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S. Lee, H. Koh, S. Kim, O. Kwon; The Analysis of Diagnostic Tools Used in the Diagnosis of Choroidal Melanoma . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2249.
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Choroidal melanoma occurs very rarely in Korean patients and displays different clinical features compared to that in western countries. The authors reviewed and analyzed the results of FNAB and imaging studies such as MRI, PET, ultrasonography that are used in diagnosing choroidal melanoma.
The medical records of 81 eyes of 81 patients who visited our institute in the past 1 year were retrospectively reviewed for the differential diagnosis of choroidal melanoma.
19 eyes out of 81 eyes were diagnosed with choroidal melanoma based on the fundus findings and ultrasonogram. Among them, 17 eyes were finally confirmed as choroidal melanoma, 1 eye was found to be of metastatic origin based on the PET finding, and 1 eye was diagnosed as metastatic epithelial cell carcinoma based on FNAB. Of 14 eyes, A–scan ultrasonography revealed regular medium–low reflectivity and sound attenuation in 9 eyes (including 2 metastatic carcinoma). Although 3 eyes showed regular reflectivity, there was no sound attenuation. Also, irregular reflectivity was observed in 2 eyes. In all cases, MRI findings revealed hyperintense T1W image, hypointense T2W image and 8 eyes out of 19 eyes were enhanced by contrast in MRI. Since the increased uptake in PET was found in only 2 out of 7 eyes, PET is considered to have low sensitivity in detecting choroidal melanoma. FNAB was performed in 9 eyes and 8 eyes were confirmed as choroidal melanoma and 1 eye as metastatic carcinoma.
In addition to the ophthalmoscopic examination of the retina, ultrasonography can be a useful tool in the diagnosis of choroidal melanoma, but the variations in ultrasonographic findings should be taken into consideration. It was found that MRI was not of much assistance in the differential diagnosis of choroidal melanoma, but the use of whole body PET and FNAB could provide diagnostic aid in uncertain cases.
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