Purchase this article with an account.
Rie Tanaka, Toshikatsu Kaburaki, Ayako Karakawa, Kazuki Taoka, Junko Matsuda, Hideki Tsuji, Atsushi Yoshida, Mitsuko Takamoto, Yujiro Fujino; Sensitivity of four diagnostic tests using vitreous samples for diagnosing intraocular lymphoma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5579.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Intraocular lymphoma (IOL) is a masquerade syndrome that mimics uveitis and occasionally delays diagnosis. The diagnosis of IOL requires a multidisciplinary approach because cytology alone can confirm IOL in 45%–60% of cases. This study examined the diagnostic significance of results from vitreous samples, including cytology, interleukin (IL)-10:IL-6 measurements, immunoglobulin H (IGH) gene rearrangement, and light chain restriction by flow cytometry in patients definitively diagnosed with IOL who had typical ocular findings and were pathologically diagnosed with malignant lymphoma (ML) in other systemic organs.
We reviewed the clinical records of 26 patients with IOL with a history of biopsy-proven systemic ML who underwent diagnostic pars plana vitrectomy at the Uveitis Clinic of the University of Tokyo Hospital between July 2008 and February 2017. All patients showed typical ocular features of IOL such as dense diffuse vitreous opacity and/or whitish-yellow multifocal subretinal infiltrates. Vitreous samples were subjected to cytology, IL-10:IL-6 measurement, IGH gene rearrangement, and light chain restriction by flow cytometry. We assessed the sensitivity of each diagnostic test and determined the number of positive results required for diagnosis of IOL. This study was approved by our institutional ethical review committee and followed the tenets of the Declaration of Helsinki. All participants provided informed consent.
We examined 13 men and 13 women (mean age, 62.8 years). Primary ML lesions were detected in the brain (n=11), lymph nodes (n=8), testis (n=4), and others (n=3). The positive cytology rate for malignancy (class IV or V) was 53.8%. The rates of IL-10/IL-6 > 1.0, IGH gene rearrangement, and light chain restriction by flow cytometry were 80.8%, 76.9%, and 57.7%, respectively. The number of positive diagnostic results was four in 4 cases, three in 11 cases, two in 10 cases, and one in one case. If we determined more than two of four positive diagnostic results required for the diagnosis of IOL, we can diagnose 25 patients (96.2%). One patient (3.8%) with multifocal subretinal infiltrates and poor vitreous opacity showed only one positive result (IL-10/IL-6).
This study suggested that two of four positive diagnostic results may be adequate for diagnosing IOL because 96% of definitive IOL cases fulfilled the criteria.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
This PDF is available to Subscribers Only