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claudine Bellerive, Charles V. Biscotti, Nakul Singh, Arun D Singh; Fine Needle Aspiration for Suspected Uveal Metastases. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4403.
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© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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%.
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.
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