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Rita D Page, Teresa Martz, Oliver Filutowski, Zeynel Karcioglu; The accuracy of orbital imaging in foretelling specific tumor diagnosis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5606.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the accuracy of orbital imaging in diagnosis of orbital tumors
This retrospective (2003-2015) case series evaluated 127 patients who were identified as having an orbital mass lesion and had undergone orbitotomy at the University of Virginia Hospital. We collected patient demographics at the time of orbitotomy and details of the orbital imaging information, operative notes and pathology reports. Inclusion criteria comprised of the availability of detailed imaging and pathology records. Out of 127 patients only 25 patients met the inclusion criteria. Absence of reliable in-house imaging prior to orbitotomy/biopsy and lack of meaningful differential diagnoses in the imaging reports were the most common causes of exclusion limiting the cohort numbers. Data analysis was based on the correlation accuracy between the differential diagnoses reported in the imaging study with the final diagnosis obtained from the histopathology report.
The patient age ranged from 1 to 93 years. There were 5 cases of dermoid cysts, 3 solitary fibrous tumors, 2 lymphomas, 2 neurofibromas, 2 cavernous hemangiomas, and single cases of osteoma, squamous cell carcinoma, lacrimal gland carcinoma, eccrine hydrocystoma, optic nerve meningioma, myxoid stromal tumor, granular cell tumor, arteriovenous malformation, and “malignant spindle cell tumor”. There were two cases where a tumor was suspected by imaging, but only inflammatory cells or fibrosis with foreign bodies were found on histopathology. Forty percent (10 patients) had final histopathologic diagnoses correlating with the diagnosis listed as most likely in the imaging differential diagnosis, 60% (15) had final pathologic diagnoses that were listed in the imaging differential diagnosis, and 92% (23) had final pathologic diagnoses consistent with the category of pathology (neoplasm versus inflammation) described in the imaging differential.
Imaging with MRI and/or CT is accurate at predicting the category of pathology for orbital mass lesions but detects the actual diagnosis much less frequently. Orbital imaging is very helpful to guide in the surgical and therapeutic approach of orbital lesions, but it is not reliable in determining the final histopathologic diagnosis specifically.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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