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I. V. Koreen, C. C. Nelson, B. R. Frueh, V. M. Elner; Frequency of Non-diagnostic Conjunctival Map Biopsies for Sebaceous Carcinoma Correlates with Disease Severity and Recurrence. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5737.
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Determine the fraction of non-diagnostic conjunctival map biopsies due to loss of epithelium and whether non-diagnostic biopsies correlate with recurrence and greater extent of disease.
Retrospective chart and pathologic specimen review of 20 cases of periocular sebaceous carcinoma. At least four sections along the long axis of each conjunctival map biopsy specimen were reviewed with particular attention to the presence of epithelium. A biopsy was categorized as non-diagnostic if there was complete absence of epithelium or if epithelium was only present in one 40x objective field. If more epithelium was present, it was categorized as diagnostic.
The patient population consisted of 40% men and 60% women, with an average follow-up period of 27 months. One patient developed tumor recurrence during follow-up. Four patients had extensive Pagetoid intraepithelial disease at presentation, requiring exenteration. There were no deaths. The average number of conjunctival biopsies obtained from each patient was 8. Of 163 biopsies from 20 patients, 81.6% were diagnostic and 18.4% non-diagnostic. Chi-square analysis revealed that the presence of non-diagnostic map biopsies was correlated with disease recurrence and extensive intraepithelial disease with an odds ratio of 5.939 (95% CI: 2.575-13.712; p<0.0001).
Non-diagnostic conjunctival map biopsies were more common among patients with sebaceous carcinoma who had extensive intraepithelial disease on presentation or who developed tumor recurrence following initial treatment. This may be a result of disruption of epithelial cell adhesion to the basement membrane by infiltrating sebaceous cells, resulting in greater specimen fragility. Map biopsies without epithelium should be reported as non-diagnostic, rather than negative for tumor.
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