Multi-center analysis of intraocular biopsy technique and outcomes for uveal melanoma: Ocular Oncology Study Consortium report 4

• Type of Material: Article
• Authors: Michael I. Seider, The Permanente Medical Group; Duncan E. Berry, Emory University; Amy C. Schefler, Houston Methodist Hospital; Miguel Materin, Duke University; Sandra Stinnett, Duke University; Prithvi Mruthyunjaya, Duke University
• Language: English
• Date: 2019-12-06
• Publisher: SPRINGER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: 2020
• Final Published Version (URL): http://dx.doi.org/10.1007/s00417-019-04531-8
• Title of Journal or Parent Work: GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY
• Volume: 258
• Issue: 2
• Start Page: 427
• End Page: 435
• Grant/Funding Information: This study was funded by The Heed Ophthalmic Fellowship - (M.Seider), The Childress Family Foundation (NC), unrestricted departmental funding from Research to Prevent Blindness (New York, NY) and by grant P30 EY010572 from the National Institutes of Health (Bethesda, MD) - (P.Mruthyunjaya).
• Keywords: Oncology; FINE-NEEDLE-ASPIRATION; Science & Technology; Ophthalmology; VITRECTOMY; Life Sciences & Biomedicine; GENE-EXPRESSION PROFILE
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

Purpose: To investigate the relationship between surgical approach for intraocular tumor biopsy of uveal melanoma and tumor morphologic features such as size and intraocular location and the effect of these variables on diagnostic yield and biopsy outcome. Methods: Consecutive patients from nine Ocular Oncology centers with uveal melanoma (UM) undergoing tumor biopsy immediately preceding I125 plaque brachytherapy with tissue sent for gene expression profiling (GEP) testing were reviewed retrospectively. Results: Three hundred sixty patients were included (50% men, mean age 60.2 years). Overall biopsy yield was 99% and 83% for GEP and cytopathology, respectively. Surgeon choice of biopsy approach (trans-vitreal vs. trans-scleral) was found to associate with both tumor location and tumor thickness. A trans-scleral rather than trans-vitreal approach was used more commonly for anteriorly located tumors (92% vs. 38% of posterior tumors, p < 0.001) and thicker tumors (86% vs. 55% of thin tumors, p < 0.001). When performing trans-vitreal biopsies, ocular oncologists with previous vitreoretinal surgery fellowship training were more likely to use wide-field surgical viewing systems, compared with indirect ophthalmoscopy (82.6% vs. 20.6%, p < 0.001). Surgical complications were rare and occurred more frequently with trans-vitreal biopsies (3.6% vs. 0.46%, p = 0.046). Conclusions: In this multi-center analysis of UM tumor biopsy, surgical yield was high for obtaining tumor tissue for GEP and cytopathology analysis with both trans-scleral and trans-vitreal techniques. Fellowship-trained ocular oncologists’ preferred intraocular biopsy techniques associated strongly with tumor location, tumor thickness, and fellowship training of the surgeon. Short-term complication rates were low.