September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Vitrectomy-Assisted Biopsy for Molecular Prognostication of Choroidal Melanoma 2 mm or Less in Thickness with a 27-Gauge Vitreous Cutter
Author Affiliations & Notes
  • Aaron Nagiel
    Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Christian Moreno
    Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Colin McCannel
    Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Tara A McCannel
    Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Footnotes
    Commercial Relationships   Aaron Nagiel, None; Christian Moreno, None; Colin McCannel, None; Tara McCannel, None
  • Footnotes
    Support  Research to Prevent Blindness and the George E. and Ruth Moss Trust
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 5891. doi:
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      Aaron Nagiel, Christian Moreno, Colin McCannel, Tara A McCannel; Vitrectomy-Assisted Biopsy for Molecular Prognostication of Choroidal Melanoma 2 mm or Less in Thickness with a 27-Gauge Vitreous Cutter. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5891.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Fine needle aspiration biopsy (FNAB) is a well-established technique for molecular prognostication of uveal melanoma. However, transscleral or transvitreal FNAB of very small melanomas 2 mm or less in thickness has been associated with a low biopsy yield. This report describes our center’s experience using a 27-gauge vitreous cutter to perform tumor sampling in these small melanomas.

Methods : This was a retrospective analysis of all patients who underwent a 27-gauge vitreous cutter biopsy for molecular prognostication at the time of iodine-125 plaque placement for local treatment of choroidal melanoma. Baseline patient demographics, tumor characteristics, and biopsy results for cytopathology, cytogenetics, and gene expression profiling were reviewed.

Results : Sixteen consecutive patients with a median follow-up time of 3.8 months (range, 0.5 – 12.4 months) were included in this study. The mean baseline tumor height was 1.71 mm (range, 1.31 – 2.18 mm) and the mean largest basal diameter was 8.9 mm (range, 5.4 – 14.9 mm). 27-gauge biopsy yielded sufficient material for cytopathology, cytogenetics, or gene expression profiling in 16/16 (100%) cases using an average of two passes with the cutter to collect biopsy material. Only certain molecular diagnostic tests were ordered for each patient as determined by the amount of biopsy material and the cost of the testing. Multiplex ligation-dependent probe amplification analysis of the samples revealed monosomy 3 in 4/10 (40%) cases. Gene expression profiling revealed class 1A status in 9/13 (69%) tumors, class 1B in 2/13 (15%), and class 2 in 2/13 (15%). Focal vitreous hemorrhage over the tumor occurred in 11/16 (69%) eyes and diffuse vitreous hemorrhage occurred in 1 case (6.3%); all hemorrhages resolved by one month with observation only. There was no instance of retinal detachment or choroidal hemorrhage associated with the biopsy.

Conclusions : Tumor sampling of very small uveal melanomas with a 27-gauge vitreous cutter is a safe technique that offers excellent biopsy yield for molecular prognostication when cancer prognosis is desired in patients with very small choroidal melanoma.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Intraoperative video image of the 27-gauge vitreous cutter penetrating the retina to obtain a biopsy of this 1.79 mm choroidal melanoma.

Intraoperative video image of the 27-gauge vitreous cutter penetrating the retina to obtain a biopsy of this 1.79 mm choroidal melanoma.

 

Focal vitreous hemorrhage can be seen over the tumor shortly after performing the biopsy.

Focal vitreous hemorrhage can be seen over the tumor shortly after performing the biopsy.

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