Abstract
Purpose:
To report outcomes and complications of diagnostic fine-needle aspiration biopsy (FNAB) of uveal melanoma.
Methods:
Prospective interventional series of 150 consecutive patients with uveal melanoma treated at the Cleveland Clinic Cole Eye Institute between May 2009 and August 2012. The FNAB approach (trans corneal [TCO], trans scleral [TSC], and trans vitreal [TSV] were primarily determined by the location of the tumor. The FNAB was performed using 25 Gauge needle using previously published technique. All aspirated material was flushed into in Cytolyt® solution for ThinPrep® processing. The diagnosis of uveal melanoma was based upon characteristic cellular features. The cytological reporting was divided into 4 conventional categories: 1. Unsatisfactory for interpretation, 2. Negative for melanoma, 3. Atypical cells (not diagnostic or consistent with melanoma) and 4. Positive for melanoma. Patients were evaluated 1-4 weeks postoperatively, then every 3 months for the first year, followed by every 6 months thereafter. Data were analyzed using STATA version 11.
Results:
FNAB was obtained via TCO (8), TSC (71), and TVT (64) approach and impression smear in 7 cases. Diagnostic yield was 92% (Positive for melanoma 122, Atypical cells : consistent with melanoma 9). False negative results were oserved in 8% (Unsatisfactory 7, Negative for melanoma 3, Atypical cells : not diagnostic 2). Diagnostic yield was significantly correlated to biopsy approach (TCO 100%, TSC 96%, 86%; p = 0.029, Fisher’s exact test) and tumor size (basal diameter >5.0 mm; height >2.5 mm). Visual acuity (<20/40 and > 20/400) at baseline and at 3 months was recorded in 68%,13% and 57%, 22% respectively). Visually significant complications such as persistent hemorrhage (sub retinal hemorrhage or vitreous) requiring surgical intervention (1%) and rhegmatogenous retinal detachment (1%) were rare. Endophthalmitis, hypotony, and detectable needle tract seeding were not observed.
Conclusions:
FNAB for uveal melanoma with 25-gauge needle is a safe procedure that can yield diagnostic samples in more than 90% of cases. Possibility of negative diagnostic FNAB yield should be considered when counseling patients with small tumors.