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Amy C Schefler, Maru Eugenia Bretana, Patricia Chevez-Barrios, Bin Teh, Neda Nikpoor, Daniel Gologorsky; Rates of Sample Acquisition in Uveal Melanoma Fine Needle Aspiration Biopsies Using Transscleral and Transvitreal Techniques. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5328.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of this study was to compare the rate of successful sample acquisition during uveal melanoma fine needle aspiration biopsies using transscleral versus transvitreal techniques.
This was a single-center, retrospective review of patients who chose to undergo fine needle aspiration biopsies for cytopathologic and genomic analyses of uveal melanoma concurrent or before definitive treatment with Iodine-125 plaque or biopsy in 2014. Only patients with 3 months or more of follow-up and adequate data for analysis were included. Clinical variables were reviewed including: patient demographic data (age, sex, right/left eye); clinical tumor data (size of tumor, presence of subretinal fluid, location of tumor); biopsy technique details (transscleral versus transvitreal, number of passes needed, adequacy of sample obtained, GEP class and discriminant value).
There were 30 patients who met the inclusion criteria. Ten were females and 20 were males. Seventeen of the eyes in the study were right eyes, and 13 were left eyes. The mean age of the patients was 61 (range, 19-82). Seventeen underwent biopsies with a transvitreal approach and 13 underwent biopsies via a transscleral approach. Of the 30 biopsies, only two patients who underwent transvitreal biopsies had an inadequate sample (93% success rate). Sixteen were Gene Expression Profiling Class 1A; Three patients were Class 1B; and 11 were Class 2. Mean discriminant value was 0.86 for the gene expression profiling sample and all patients except one in the study had a discriminant value > 0.1. The vast majority of the time, only one biopsy pass was needed. No patients developed a retinal detachment and transient vitreous hemorrhage occurred in nearly all patients. There were no cases of extraocular extension. Various techniques were used to ensure biopsy success including adequacy checks with the ophthalmic pathologist present in the operating room for the procedure, use of the 27 g vitreous cutter for lesions < 1.5 mm, direct visualization with a retinal viewing system, and others.
Very high success rates can be achieved with both transscleral and transvitreal approaches to fine needle aspiration biopsy for uveal melanoma using the technical approaches described in this study.
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