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R. C. Carneiro, E. M. S. Macedo, S. Matayoshi; Punch Biopsy: Effective Diagnostic Test for Detection of Periocular Malignancy ?. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3516.
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This study aims to evaluate the accuracy of 2mm punch technique incisional biopsy of periocular tumors in the diagnosis of malignant lesions. The use of these modes of biopsy is not widespred in Ophthalmology.
Punch biopsies were performed according to a pre-defined protocol. The most typical areas of the lesions were chosen, generally the borders or the core. Patients were then submitted to excisional surgeries and reconstruction of the affected areas. Histopathological analysis of excised tissue samples served as the "gold-standard" in order to estimate the diagnostic performance of punch biopsy.
40 patiens were evaluated. Punch biopsy evidenced 19 basal cell carcinomas (BCC), five spinocellular carcinomas (SCC), three actinic keratosis, one elastosis, one melanoma, one epidermal adnexal and eccrine glands tumor, one molluscum, five melanocitic intradermal nevii, one inflammatory process, one granulation tissue , one papiloma and one Bowen's disease. Punch biopsy showed the following indicators: Sensibility: 90%; Specificity: 91%; Positive predictive value: 96%; Negative predictive value: 77%. The accuracy was 90% for detection of malignancy and 77,5% for determination of histopathological type in eyelid lesions. Kappa was 0,763 (p<0,001).
The confirmation of malignancy with the 2mm punch is a helpful tool in evaluating eyelid lesions and defining a surgical approach for the Ophthalmologist. Clinical examination often raises doubt as to the nature of eyelid lesions and not seldom, patients with malignant eyelid lesions may be found being treated as trichiasis, blepharitis, meibomianitis or other inflammatory processes.
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