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JJ Augsburger, S Schneider, ZM Correa, RS Yassin, TM Robinson-Smith, H Ehya, N Trichopoulos; Fine-Needle Aspiration Biopsy of Solid Intraocular Tumors in Patients who Requested Biopsy Prior to Consenting to Recommended Treatment . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1157.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To summarize the results of fine-needle aspiration biopsy (FNAB) of solid intraocular tumors in patients with an unequivocal clinical diagnosis of malignant intraocular neoplasm who requested (or whose parents requested) pathologic confirmation of the diagnosis by biopsy prior to consenting to treatment. Methods: Retrospective descriptive clinical study of 50 patients who underwent FNAB of a solid intraocular tumor in response to patient request for pathologic confirmation of our clinical diagnosis prior to planned treatment. The pre-biopsy clinical diagnosis was uveal melanoma in 46, lymphoma in 2, and retinoblastoma in 2. Results: FNAB yielded a sufficient aspirate for reliable cytodiagnosis in 48 of the 50 patients (96.0%). Cytopathologic study confirmed the pre-biopsy clinical diagnosis in all 48. These 48 patients were subsequently treated by the method recommended prior to FNAB. The two tumors that yielded an insufficient aspirate for cytodiagnosis were felt to be primary uveal melanomas. Both were relatively thin (each 2.7 mm in maximal thickness by A-scan biometry) in comparison with the tumors in the group as a whole (mean thickness 5.1 mm). After being informed about the inconclusive results, both of these patients consented to the treatment that had been recommended prior to FNAB. Enucleation was the selected method of treatment for 27 of the 50 affected eyes. The cytopathologic diagnosis was uveal melanoma in 26 of these eyes and retinoblastoma in 1. Histopathologic study confirmed the cytopathologic diagnosis in 26 of the 27 cases. One case diagnosed as an amelanotic spindle cell melanoma by cytopathology proved to be an isolated retinal astrocytoma by histopathology. The FNAB-derived tumor aspirate in this case was too scant to allow immunohistochemical staining that might have avoided this misdiagnosis. Conclusion: In patients with an unequivocal diagnosis of malignant intraocular neoplasm, FNAB provides a sufficient aspirate to confirm the clinical diagnosis in the great majority of cases. Erroneous cytopathologic diagnosis is possible in cases that yield an insufficient aspirate for immunocytochemical staining studies.
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