Fine–Needle Aspiration Biopsy of Clinically Diagnosed Choroidal and Ciliochoroidal Melanomas

Abstract

Abstract: : Purpose: To summarize the results of a 20–year experience with fine–needle aspiration biopsy (FNAB) of selected clinically diagnosed choroidal and ciliochoroidal melanomas. Methods: Retrospective analysis of 124 clinically diagnosed choroidal or ciliochoroidal melanomas evaluated by diagnostic FNAB during the interval January 1981 through December 2000. Cases were divided into three subgroups based on our a priori level of certainty about the diagnosis: (1) typical melanoma, (2) probable melanoma but atypical, and (3) nevus versus melanoma. Results: FNAB yielded a sufficient aspirate for cytodiagnosis in 97 of the 124 cases (78%), 38 of the 40 typical melanomas (97%), 37 of the 50 atypical probable melanomas (74%), and 22 of the 34 nevus versus melanoma cases (65%). Factors associated with an insufficient aspirate included smaller tumor size, pre–biopsy clinical diagnosis of nevus versus melanoma, and fewer needle passes. Tumors that failed to yield a sufficient aspirate for cytodiagnosis were managed as if the biopsy had not been performed. Among the 97 tumors that yielded a sufficient aspirate, our cytopathologic diagnosis was melanoma in 70, intermediate or borderline melanocytic tumor in 18, and benign nevus in 9. Of the 23 cases managed by enucleation following the biopsy, histopathologic study confirmed our cytodiagnosis of the intraocular tumor in 22 (96%). Complications of FNAB included intravitreal and subretinal bleeding, surface wrinkling retinopathy, rhegmatogenous retinal detachment (3 cases), traumatic cataract (3 cases), and endophthalmitis (2 cases). No patient developed a clinical implantation tumor at the eye wall puncture site. The results of FNAB changed our treatment plan in 32% of the patients. Conclusions: FNAB of clinically diagnosed choroidal and ciliochoroidal melanomas usually provided a sufficient aspirate for cytodiagnosis. Cytologic–histologic correlation studies confirmed the cytopathologic diagnosis in the vast majority of cases. Complications were generally minor. Although not evaluated in this study, FNAB holds promise of providing sufficient specimens of melanocytic uveal tumors for testing to reveal cytogenetic abnormalities associated with metastasis in tumors managed by eye preserving methods.

Keywords: pathology: human • cytology • oncology