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N. Trichopoulos, J. J. Augsburger, Z. M. Correa; Prognostic Implication of Cellularity of Aspirates From Melanocytic Choroidal Tumors Evaluated by Fine-Needle Aspiration Biopsy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4776.
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Insufficiency of aspirates for cytodiagnosis is a reported problem associated with fine-needle aspiration biopsy of some presumed choroidal melanomas. The purpose of this study was to determine whether the cellularity of an aspirate from a melanocytic choroidal tumor has any prognostic value for post-treatment survival in those patients.
Retrospective outcomes analysis and prognostic factor assessment in 248 consecutive cases of presumed choroidal melanoma evaluated by 25-gauge fine-needle aspiration biopsy in two collaborating centers 1981-2001. We did not include biopsies which were performed using a biopsy needle < 25 gauge and entailed sampling of a single tumor site in this case series. Patients whose tumor was classified pathologically as a melanoma were usually treated promptly by either I-125 plaque radiotherapy or enucleation, while patients whose tumor was classified pathologically as a benign nevus were usually not treated unless the tumor exhibited progressive post-biopsy enlargement. Patients whose tumor yielded an insufficient number of cells for cytodiagnosis were managed on a case-by-case basis based on factors other than the pathologic diagnosis of the tumor. Principal outcomes evaluated were metastatic uveal melanoma and patient death. In this study, cellularity of FNAB aspirates was classified dichotomously as sufficient or insufficient for cytodiagnosis. The log rank test was applied to comparative Kaplan-Meier survival curves to estimate the significance of individual potential prognostic factors, and Cox proportional hazards modeling was used to evaluate the independent significance of potential prognostic factors in combination in this series.
Of the 248 biopsies, 226 (91.1%) yielded a sufficient number of cells for cytodiagnosis. Of these, the tumor cells were classified as malignant in 195, borderline in 21, and benign in 10. Twenty two (8.9%) biopsies yielded an insufficient aspirate. None of the 22 patients whose tumor yielded an insufficient specimen for cytodiagnosis has thus far developed metastatic uveal melanoma or died of that condition. In contrast, the cumulative actuarial probability of death at 12 years was approximately 50% for the patients whose biopsy yielded a sufficient specimen classified as either malignant or borderline. This difference was highly significant (P<0.001, log rank test).
Cellularity of fine-needle aspirates of presumed choroidal melanomas appears to be an important prognostic factor for metastasis and tumor-related death.
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