Abstract
Purpose: :
To evaluate the accuracy of punch biopsy with 2-mm trephine in the diagnosis of eyelid tumors and verify the existence of associations, both quantitative (age, duration of disease, tumor area and largest diameter) and qualitative (gender, tumor location, ulceration, margins and punch), capable of interfering in the result
Methods: :
Prospective analysis of eyelid tumors with suspicion of malignancy conducted at the Ocular Plastic Surgery Center (Hospital das Clínicas, University of São Paulo School of Medicine). The tumors were photographed and measured with the software ImageJ. The results of the preoperative 2-mm punch biopsies were compared with the surgical specimens (gold standard). The anatomo-pathological examination of the biopsy and the surgical specimen was performed by a blinded pathologist. Discordant results were reviewed by a second pathologist. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and Kappa coefficients were calculated to determine the agreement between the 2-mm punch biopsy and the gold standard. The chi-square test was used to verify associations with qualitative variables. Associations with quantitative variables were analyzed with Student's t test (age and tumor diameter) or the Mann-Whitney test (tumor area and disease duration).
Results: :
Sixty-one tumors were evaluated, 57.4% of which were basal cell carcinomas (BCC). Sensitivity and specificity for malignancy were 87.8% and 91.7%, respectively, while VPP was 97.7% and VPN was 64.7%. The accuracy for malignancy was 88.5%, with 69.0% agreement by Kappa analysis. The accuracy for histological type and subtype of BCC was 82.0% and 42.9%, respectively. In the evaluation of the most aggressive subtype, the biopsy identified 68.5% of cases. No significant association was observed for the quantitative variables with regard to agreement on malignancy or histological type (p>0.05), but agreement on malignancy and histological type was significantly greater for non-ulcerated tumors (p=0.035 and p=0.042, respectively).
Conclusions: :
Two-millimeter punch biopsy is a simple and reliable procedure indicated for safe ophthalmological management, with considerable accuracy for confirmation of eyelid malignancy. However, the test is less efficient for the identification of histological subtype of BCC.
Clinical Trial: :
http://www.clinicaltrials.gov NCT00865813
Keywords: eyelid • tumors • oncology