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Kelly M. Bui, Jose M. Garcia-Gonzalez, Amy Lin, Sarju Patel, Debra A. Goldstein, Deepak P. Edward; Directed Conjunctival Biopsy and Impact of Histologic Sectioning Methodology in the Diagnosis of Sarcoidosis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3215. doi: https://doi.org/.
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Ocular involvement may be the first manifestation of sarcoidosis and is present in nearly 20% of cases. Definitive diagnosis relies upon tissue biopsy. Previous studies have reported good yield with directed conjunctival biopsy when compared to non-directed biopsy of conjunctival nodules in ocular sarcoidosis. However, few studies reported their histologic methodology, which can directly affect yield. This study evaluated the sensitivity of directed conjunctival biopsy at our institution, comparing biopsy yield using standard institutional tissue sectioning protocol to a multi-plane sectioning method previously described in the literature.
Retrospective case series of patients who underwent directed conjunctival biopsy for suspected ocular sarcoidosis at the University of Illinois-Chicago Department of Ophthalmology from January 1999-August 2011. Directed biopsies of conjunctival nodules in the inferior fornix were obtained. Tissue was fixed in 10% formalin and embedded in paraffin, sectioned, and stained with hematoxylin and eosin. For the standard sectioning method, 4 to 6 sections at one level of the tissue were taken. For the multi-plane sectioning method, a minimum of 15 sections were obtained, evaluating at least five sections at three different tissue levels. A biopsy was defined as positive if discrete noncaseating granulomas were identified. Interpretation of histologic data was performed by one of two ocular pathologists.
Eight patients were identified. All were females with a mean age of 43.5 [range 20-62]. Seven patients (87.5%) were African-American. Four patients had granulomatous anterior uveitis and 4 had panuveitis. 62.5% (5/8) had positive conjunctival biopsies for sarcoidosis. 100% (2/2) of biopsies initially prepared by multi-plane sectioning were positive, compared to 33% (2/6) prepared by standard sectioning. Re-examination of these negative biopsies by multi-plane sectioning revealed an additional positive case, raising the total yield to 62.5%. Four of the five positive biopsy patients were on anti-inflammatory treatment (including topical prednisolone, oral prednisone, and methotrexate) prior to conjunctival biopsy.
Directed conjunctival biopsy represents a minimally invasive, moderately high yield method of diagnosing ocular sarcoidosis which can be performed even after initiation of anti-inflammatory therapy. Using a multi-plane histologic sectioning method may increase biopsy yield.
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