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Amy C Schefler, Daniel Gologorsky, Maria Eugenia Bretana, Patricia Chevez-Barrios, Bin Teh; Fine Needle Aspiration Biopsies (FNAB) of Uveal Melanoma: Rates of Sample Acquisition Using Transscleral and Transvitreal Techniques. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5882.
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The purpose of this study was to assess the rate of successful sample acquisition during uveal melanoma FNAB using both transscleral and trans-pars plana techniques.
This was a retrospective review of 50 sequential patients who underwent FNAB for cytopathologic and genomic analyses of uveal melanoma concurrent or before definitive treatment with Iodine-125 plaque. Only patients with 6 months or more of follow-up and adequate data for analysis were included. Clinical variables were reviewed including: patient demographic data (age, sex, right/left eye); clinical tumor data (size of tumor, presence of subretinal fluid, location of tumor); biopsy technique details (transscleral versus transvitreal, number of passes needed, adequacy of sample obtained, GEP class and discriminant value).
Twenty-nine patients underwent FNAB with a transvitreal approach and 21 underwent FNAB via a transscleral approach. Of the 50 FNABs, only three patients who underwent transvitreal biopsies had an inadequate sample (94% success rate). Twenty-two were Gene Expression Profiling Class 1A (low risk for metastases); Four patients were Class 1B (moderate risk); and 24 were Class 2 (high risk). Mean discriminant value was 0.87 for the gene expression profiling sample and all patients except one in the study had a discriminant value > 0.1, indicating that the samples were of excellent quality for analysis. The vast majority of the time, only one biopsy pass was needed. No patients developed a retinal detachment and transient vitreous hemorrhage occurred in nearly all patients with higher severity with patients undergoing biopsy with a cutter. There were no cases of extraocular extension. Various techniques were used to ensure biopsy success including adequacy checks with the ophthalmic pathologist present in the operating room, use of the cutter for lesions < 2.5 mm, direct visualization with a retinal viewing system, avoidance of infusion placement, and others.
Using the technical approach described in this study, an extremely high success rate for transscleral and transvitreal approaches to FNAB for uveal melanoma can be achieved. These techniques are important as diagnostic and genomic results are rapidly becoming more critical for patient care and entry into clinical trials.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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