Abstract
Purpose: :
Two-millimeter punch biopsy is a swift and practical diagnostic tool in the outpatient setting. In patients with basal cell carcinoma, however, a diagnosis of histological subtype is necessary to establish indication for topic immunotherapy with 5% imiquimod cream and photodynamic therapy. The objective of this study was to evaluate the ability of 2-mm punch biopsy to identify the main growth patterns of basal cell carcinoma and, consequently, identify patients with indication for alternative therapy.
Methods: :
Observational study of patients with suspected periocular malignancy attending the ophthalmology service at Hospital das Clínicas (FM-USP). Patients were submitted to standard preoperative biopsy using a 2-mm trephine. Surgical excision with safety margins was followed by reconstruction. Histological analysis of the surgical specimen was used as gold standard.
Results: :
Fifty periocular lesions suspected of malignancy were biopsied with a 2-mm trephine. The ability of the procedure to confirm periocular malignancy was expressed by the following indicators: sensitivity=88%, specificity=100%, positive predictive value=100% and negative predictive value=64%. Accuracy was 90% for the presence of malignancy and 70% for histological type. The ability of the procedure to identify superficial and nodular basal cell carcinoma growth patterns in the remaining lesions (ie, identify patients with indication for alternative therapy) was expressed by the following indicators: sensitivity=67%, specificity=89%, positive predictive value=71%, negative predictive value=86% and accuracy=82%.
Conclusions: :
Two-millimeter punch biopsy was shown to be an effective technique for the confirmation of periocular malignancy and a useful aid in the choice of surgical approach and alternative therapy.
Clinical Trial: :
http://www.clinicaltrials.gov NCT00865813
Keywords: eyelid • tumors • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials