 96%, 86%; p = 0.029, Fisher’s exact test) and tumor size (basal diameter >5.0 mm; height >2.5 mm). Visual acuity (<20/40 and > 20/400) at baseline and at 3 months was recorded in 68%,13% and 57%, 22% respectively). Visually significant complications such as persistent hemorrhage (sub retinal hemorrhage or vitreous) requiring surgical intervention (1%) and rhegmatogenous retinal detachment (1%) were rare. Endophthalmitis, hypotony, and detectable needle tract seeding were not observed.
FNAB for uveal melanoma with 25-gauge needle is a safe procedure that can yield diagnostic samples in more than 90% of cases. Possibility of negative diagnostic FNAB yield should be considered when counseling patients with small tumors.
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