Abstract
Purpose :
Fine needle aspiration (FNA) has widespread acceptance as a diagnostic test in the evaluation of intraocular masses, albeit indicated in only a small minority of cases. One such indication is the confirmation of a clinical suspicion of uveal metastasis. We analyzed our experience in this clinical setting to assess the effectiveness of FNA technique, which includes liquid-based cellular processing.
Methods :
Twenty-eight consecutive patients presenting with suspected uveal metastasis were selected. The aspirates were performed using 25-gauge needle attached by tubing to a 5 ml syringe. Aspirate samples were visually inspected for adequacy, and then transferred to 30 ml CytoLyt® (Cytyc, Marlborough, MA). Subsequent ThinPrep® processing yielded at least one alcohol fixed Papanicolaou stained slide per case. Each aspirate sample was classified into the following categories: positive, atypical, negative or non-diagnostic. The "non-diagnostic" criterion was applied when atypical or malignant cells were not identified and yet there were insufficient cells for a "negative" interpretation (absence of metastasis). The electronic medical records provided all clinical data.
Results :
The study group included 16 men and 12 women ranging from 27 to 85 years of age. Cytological interpretations were positive in 19 cases (68%), atypical in 2 cases (7%), negative in 4 cases (14%), and non-diagnostic in 3 cases (11%). The positive cases included 9 adenocarcinomas, 3 uveal lymphomas, 3 small cell carcinomas, 3 non-small cell carcinomas, and 1 metastatic paraganglioma. Both of the atypical cases were suspicious for non-Hodgkin lymphoma (NHL), including 1 vitreoretinal large cell NHL and 1 uveal low grade NHL. The 4 negative cases included 1 cryptococcosis, 1 inflammatory lesion that resolved spontaneously, and 2 inflammatory aspirates that subsequently proved to be metastatic adenocarcinoma. The 3 non-diagnostic cases included 1 schwannoma, 1 low grade uveal NHL and 1 metastatic adenocarcinoma. The overall sensitivity for FNA in cases of suspected uveal metastasis was 87.5%, with a specificity of 100%.
Conclusions :
In our experience, FNA effectively confirms a clinical impression of uveal metastasis. Sixteen (84%) of 19 aspirates, from metastatic lesions, provided definitive diagnoses.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.